Randomized Trial of Stepped Care for Suicide Prevention in Teens and Young Adults

家长奖摘要 我们提出了一个严格的随机试验，以评估一个创新的自杀预防阶梯护理 青少年和年轻人的干预，相比之下，零自杀（ZS）计划发起的健康 系统一个有效的ZS战略，这一年龄组是迫切需要的，因为这是一个发展时期 当：1）自杀是死亡的第二大原因，比任何医疗疾病都多; 2） 自杀倾向和行为往往首先出现在这个年龄段; 3）自杀率和自杀未遂率 (SAs)显著增加; 4）有效的干预可以减少风险，痛苦和一生的成本。 该项目将伙伴关系与具有强大基础设施和承诺的卫生系统相结合 与一个成功实施协作步骤的研究团队一起为ZS进行质量改进 卫生系统的护理干预措施，并在临床，卫生服务，经济学和政策方面拥有专业知识 研究和传播。我们将确定并招募300名年龄在12-24岁之间的自杀率和SA升高的年轻人， 风险符合条件的青少年将被随机分配到：1）零自杀最佳实践，强调卫生系统 使用ZS工具包（ZBP，www.sprc.org）进行质量改进;或2）ZBP+自杀阶梯式护理 预防先前的研究证明了类似干预措施对改善患者预后的价值， 护理率和护理的连续性-这是ZS工作的一个关键问题，因为许多年轻人过早地停止了护理 尽管仍有风险。ZSBP+方法使用：1）风险评估，将青少年分类到适当的护理 2）护理经理提供CBT和DBT技能培训，并支持初级保健临床医生， 患者评估和治疗; 3）互联网eCBT和治疗DBT技能视频以及获得指导 为低风险青少年提供支持（24/7），增加面对面的小组和/或个人治疗， 高危青少年;以及4）定期监测患者结果，并向临床医生提供实时反馈， 促进决策制定和阶梯护理算法的使用。干预期为12个月：6 急性治疗6个月;持续治疗6个月。在基线和 3、6和12个月随访。我们假设，与BMPs中的年轻人相比， 随着时间的推移，SBP+将显著降低致死性和非致死性SA的发生率（主要结局），并将显示 次要结局的改善（随时间推移的自杀事件、自我伤害事件、抑郁症状）。 我们亦会进行成本效益分析。结果将为卫生系统提供重要信息 和科学，通过将最先进的科学与实践相结合， 质量改进。BP+预防自杀的阶梯式护理有可能更广泛地持续采用 在卫生系统和全国传播，提高我们的能力，以满足ZS的挑战。

Parent Award Abstract We propose a rigorous randomized trial to evaluate an innovative stepped care for suicide prevention intervention for adolescents and young adults, compared to a zero suicide (ZS) program initiated by a health system. An effective ZS strategy for this age group is critically needed because this is a developmental period when: 1) suicide is the second leading cause of death, accounting for more deaths than any medical illness; 2) suicidal tendencies and behaviors often first occur in this age span; 3) rates of suicide and suicide attempts (SAs) increase dramatically; and 4) effective intervention can reduce risk, suffering, and costs over lifetimes. The project combines a partnership with a health system that has strong infrastructure and commitment to quality improvement for ZS with a research team that has successfully implemented collaborative stepped care interventions in health systems and has expertise in clinical, health services, economics, and policy research and dissemination. We will identify and enroll 300 youths ages 12-24 with elevated suicide and SA risk. Eligible youths will be randomized to: 1) zero suicide best practices, which emphasizes health system quality improvement using the ZS toolkit (ZSBP, www.sprc.org); or 2) ZSBP+ stepped care for suicide prevention. Prior research demonstrates the value of similar interventions for improving patient outcomes, rates of care, and continuity of care- a critical issue for ZS efforts, as many youths discontinue care prematurely despite continuing risk. The ZSBP+ approach uses: 1) risk assessments to triage youths to appropriate care levels; 2) Care Managers to deliver CBT and DBT skills training and support primary care clinicians with patient evaluation and treatment; 3) internet eCBT and therapeutic DBT skills video plus access to coaching support (24/7) for lower risk youths, with stepped up in-person group and/or individual treatment added for higher risk youths; and 4) regular monitoring of patient outcomes, with real-time feedback to clinicians to facilitate decision-making and use of the stepped care algorithms. The intervention period is 12 months: 6 months of acute treatment; and 6 months of continuation treatment. Outcomes are assessed at baseline and at 3, 6 and 12-month follow-ups. We hypothesize that, compared to youths in ZSBP, youths randomized to ZSBP+ will have significantly lower rates of fatal and nonfatal SAs over time (primary outcome) and will show improvements on secondary outcomes (suicide events over time, self-harm episodes, depressive symptoms). We will also conduct cost effectiveness analyses. Results will provide critical information for health systems and science regarding the potential to achieve ZS goals by integrating state of the art science with practice quality improvement. ZSBP+ stepped care for suicide prevention has potential for broader sustained adoption within the health system and national dissemination, enhancing our capacity to meet the ZS challenge.