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

项目总结 自杀风险较高的患者如果接受心理健康治疗，自杀死亡的可能性较小。有自杀倾向 个人在开始和持续参与心理健康服务方面存在困难，但目前还没有研究表明 系统地制定和测试战略，以增加对自杀患者的治疗启动。一致 随着NIMH的战略目标4加强NIMH支持的研究对公共健康的影响， 这项研究的主要目标是开发可接受的、可行的、低成本和有效的战略，以提高 在初级保健中发现自杀风险后，患者首次进行精神健康检查的情况。我们会 与大型、多样化的医疗系统合作，该系统已在8个城市初级保健中实施了协作护理 实践，以快速原型和测试有希望的战略，以实现这一目标。快速成型涉及到 在早期研究阶段进行了一系列严格的实验来优化操作。医疗保健以外的行业 通常使用这种方法来快速学习，并在较短的时间内在较短的时间内进行决策 卷展栏。我们开发和测试的策略将由行为经济学和实施科学提供信息 方法，利用宾夕法尼亚大学的P50快感中心，将包括 针对阻碍就诊的关键机制。首先，我们将确定患者的特征 是否参加使用医疗记录和索赔数据进行转介后的第一次精神健康访问。然后，我们 将既定的方法应用于背景调查，以确定心理健康的障碍和促进者 为有自杀危险的个人提供治疗服务。我们将采用直接观察和简短采访的方式 主要利益相关者(来自宾夕法尼亚大学卫生系统内外)了解关键障碍和促进者 让有自杀风险的患者接受精神健康服务。最后，我们将快速制作原型并进行测试 优化参与度的策略。使用来自实施科学和行为学的既定程序 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，以 支持参加第一次心理健康检查。还将与一个团队合作制定战略 自杀、实施科学、行为经济学以及初级和精神卫生保健方面的专家。基座 根据文献和我们之前的工作，我们预计增加动机的战略(例如，财务 将需要建立联系(例如，关爱联系)和促进联系。然后我们将迭代地测试和 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和 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 一份最有希望和最可行的实施战略菜单，以支持启动心理健康 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 为有自杀倾向的个人提供更多心理健康服务。

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.