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.”

项目摘要 生活在社区中的司法青年（JIY）经历自杀思想的高度高率 与普通人群的青少年相比，行为（STB）和非杀伤性自我伤害（NSSI）。许多 JIY缺乏专门设计用于治疗NNSI和STB的循证治疗的机会，从而增加 该人群自杀的总体风险。此外，即使JIY确实可以使用基于证据的治疗， 该人群的治疗计划很低。当前的提案旨在减少JIY中的STB和NSSI，以及 因此，在这个脆弱和服务不足的青年人口中减少心理健康差异。我们的主要目的是 实施系统级干预措施，旨在增加获得基于证据的治疗策略的机会 专门设计用于治疗Rhode Island的JIY的STB和NSSI行为 家庭法院。我们将进行一个群集随机阶梯楔试验，其中9个不同的社区精神 在罗德岛州为JIY服务的卫生机构（CMHA）将被随机接受标准化 培训计划。选择数量的CHMA管理员和提供商将完成半结构 定性访谈进行预定前，以评估代理/系统级和提供商级别的因素 促进或阻碍在CMHA中为STB和NSSI提供基于证据的治疗策略 生活在社区。定量数据将评估组织，提供商和青年特征，并将 可以通过问卷调查CMHA提供商完成，并从电子记录中 实施，实施后立即进行维持和9个月。假设在 系统级别，CMHA将至少维持培训计划至少一年，最多3年 管理员。在提供者层面，假设在使用基于循证治疗的培训 STB和NSSI的策略将显着提高这些策略的使用及其质量 在一年的随访期内交付。在患者一级，我们假设培训计划将有所改善 父母遵守门诊治疗并降低了需要的青少年STB和NSSI的速度 我们的医疗保健系统中的紧急医疗/精神病护理。我们的次要目的是研究 影响居住在社区中的JIY中的治疗计划。我们将注册180名JIY青年的照顾者 筛选最近的NSSI/STB呈阳性，以测试其护理人员被随机分配给的假设 与教育视频相比，心理教育/行动计划条件将更有可能 在CMHA上开始治疗。护理人员将在3个月和6个月后完成后续评估 评估他们的青春期是否开始治疗以及青少年参加了多少课。这 应用程序与NIMH的战略目标3.3非常一致：“测试干预措施 社区实践环境”以及RFA-MH-21-187的目标，以测试有效的“系统级策略 在服务不足的儿童和青少年中，对SIB和/或NSSI的检测和预防。”