Treating Drivers of Suicide in Primary Care using Jaspr Health

项目概要/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，同年还有 1200 万人认真考虑过自杀。酒精 使用障碍（AUD）呈指数增加自杀风险，也可能干扰自杀预防 干预努力。过去十年的自杀预防举措以医疗保健系统为目标 (HCS) 一般而言，尤其是初级保健诊所 (PCC)，因为许多自杀者都可以寻求他们的帮助 死亡前几个月和一年的初级保健提供者 (PCP)。尽管普遍的自杀筛查是 现在已在 PCC 中常规进行，许多 HCS 和 PCC 都在努力提供基于证据的自杀预防 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 有效、可靠地帮助 PCC 提供自杀预防 EBP，并增强信心和 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) 的急性自杀患者可提供自杀预防 EBP。扎根于 Jaspr 指导患者完成乔布斯的自杀协同评估和管理 (CAMS) 全面的自杀风险评估和致命手段咨询，制定危机稳定计划，以及 教授行为技巧以减少迫在眉睫的痛苦；有现场经验的人 (PLE) 的视频提供智慧 并希望度过自杀危机。为护理团队汇总信息以帮助出院 处置计划。配套应用程序提供出院后支持。随机对照的结果 比较 Jaspr 与 Care-as-Usual 的试验（RCT；N=31）强烈支持其可行性、可接受性和 有效增加 EBP 的提供，减少焦虑和痛苦，提高应对能力 自杀念头，并提高急诊科满意度。 这个为期 34 个月的快速通道旨在通过扩大 Jaspr Health 的效用来增加其对公共卫生的影响 提供基于证据的简短干预措施，直接针对和治疗一个人想死的原因 （他们的自杀“驱动力”），同时解决酗酒问题。该提案由三项定义 项目阶段包括：（1）概念验证形成性评估阶段，我们将迭代 设计、测试和构建原型（第一阶段；第 1-10 个月）； (2) 产品设计与制造形成 评估阶段，我们将设计、构建和测试所有剩余的功能和应用程序（第二阶段；第 11 个月至 22); (3) 总结性评估阶段，涉及比较 Jaspr 的先导测试 (N=20) 和 RCT (N=120) 自杀预防应用程序和其他在线健康资源（第二阶段；第 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).