Signature Project

宾夕法尼亚大学自杀预防实施研究创新中心（INSPIRE） 是一项大规模的研究，旨在检查有效性和实施的证据为基础的 在卫生保健环境中采取干预措施降低自杀风险。该项目将利用方法和 INSPIRE中心的行政支持，重点是优化基于实践的实施 针对少数群体和弱势群体的自杀预防干预措施。自杀高危人群 经常出现在急性护理环境中，例如急诊科（ED），然后通常住院 或被转介接受门诊心理健康治疗然而，尽管自杀行为的风险增加， 在艾德就诊后自杀，许多患者不参加门诊治疗。简要循证 安全规划干预和后续服务（SPI+）等干预措施可用于缓解 这一风险，并从事病人在门诊治疗。然而，这样的做法往往可以是具有挑战性的忙碌 艾德临床医生提供自杀的病人。我们的跨学科团队自杀，实施，健康 服务，定性和定量研究人员以及艾德临床医生，健康 系统领导者，心理健康临床医生和患者将合作，以改善基于ED的 自杀预防工作。我们提出了一种新的交付模式，其中艾德工作人员将连接有风险的患者， 自杀的心理健康临床医生谁是位于外部的ED。这些场外许可和凭证 临床医生将在出院前通过远程医疗为艾德患者提供SPI+，并在出院后提供随访服务。 艾德出院作为创新的自杀预防咨询中心（SPCC）的一部分。该项目有三 具体目标。目的1将使用逐步楔形随机分组设计来评价SPI+的有效性 由SPCC临床医生通过远程医疗提供，与由SPI+培训的艾德临床医生提供的SPI+相比， 自杀行为和艾德出院后的护理。目标2将评价 SPCC临床医生提供的SPI+与艾德临床医生提供的SPI+在关键实施方面的比较 结果包括采用，保真度，可接受性和可行性，并将探讨临床医生的调解 意图、规范和自我效能感对SPI+忠诚度的影响。目标3将评估艾德和SPCC实践的成本 并检查卫生系统的潜在成本抵消，以提供SPCC可扩展性的证据， 持续发展如果成功且具有成本效益，在ED外部使用SPCC可能会成为一种可扩展的模式 为那些有自杀风险的人提供自杀预防循证实践， 有可能拯救生命的护理。

The Signature Project of the Penn Innovation in Suicide Prevention Implementation Research (INSPIRE) Center is a large-scale research study designed to examine the effectiveness and implementation of an evidence-based intervention to lower suicide risk in health care settings. The Project will leverage the methodological and administrative support of the INSPIRE Center with its focus on optimizing implementation of practice-based suicide prevention interventions for minority and disadvantaged populations. Individuals at high risk for suicide often present to acute care settings, such as emergency departments (EDs), and then typically are hospitalized or referred for outpatient mental health treatment. Yet, despite being at increased risk of suicidal behavior and suicide following an ED visit, many patients do not attend outpatient treatment. Brief evidenced-based interventions such as the Safety Planning Intervention and follow-up services (SPI+) are available to mitigate this risk and engage patients in outpatient treatment. However, such practices often can be challenging for busy ED clinicians to provide for suicidal patients. Our interdisciplinary team of suicide, implementation, health services, qualitative and quantitative researchers as well as diverse stakeholder groups of ED clinicians, health systems leaders, mental health clinicians, and patients will collaborate to improve the delivery of ED-based suicide prevention efforts. We propose a novel delivery model in which ED staff will connect patients at risk for suicide to mental health clinicians who are located external to the ED. These off-site licensed and credentialed clinicians will provide SPI+ via telehealth for ED patients prior to discharge and provide follow-up services after ED discharge as part of an innovative Suicide Prevention Consultation Center (SPCC). The Project has three Specific Aims. Aim 1 will use a stepped-wedge cluster-randomized design to evaluate the effectiveness of SPI+ delivered by SPCC clinicians via telehealth compared to SPI+ delivered by SPI+-trained ED clinicians on rates of suicidal behavior and engagement in care following ED discharge. Aim 2 will evaluate the implementation of SPI+ delivered by SPCC clinicians compared to SPI+ delivered by ED clinicians on key implementation outcomes including adoption, fidelity, acceptability, and feasibility and will also explore the mediation of clinician intentions, norms, and self-efficacy on the fidelity of SPI+. Aim 3 will evaluate the costs to ED and SPCC practices and examine potential cost offsets to the health system to provide evidence of SPCC scalability and sustainability. If successful and cost effective, use of a SPCC, external to EDs, could become a scalable model for providing suicide prevention evidenced-based practices to those at risk for suicide presenting for emergency care with the potential to save lives.