From Court to the Community: Improving Access to Evidence-Based Treatment for Underserved Justice-Involved Youth At-Risk for Suicide

从法院到社区：改善有自杀风险、司法服务不足的青少年获得循证治疗的机会

• 批准号: 10609530
• 负责人: Kathleen Kemp
• 金额: $ 61.68万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-15 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10609530
• 关键词: Accident and Emergency department; Adherence; Administrator; Adolescent; Affect; Ambulatory Care; Behavior; Caregivers; Characteristics; Child; Client; Climate; Clinic; Clinical Trials; Cluster randomized trial; Collaborations; Communities; Community Practice; Computerized Medical Record; Consultations; Data; Detection; Education; Effectiveness; Effectiveness of Interventions; Emergency Care; Enrollment; Evidence based intervention; Evidence based treatment; Family; Feeling suicidal; General Population; Goals; Health Personnel; Health system; Healthcare Systems; Imprisonment; Improve Access; Inpatients; Intervention; Interview; Justice; Leadership; Legal Guardians; Measures; Mental Health; Mental Health Court; Mental Health Services; National Institute of Mental Health; Neighborhoods; Organization and Administration; Outpatients; Parents; Patients; Phase; Population; Preparation; Prevention; Procedures; Process; Provider; Psychiatric therapeutic procedure; Psychiatry; Public Health; Questionnaires; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Reporting; Research; Resources; Rhode Island; Risk; Safety; Secure; Site; Standardization; Structure; Suicide; Suicide attempt; Supervision; System; Testing; Time; Training; Training Programs; United States Substance Abuse and Mental Health Services Administration; Work; Youth; access restrictions; barrier to care; court; court personnel; design; ethnic minority; evidence base; experience; follow up assessment; follow-up; health disparity; improved; juvenile justice system; non-suicidal self injury; organizational readiness; parental involvement; post implementation; practice setting; provider factors; psychiatric emergency; psychoeducation; psychoeducational; racial minority; randomized trial; reducing suicide; response; standard care; suicidal; suicidal adolescent; suicidal behavior; suicidal risk; suicide rate; therapy design; treatment as usual; treatment comparison; treatment strategy; uptake; vulnerable adolescent

PROJECT SUMMARY Justice-involved youth (JIY) living in the community experience disproportionately high rates of suicidal thoughts and behavior (STB) and non-suicidal self-injury (NSSI) compared to adolescents in the general population. Many JIY lack access to evidence-based treatment specifically designed to treat NNSI and STB, thereby increasing the overall risk of suicide in this population. Further, even when JIY do have access to evidence-based treatment, treatment initiation in this population is low. The current proposal aims to reduce STB and NSSI among JIY, and thus reduce mental health disparities in this vulnerable and underserved youth population. Our primary aim is to implement a systems-level intervention designed to increase access to evidence-based treatment strategies specifically designed to treat STB and NSSI behaviors for JIY referred to outpatient care by the Rhode Island Family Court. We will conduct a cluster randomized stepped wedge trial in which 9 distinct community mental health agencies (CMHA) who serve JIY in the state of Rhode Island will be randomized to receive a standardized training program. A select number of CHMA administrators and providers will complete semi-structured qualitative interviews pre-implementation to assess agency/system-level and provider-level factors that may promote or hinder the uptake of evidenced-based treatment strategies for STB and NSSI in CMHAs serving JIY living in the community. Quantitative data will assess organizational, provider, and youth characteristics and will be collected through questionnaires CMHA providers complete and from the electronic medical record pre- implementation, immediately post-implementation, and 9-months into sustainment. It is hypothesized that at the systems level, the training program will be sustained for at least one year and up to 3 years by CMHA administrators. At the provider level, it is hypothesized that training in the use of evidence-based treatment strategies for STB and NSSI will significantly increase both the use of these strategies and the quality of their delivery over a year’s follow-up period. At the patient level, we hypothesize that the training program will improve parental adherence to outpatient treatment and reduce rates of adolescent STB and NSSI that require emergency medical/psychiatric care in our healthcare system. Our secondary aim is to examine factors that influence treatment initiation among JIY living in the community. We will enroll 180 caregivers of JIY youth who screen positive for recent NSSI/STB to test the hypothesis that JIY whose caregivers are randomized to the psychoeducation/action plan condition, compared to an educational video, will be significantly more likely to initiate treatment at a CMHA. Caregivers will complete follow-up assessments at 3- and 6-months post-baseline to assess whether their adolescent initiated treatment and how many sessions the adolescent attended. This application has strongly aligns with NIMH’s Strategic Objective 3.3: “Test interventions for effectiveness in community practice settings,” and the goals of the RFA-MH-21-187 to test effective “systems-level strategies for the detection and prevention of SIB and/or NSSI specifically among underserved children and adolescents.”

项目概要 生活在社区的热衷于正义的青少年 (JIY) 有自杀念头的比例极高 与一般人群中的青少年相比，行为（STB）和非自杀性自伤（NSSI）。 JIY 缺乏专门用于治疗 NNSI 和 STB 的循证治疗，从而增加了 此外，即使 JIY 确实能够获得循证治疗， 该人群的治疗起始率较低 目前的提案旨在减少 JIY 中的 STB 和 NSSI。 从而减少这一弱势且服务不足的青年群体的心理健康差异。我们的首要目标是： 实施系统级干预措施，旨在增加获得循证治疗策略的机会 专门设计用于治疗 JIY 的 STB 和 NSSI 行为，由罗德岛州转介门诊护理 家庭法庭将进行一项整群随机阶梯楔形试验，其中 9 个不同的社区心理。 在罗德岛州为 JIY 提供服务的卫生机构 (CMHA) 将被随机分配接受标准化的 选定数量的 CHMA 管理员和提供者将完成半结构化培训计划。 实施前的定性访谈，以评估可能影响的机构/系统级和提供商级因素 促进或阻碍在服务 JIY 的 CMHA 中采用针对 STB 和 NSSI 的循证治疗策略 定量数据将评估组织、提供者和青年的特征和意愿。 通过 CMHA 提供者填写的问卷和预先从电子病历中收集 实施、实施后立即以及维持后 9 个月。 系统层面，培训计划将由 CMHA 持续至少一年，最长 3 年 在提供者层面，开展了使用循证治疗的培训。 STB 和 NSSI 策略将显着提高这些策略的使用及其质量 在一年的随访期内，我们认为培训计划将会有所改善。 家长坚持门诊治疗并降低青少年 STB 和 NSSI 的发生率 我们的医疗保健系统中的紧急医疗/精神护理是我们的次要目标。 影响居住在社区的 JIY 青少年的治疗开始 我们将招募 180 名 JIY 青少年的照顾者。 最近 NSSI/STB 筛查呈阳性，以检验 JIY 的假设，其护理人员被随机分配到 与教育视频相比，心理教育/行动计划条件更有可能 在 CMHA 开始治疗。护理人员将在基线后 3 个月和 6 个月完成后续评估。 评估他们的青少年是否开始治疗以及青少年参加了多少次治疗。 应用程序与 NIMH 的战略目标 3.3 高度一致：“测试干预措施的有效性 社区实践设置”以及 RFA-MH-21-187 测试有效性的目标“系统级策略 检测和预防 SIB 和/或 NSSI，特别是在服务不足的儿童和青少年中。”