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.

项目摘要 COVID-19大流行已导致自杀念头，自杀企图和 美国青少年中的自杀死亡。急诊医院的急诊科（EDS）越来越多 充当照顾自杀年轻人的门户；在Covid-19期间，这种趋势进一步加剧了。 当有自杀意念或尝试的青年被认为需要住院的精神病护理时，对 床通常超过供应，导致精神病登机。在这段时间里，青年可能等待几天到几周 急诊或住院医疗部门，直到精神科入院；登机频率和持续时间都有 在19日期间增加。经历登机的青年很少接受循证心理治疗 鉴于全国性的缺乏和不均匀的精神卫生专业人员分布。为了解决这个差距， 儿科医生，心理学家，临床社会工作者和患者伴侣的多学科团队开发了 模块化数字干预措施，为具有自杀性的年轻人提供基于证据的社会心理技能 登机。该计划称为I-Care（改善护理，加速恢复和教育），包括一个 一系列基于网络的动画视频和基于认知行为疗法的活动优先考虑 通过严格的Delphi过程。 I-Care旨在由目前的安全服务员促进 在登机过程中，为青年提供1对1的安全监督。因此，I-Care需要最小的额外 资源超出了急诊医院已经可用的资源。在试点计划评估中，I-Care有 被证明是可行的，可以被青年，临床医生及其护理人员接受，并且 参与后的情绪困扰大大减少。在此初步数据的基础上，这种混合动力 1型有效性试验将在6家医院使用簇随机梯级楔形设计（960年青年12-17 具有自杀念头或尝试的年）：（i）应用动态适应过程来优化I-Care 培训和实施，同时保持干预保真度，并考虑到COVID-19和 医院的变化； （ii）确定I-Care减少情绪困扰的有效性，自杀 与通常的护理相比，使用经过验证的措施的构想和自杀尝试，评估I-Care的影响 关于变革的动机（目标机制），并确定更大的变革动机是否会导致 对情绪困扰，自杀构想和尝试的影响，（iii）将RE-AIM框架应用于 确定I-Care覆盖，有效性，采用，实施和维护的障碍和促进者 从青年，看护人和临床医生的角度来看。这项研究的结果有可能 改造目前由卫生系统服务不足的人口的医疗保健提供，增加了对 在应用新颖的数字干预时，精神卫生服务在巨大的脆弱性期间 具有可伸缩性的巨大潜力。