I-CARE: The Effectiveness of a Modular Digital Intervention to Reduce Suicidal Ideation and Emotional Distress during Pediatric Psychiatric Boarding

I-CARE：模块化数字干预对减少儿科精神科寄宿期间的自杀意念和情绪困扰的有效性

• 批准号: 10756733
• 负责人: JoAnna Leyenaar
• 金额: $ 103.78万
• 依托单位: DARTMOUTH-HITCHCOCK CLINIC
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10756733
• 关键词: Acceleration; Accident and Emergency department; Address; Admission activity; Adolescent; Anxiety; Beds; COVID-19; COVID-19 pandemic; Caregivers; Caring; Cause of Death; Child; Childhood; Clinical; Cognitive Therapy; Data; Discipline of Nursing; Distal; Distress; Education; Effectiveness; Evaluation; Event; Exercise; Family; Feeling suicidal; Focus Groups; Frequencies; Goals; Head Start Program; Health Professional; Health system; Healthcare; High School Student; Hospitalization; Hospitals; Hybrids; Improve Access; Inpatients; Intervention; Joints; Licensing; Location; Measures; Mediating; Medical; Mental Depression; Mental Health; Mental Health Services; Methods; Modeling; Motivation; Online Systems; Outcome; Participant; Patients; Population; Process; Program Evaluation; Psychologist; Psychotherapy; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Recovery; Reporting; Research; Resources; Safety; Sentinel; Series; Social Workers; Suicide; Suicide attempt; Surveys; Time; Training; Training and Education; United States; Variant; Youth; active method; acute care; adolescent suicide; animation; design; digital intervention; digital tool; effectiveness evaluation; effectiveness testing; effectiveness trial; emotional distress; evidence base; experience; health care delivery; hospital care; implementation science; improved; inpatient psychiatric treatment; multidisciplinary; novel; pandemic disease; pediatrician; pre-pandemic; programs; psychosocial; reducing suicide; safety supervision; skills; standard of care; suicidal; suicidal morbidity; treatment as usual; trend

PROJECT SUMMARY The COVID-19 pandemic has contributed to a substantial increase in suicidal ideation, suicide attempts, and suicide deaths among US adolescents. Emergency departments (EDs) at acute care hospitals increasingly serve as gateways to care for youth with suicidality; this trend has been further exacerbated during COVID-19. When youth with suicidal ideation or attempt are deemed to require inpatient psychiatric care, the demand for beds often exceeds supply, leading to psychiatric boarding. During this time, youth may wait days to weeks in an ED or inpatient medical unit until psychiatric admission; boarding frequencies and durations have both increased during COVID-19. Youth experiencing boarding rarely receive evidence-based psychotherapies given a national shortage and uneven distribution of mental health professionals. To address this gap, a multidisciplinary team of pediatricians, psychologists, clinical social workers and patient partners developed a modular digital intervention to deliver evidence-based psychosocial skills to youth with suicidality during boarding. This program, called I-CARE (Improving Care, Accelerating Recovery & Education), consists of a series of web-based animated videos and activities grounded in cognitive behavioral therapy, prioritized through a rigorous Delphi process. I-CARE is designed to be facilitated by safety attendants who currently provide 1-on-1 safety supervision for youth during boarding. Accordingly, I-CARE requires minimal additional resources beyond those already available at acute care hospitals. In a pilot program evaluation, I-CARE has been shown to be feasible to implement and acceptable to youth, clinicians, and their caregivers, with levels of emotional distress significantly decreased following participation. Building on this preliminary data, this Hybrid Type 1 effectiveness trial will use a cluster randomized stepped wedge design at 6 hospitals (960 youth 12-17 years with suicidal ideation or attempt) to: (i) apply the Dynamic Adaptation Process to optimize I-CARE training and implementation while maintaining intervention fidelity and taking into account COVID-19 and variation across hospitals; (ii) determine the effectiveness of I-CARE to reduce emotional distress, suicidal ideation and suicide attempts using validated measures compared to usual care, assess the effects of I-CARE on motivation for change (target mechanism), and determine whether greater motivation for change mediates I-CARE effects on emotional distress, suicidal ideation and attempts, and (iii) apply the RE-AIM framework to identify barriers to and facilitators of I-CARE reach, effectiveness, adoption, implementation and maintenance from the perspectives of youth, caregivers, and clinicians. The results of this study have the potential to transform healthcare delivery for a population currently underserved by the health system, increasing access to mental health services during a period of tremendous vulnerability while applying a novel digital intervention with substantial potential for scalability.

项目概要 COVID-19 大流行导致自杀意念、自杀企图和自杀人数大幅增加 美国青少年自杀死亡人数。急症护理医院的急诊科 (ED) 越来越多 作为照顾有自杀倾向的青少年的门户；这种趋势在 COVID-19 期间进一步加剧。 当有自杀意念或企图的青少年被认为需要住院精神科护理时，对 床位常常超出供应，导致精神病院寄宿。在此期间，青少年可能会等待数天至数周 急诊室或住院医疗机构直至送入精神病院；登机频率和持续时间都有 在 COVID-19 期间有所增加。经历寄宿的青少年很少接受循证心理治疗 鉴于全国范围内精神卫生专业人员短缺且分布不均。为了解决这一差距， 由儿科医生、心理学家、临床社会工作者和患者伙伴组成的多学科团队制定了 模块化数字干预，为有自杀倾向的青少年提供基于证据的心理社会技能 登机。该计划称为 I-CARE（改善护理、加速康复和教育），包括 一系列基于网络的动画视频和活动，以认知行为疗法为基础，优先考虑 通过严格的德尔福流程。 I-CARE 旨在由当前安全服务员提供便利 为青少年登机期间提供一对一的安全监督。因此，I-CARE 需要最少的额外 超出急症护理医院现有资源的资源。在试点项目评估中，I-CARE 已 已被证明是可行的，并且可以为青少年、临床医生及其护理人员所接受，其水平 参与后情绪困扰显着减少。在此初步数据的基础上，该混合 1 类有效性试验将在 6 家医院（960 名 12-17 岁青少年）使用整群随机阶梯楔形设计 年有自杀意念或企图）：(i) 应用动态适应流程来优化 I-CARE 培训和实施，同时保持干预保真度并考虑到 COVID-19 和 各医院之间的差异； (ii) 确定 I-CARE 对减少情绪困扰、自杀倾向的有效性 与常规护理相比，使用经过验证的措施来评估意念和自杀企图，评估 I-CARE 的效果 改变的动机（目标机制），并确定更大的改变动机是否会起到中介作用 I-CARE 对情绪困扰、自杀意念和企图的影响，以及 (iii) 将 RE-AIM 框架应用于 确定 I-CARE 影响范围、有效性、采用、实施和维护的障碍和促进因素 从青少年、护理人员和临床医生的角度来看。这项研究的结果有可能 改变目前卫生系统服务不足的人群的医疗保健服务方式，增加获得服务的机会 在极其脆弱的时期应用新颖的数字干预措施提供心理健康服务 具有巨大的可扩展潜力。