IntERact: Preventing Risky Firearm Behaviors Among Urban Youth Seeking Emergency Department Care

Interact：预防寻求急诊科护理的城市青少年的危险枪支行为

• 批准号: 10161026
• 负责人: Patrick M. Carter
• 金额: $ 65万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2023-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10161026
• 关键词: IntERact; Preventing; Risky; Firearm; Behaviors

Firearms are the leading cause of death for U.S. youth. National organizations have highlighted the need for prevention programs focused on decreasing interpersonal firearm violence. Urban EDs are an underutilized setting for such programs, as they provide access to at-risk youth engaged in risky firearm behaviors (RFBs). Intervening early with youth in this setting may decrease subsequent firearm violence and related consequences. Despite the importance of this problem, evidence-based interventions to decrease RFBs are lacking. Given our prior work showing that single session ED interventions (i.e., SafERteens) integrating motivational interviewing (MI) and cognitive behavioral therapy (CBT) are efficacious reducing violence among lower risk youth, the application of this behavioral therapy, expanded to address greater problem severity over multiple sessions and enhanced by adding care management (CM), represents a potentially efficacious approach for decreasing RFBs. Our pilot of this integrated approach was found to be feasible among high-risk youth engaged in violence. Utilizing centralized remote therapy to address identified in-person therapy barriers (e.g., transportation) and supporting the intervention with an APP may be a promising way of enhancing session attendance, intervention dose, and engagement, while considering future implementation issues. This proposal addresses Objective Two (Funding Option B) of the CDC NOFO as it focuses on collecting new data on strategies to decrease firearm violence. We propose a 2-arm randomized control trial (RCT) enrolling ED youth (age 16-24) reporting past 3-month firearm carriage and smartphone ownership, randomizing them to either: (1) IntERact; or, (2) an enhanced usual care + assessment (EUC+A) condition where they will receive a resource brochure and daily assessments. The IntERact condition will receive: (1) 6 remotely delivered behavioral therapy sessions integrating MI, CBT, and CM; and, (2) an smartphone APP supporting the therapy by facilitating therapist contact, conducting automated daily assessments, delivering between session tailored MI/CBT content, delivering just-in-time GPS-triggered notifications upon entry into high-risk locations, and aiding with CM resources. Specific aims are: (1) To conduct an RCT enrolling 400 eligible youth (200/group) to examine IntERact efficacy; and, (2) To conduct a cost evaluation, comparing resource costs for intervention delivery to costs for outcomes averted. As a secondary aim, we will examine mediators/moderators of efficacy. Outcomes will be assessed at 3- and 6-months. Primary outcomes include: (1) risky firearm behaviors (RFBs); (2) firearm carriage; and, (3) violence (i.e., aggression; victimization; consequences). Secondary Outcomes include: (1) ED visits for violent injury (e.g., firearm injuries); (2) substance use; (3) mental health symptoms (i.e., anxiety, depression, PTSD); and, (4) criminal justice involvement (i.e., arrests). Given elevated rates of RFBs among socio-disadvantaged youth with disparities in access to services, the proposed IntERact intervention, if found to be efficacious, has the potential for significant public health impact.

枪支是美国年轻人死亡的主要原因。国家组织强调， 预防方案的重点是减少人与人之间的枪支暴力。城市急诊室是一个未充分利用的 这是为此类计划设置的，因为它们为从事危险枪支行为（RFBs）的高危青年提供了机会。 在这种情况下及早对青年进行干预可能会减少随后的枪支暴力和相关的 后果尽管这一问题很重要，但减少RFB的循证干预措施仍是 缺乏鉴于我们先前的工作表明单次艾德干预（即，SafERteens）整合 动机访谈（MI）和认知行为疗法（CBT）是有效的减少暴力， 低风险青年，这种行为疗法的应用，扩大到解决更大的问题的严重性， 多个疗程并通过添加护理管理（CM）进行增强，代表了一种潜在的有效方法 减少RFB的方法。我们的试点这种综合方法被认为是可行的高风险 年轻人参与暴力。利用集中式远程治疗解决已确定的面对面治疗障碍 (e.g.,交通）和支持与应用程序的干预可能是一个有前途的方式，提高 会议出席率、干预剂量和参与度，同时考虑未来的实施问题。这 该提案涉及CDC NOFO的目标二（供资方案B），因为它侧重于收集新的 减少枪支暴力战略的数据。我们提出了一项2组随机对照试验（RCT）， 艾德青少年（16-24岁）报告过去3个月携带枪支和拥有智能手机，将他们随机分组 （1）IntERact;或（2）增强常规护理+评估（EUC+A）条件，他们将接受 资源手册和每日评估。IntERact条件将接收：（1）6个远程交付 整合MI、CBT和CM的行为治疗课程;以及（2）支持治疗的智能手机APP 通过促进治疗师联系，进行自动化的日常评估，在会话之间提供定制的 MI/CBT内容，在进入高风险地点时及时提供GPS触发的通知，以及 帮助CM资源。具体目标是：（1）进行RCT，招募400名符合条件的青年（200人/组） 检查干预的有效性;（2）进行成本评估，比较干预的资源成本 为避免的结果交付成本。作为第二个目标，我们将研究调解人/主持人的 功效将在3个月和6个月时评估结局。主要成果包括：（1）危险枪支 行为（RFB）;（2）携带枪支;以及（3）暴力（即，侵略;受害;后果）。 次要结局包括：（1）暴力伤害的艾德就诊（例如，（2）使用药物;（3） 心理健康症状（即，焦虑，抑郁，创伤后应激障碍）;和，（4）刑事司法参与（即，逮捕）。 鉴于在获得服务方面存在差距的社会弱势青年中， 建议的干预措施，如果发现是有效的，有可能产生重大的公共卫生影响。