Signature Project

自杀是10至19岁人群的第二大死因，是一个严重的公共卫生问题。 自杀意念和非致命性自杀企图甚至更为普遍，并导致大量的发病率， 增加自杀的风险。儿科初级保健是干预研究的理想服务环境， 迅速减少美国青年的自杀和自杀行为，因为80%的自杀青年被认为是 在死亡前一年，他们的初级保健医生（PCC），而只有20%的人与精神病患者有过接触。 健康专业人士。尽管识别有自杀行为风险的青少年很重要，但大多数PCC并没有 定期筛查自杀。 近年来，新的治疗和管理策略已经开发、测试和实施 在一些组织中，但尚未广泛使用。现有的临床试验往往侧重于测试 循证干预措施的有效性（例如，普遍筛查、安全规划） 急诊科的人群;对这些方法在初级保健中的有效性知之甚少 设置.迫切需要进行研究，以测试循证实践的有效性， 在初级保健中接受治疗的青少年的自杀风险。 为了解决这一差距，我们提出了一个阶梯楔形混合有效性实现集群随机 对照试验，以测试基于人群的质量改善（QI）干预措施的有效性，逐步 减少初级保健中自杀的方法（STARRS_PC），为青年实施临床路径 通过筛查被确定为自杀风险较高。该途径旨在促进使用 基于证据的自杀临床护理过程包括三个独立的组成部分：自杀风险 筛查、风险评估和分诊以及护理管理。该应用程序建立在对真实的 在儿科初级保健环境中实施自杀风险筛查，使用迭代计划，做， 研究，法案（PDSA）的质量改进方法，被患者，家属和PCC广泛接受。在 在拟议的研究中，我们将测试STARRS-PC相对于常规治疗（TAU）的有效性， 主要结局（自杀企图和自杀死亡），次要结局（自杀意念，非自杀性自伤， 和家庭满意度）;检查临床医生的知识、自我效能和购买- 将自杀风险筛查、评估和管理视为变革机制; 组织因素（例如，组织准备和实践整合）作为潜在的主持人， 在这个为期五年的项目中，我们将招募和评估2274名年龄在15岁以下的年轻人， 来自12个初级保健中心的12至17岁的青少年，包括TAU阶段的910名青少年和TAU阶段的1364名青少年。 筛选+干预阶段。参与网站为城市和农村弱势低收入青年提供服务 位于俄亥俄州中部和东南部。

Suicide is the second leading cause of death in those aged 10 to 19 years; it is a critical public health problem. Suicidal ideation and nonfatal suicide attempts are even more prevalent and result in substantial morbidity and increased risk of suicide. Pediatric primary care is an ideal service setting for intervention research designed to rapidly reduce suicide and suicidal behaviors among US youth, as 80% of youth who die by suicide are seen by their primary care clinicians (PCC) in the year prior to death while only 20% have contact with a mental health professional. Despite the importance of identifying youth at risk for suicidal behavior, most PCCs do not routinely screen for suicide. In recent years, new treatment and management strategies have been developed, tested and implemented in some organizations, but they are not yet widely used. Existing clinical trials have tended to focus on testing effectiveness of evidenced-based interventions (e.g., universal screening, safety planning) for high-risk populations in emergency departments; less is known about the efficacy of these approaches in primary care settings. Research is critically needed to test the effectiveness of evidence-informed practices to reduce suicide risk for youth treated in primary care. To address this gap, we propose a stepped wedge hybrid effectiveness-implementation cluster-randomized controlled trial to test effectiveness of a population-based quality improvement (QI) intervention, Stepped Approach to Reducing Suicide in Primary Care (STARRS_PC) that implements a clinical pathway for youth identified by screening as being at elevated risk for suicide. The pathway is designed to promote the use of evidence-based suicide clinical care processes and includes three separate components: suicide risk screening, risk assessment and triage, and care management. The application builds on a pilot study of real- world implementation of suicide risk screening into a pediatric primary care setting, using an iterative Plan, Do, Study, Act (PDSA) quality improvement approach that was well-accepted by patients, families, and PCCs. In the proposed study, we will test the effectiveness of STARRS-PC relative to treatment as usual (TAU) on primary (suicidal attempts and suicide deaths), secondary outcomes (suicidal ideation, non-suicidal self-injury, and family satisfaction) at 3, 6, 12 months post-baseline; examine clinicians’ knowledge, self-efficacy, and buy- in regarding suicide risk screening, assessment, and management as mechanisms of change; and organizational factors (e.g., organizational readiness and practice integrations) as potential moderators of the treatment effect on patient outcomes During this five-year project, we will recruit and assess 2274 youth aged 12 to 17 years from 12 primary care sites, including 910 youths during the TAU phase and 1364 youths during the Screening + Intervention phase. Participating sites serve vulnerable low-income youth in urban and rural settings in central and southeastern Ohio.