Treating Drivers of Suicide in Primary Care using Jaspr Health

项目摘要/摘要 自杀在美国仍然是一个严重的公共卫生问题，自那以来，自杀率几乎每年都在上升 2005年，从每10万人11.0人增加到2018年每10万人14.8人，2018年总计48,344人；140万美国成年人 自杀未遂，同年又有1200万人认真考虑自杀。酒精 使用障碍(AUD)会成倍增加自杀风险，还会干扰自杀预防 干预努力。在过去的十年中，预防自杀的举措针对的是医疗保健系统 (HCS)，特别是在普通和初级保健诊所(PCC)，因为许多自杀身亡的人可以访问他们的 初级保健提供者(PCP)在其死亡前几个月和一年。尽管普遍的自杀筛查 现在通常在PCC中进行，许多HC和PCC努力提供以证据为基础的自杀预防 实践(EBP)与PCC中通常治疗的其他行为健康EBP相同。数字技术可以 高效可靠地帮助PCC提供预防自杀的EBP，并增加信心和 PCP治疗自杀的能力，包括可能干扰这些努力的AUD。 Jaspr Health(“Jaspr”；R44MH108222)是一个自杀预防平台，最初设计用于 急诊科(ED)的急性自杀患者提供自杀预防EBP。接地气 Jobes的自杀倾向协作评估和管理(CAMS)，JASPR指导患者完成 全面的自杀风险评估和致命手段咨询，建立危机稳定计划，以及 教授行为技能以减少迫在眉睫的痛苦；有生活经验的人的视频(PLE)提供智慧 希望能度过自杀危机。为护理团队提供信息摘要，以帮助出院 部署计划。一个配套的应用程序提供出院后的支持。来自随机对照的结果 试验(RCT；N=31)将JASPR与照常护理进行比较，有力地支持了其可行性、可接受性和 有效增加EBP的投放，减少焦虑和痛苦，提高应对能力 自杀念头和提高ED的满意度。 这项为期34个月的快速通道旨在通过延长Jaspr Health的效用来增加其对公共健康的影响 提供以证据为基础的简短干预，直接针对和治疗一个人想要死亡的原因 (他们自杀的“司机”)，同时解决酗酒问题。该提案由三个方面定义 项目阶段包括：(1)概念验证形成性评估阶段，在该阶段我们将迭代 设计、测试和构建原型(第一阶段；1-10个月)；(2)产品设计和构建形成阶段 评估阶段，我们将在此阶段设计、构建和测试所有剩余功能和应用程序(阶段II；11个月- 22)；以及(3)总结性评估阶段，包括试点测试(N=20)和比较JASPR的RCT(N=120 到自杀预防应用程序和其他在线健康资源(第二阶段；23-34个月)。

PROJECT SUMMARY/ABSTRACT Suicide remains a serious public health problem in the U.S. as rates have risen nearly each year since 2005, from 11.0 per 100,000 to 14.8 per 100,000 in 2018, totaling 48,344 in 2018; 1.4 million U.S. adults made a suicide attempt, and another 12 million thought seriously about killing themselves that same year. Alcohol use disorder (AUD) exponentially increases suicide risk and can also interfere with suicide prevention intervention efforts. Suicide prevention initiatives over the past decade have targeted healthcare systems (HCS) in general and primary care clinics (PCC) in particular because so many who die by suicide access their primary care provider (PCP) in the months and year prior to their death. Though universal suicide screening is now routinely conducted in PCC, many HCS and PCC struggle to provide suicide prevention evidence-based practices (EBP) on par with other behavioral health EBP commonly treated in PCC. Digital technologies can efficiently and reliably help deliver suicide prevention EBP in PCC and increase the confidence and competence of PCP in treating suicide, including AUD that may interfere with these efforts. Jaspr Health (“Jaspr”; R44MH108222) is a suicide prevention platform originally designed for use by acutely suicidal patients in emergency departments (ED) to deliver suicide prevention EBP. Grounded in Jobes’ Collaborative Assessment and Management of Suicidality (CAMS), Jaspr guides patients in completing a comprehensive suicide risk assessment and lethal means counseling, builds a crisis stabilization plan, and teaches behavioral skills to reduce imminent distress; videos of people with live experience (PLE) offer wisdom and hope for getting through suicide crises. Information is summarized for the care team to aid in discharge disposition planning. A companion app provides support post-discharge. Results from a randomized controlled trial (RCT; N=31) comparing Jaspr to Care-as-Usual strongly support its feasibility, acceptability, and effectiveness in increasing delivery of EBP, reducing agitation and distress, improving capacity to cope with suicidal thoughts, and improving ED satisfaction. This 34-month fast track seeks to increase the public health impact of Jaspr Health by extending its utility to deliver evidence-based brief interventions that directly target and treat a person’s reasons for wanting to die (their “drivers” for suicide) while simultaneously addressing alcohol misuse. The proposal is defined by three project stages which include: (1) a proof-of-concept formative evaluation stage where we will iteratively design, test, and build a prototype (Phase I; Months 1-10); (2) a product design-and-build formative evaluation stage, where we will design, build and test all remaining features and apps (Phase II; Months 11- 22); and (3) a summative evaluation stage involving a pilot test (N=20) and a RCT (N=120) comparing Jaspr to a suicide prevention app and other online wellness resources (Phase II; Months 23-34).