Leveraging behavioral economics and implementation science to engage suicidal patients in mental health treatment

项目摘要 自杀风险高的患者如果接受心理健康治疗，自杀死亡的可能性就较小。自杀 个人很难开始和持续参与精神卫生服务，但没有研究表明， 系统地开发和测试策略，以增加自杀患者的治疗开始。一致 NIMH的战略目标4是加强NIMH支持的研究的公共卫生影响， 本研究的主要目标是制定可接受、可行、低成本且有效的策略，以增加 在初级保健中确定自杀风险后，患者参加首次心理健康访视。我们将 与一个大型、多样化的卫生系统合作，在八个城市的初级保健中实施了协作护理 实践，以快速原型和测试有前途的战略，以实现这一目标。快速原型设计涉及 一系列严格的实验，以优化早期研究阶段的操作。医疗保健以外的行业 通常使用这种方法来快速学习，并在大规模决策之前在较短的时间轴上“降低风险” 推出。我们开发和测试的策略将受到行为经济学和实施科学的影响 方法，利用宾夕法尼亚大学的P50 ALACRITY中心，并将包括战略， 针对阻碍接受治疗的关键机制。首先，我们将确定患者的特征， 使用医疗记录和索赔数据进行转诊后，是否参加第一次心理健康就诊。然后我们 我将应用既定的方法进行情境调查，以确定心理健康的障碍和促进因素 为有自杀风险的个人提供治疗。我们将使用直接观察和简短的采访， 关键利益相关者（来自宾夕法尼亚州卫生系统内外）了解关键障碍和促进因素 让有自杀风险的病人接受心理健康服务。最后，我们将快速原型和测试 优化参与的战略。使用来自实施科学和行为科学的既定程序 经济学、相关理论和框架以及现有文献，我们将确定初步战略， 支持参加首次心理健康访问。还将与一个由以下人员组成的小组合作制定战略： 自杀，实施科学，行为经济学，初级和精神卫生保健专家。基于 根据文献和我们以前的工作，我们预计增加动机的策略（例如，金融 激励）和促进连通性（例如，将需要的联系人）。然后我们将迭代测试， 完善这些初步战略。在整个过程中，我们希望发现更多的障碍， 这将使我们能够进一步完善和优化执行战略。主要输出将是 支持启动心理健康的最有希望和可行的实施战略清单 为有自杀风险的患者提供的服务，将在随后的试验中进行测试。这项工作的长期目标是 增加对自杀者的心理健康服务的参与。

PROJECT SUMMARY Patients at high risk for suicide are less likely to die by suicide if they engage in mental health treatment. Suicidal individuals have difficulty initiating and sustaining involvement in mental health services, yet no studies have systematically developed and tested strategies to increase treatment initiation for suicidal patients. Consistent with NIMH’s Strategic Objective 4 to strengthen the public health impact of NIMH-supported research, the primary objective of this study is to develop acceptable, feasible, low-cost, and effective strategies that increase patients’ attendance at a first mental health visit following identification of suicide risk in primary care. We will partner with a large, diverse health system that has implemented collaborative care in eight urban primary care practices to rapidly prototype and test promising strategies to achieve this objective. Rapid prototyping involves a series of rigorous experiments to optimize operations in the early-study stages. Industries outside of healthcare commonly use this approach to learn quickly and “de-risk” decision-making on a short timeline prior to a large rollout. The strategies we develop and test will be informed by behavioral economics and implementation science methods, leveraging the University of Pennsylvania’s P50 ALACRITY center, and will include strategies that target key mechanisms that impede treatment attendance. First, we will identify characteristics of patients who do or do not attend a first mental health visit following referral using medical records and claims data. Then, we will apply established approaches to contextual inquiry to identify barriers and facilitators to mental health treatment attendance for individuals at risk of suicide. We will use direct observation and brief interviews with key stakeholders (from within and outside of the Penn health system) to understand key barriers and facilitators to engaging patients at risk for suicide in mental health services. Finally, we will rapidly prototype and test strategies to optimize engagement. Using established procedures from implementation science and behavioral economics, relevant theories and frameworks and the extant literature, we will identify preliminary strategies to support attendance at first mental health visit. Strategies will also be developed in collaboration with a team of experts in suicide, implementation science, behavioral economics, and primary and mental health care. Based on the literature and our previous work, we anticipate that strategies that increase motivation (e.g., financial incentives) and foster connectedness (e.g., Caring Contacts) will be needed. We will then iteratively test and refine these preliminary strategies. Throughout this process, we expect to uncover additional barriers and facilitators that will allow us to further refine and optimize implementation strategies. The primary output will be a menu of the most promising and feasible implementation strategies to support the initiation of mental health services for patients at risk of suicide that will be tested in a subsequent trial. The long-term goal of this work is to increase engagement in mental health services for suicidal individuals.