Defining a Crisis: Engagement with Crisis Call Centers and Mobile Crisis Teams

定义危机：与危机呼叫中心和移动危机团队合作

• 批准号: 10509359
• 负责人: Matthew Louis Goldman
• 金额: $ 6.08万
• 依托单位: PUBLIC HEALTH FOUNDATION ENTERPRISES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10509359
• 关键词: Address; Adult; African American population; Black race; Caring; Clinical; Data; Data Set; Databases; Decision Making; Detection; Digit structure; Feeling suicidal; Geography; Goals; Health Services Accessibility; Homelessness; Inpatients; Insurance; Logistic Regressions; Mental Health; Outcome; Pattern; Persons; Play; Population; Psychiatry; Psychoses; Records; Regression Analysis; Reporting; Role; Services; Severities; Structure; Subgroup; Suicide; Suicide prevention; Symptoms; System; Triage; Uninsured; Variant; Visit; base; biomedical referral center; clinical decision support; clinical phenotype; evidence base; experience; high risk; men; population health; programs; routine care; rural area; sociodemographics; socioeconomics; suicidal; suicidal behavior; suicidal risk; suicide hotline; suicide model; support tools; tool

7. Project Summary/Abstract In July 2022, 988 will become the nationwide 3-digit suicide prevention phoneline to access the National Suicide Prevention Lifeline (NSPL). The nationally recognized Zero Suicide (ZS) model has endorsed crisis call centers (CC) and mobile crisis (MC) as key strategies to prevent suicide. Crisis services are also envisioned as a means of increasing access to care for populations that have historically faced barriers to receiving care, including Black/African Americans, people experiencing homelessness, and people living in rural areas. When 988 goes live, the NSPL is expected to expand beyond its current role as a suicide hotline and transform into an entry point for a range of mental health crises as well as a means of dispatching MC teams. However, little is known about what types of calls may come to 988 or what factors will need to be considered to develop best practices in crisis triage decision-making. There is an urgent need to expand the evidence base to inform best practices in CC and MC settings, which are routinely caring for people at high risk of suicide. To fill this gap, this study will leverage a large, comprehensive clinical dataset from Georgia’s statewide crisis system—which is widely regarded as a national leader in crisis services—to characterize CC and MC practices and provide guidance to crisis programs as the US begins to roll out 988. In Aim 1, we will conduct a latent class analysis to quantitatively describe common clinical phenotypes of adults accessing crisis services through a statewide CC between 2016 and 2018 (n=235,762), which can inform what types of crises need to be addressed by 988 call centers. In Aim 2, we will examine sociodemographic, clinical and regional factors that may be associated with referral decisions by Georgia’s CC (n=235,762) and MC (n=34,371), with a particular focus on disparities among groups that historically have poorer access to care. Finally, in Aim 3, we will leverage Georgia’s use of a clinical decision-support tool called the Level of Care Utilization System (LOCUS) to examine cases in which the actual CC referral differs from the most appropriate level of care recommended by the LOCUS, which allows for detection of cases where referral options may be limited. These studies will fill critical gaps in the evidence base to advance our understanding of best practices for suicide prevention in crisis services and will help prepare the US for major crisis system transformations such as 988. The figures presented below are the actual number of mobile crisis visits between 1/1/2016 and 12/31/2018 in the GCAL database.

7.项目总结/摘要 2022年7月，988将成为全国3位数的自杀预防电话热线， 自杀预防生命线（NSPL）全国公认的零自杀（ZS）模式已批准危机呼吁 中心（CC）和移动的危机（MC）作为预防自杀的关键策略。危机服务也被设想为 为历史上在接受护理方面面临障碍的人口增加获得护理的机会， 包括黑人/非裔美国人、无家可归者和生活在农村地区的人。当 988上线后，NSPL预计将超越目前作为自杀热线的角色， 一系列心理健康危机的切入点以及派遣MC团队的手段。不过小 知道什么类型的电话可能会打到988，或者需要考虑哪些因素才能最好地开发 危机分类决策的实践。迫切需要扩大证据基础， 在CC和MC环境中的实践，这些环境通常照顾自杀风险高的人。为了填补这一空白， 这项研究将利用来自格鲁吉亚全州危机系统的大型综合临床数据集， 被广泛认为是危机服务的国家领导者-以CC和MC实践为特征，并提供 美国开始推出988计划时，对危机计划的指导。在目标1中，我们将进行潜在类别分析， 定量描述通过全州CC获得危机服务的成人的常见临床表型 2016年至2018年期间（n= 235，762），可以告知需要通过988呼叫解决的危机类型 中心.在目标2中，我们将研究可能与以下因素相关的社会人口统计学、临床和区域因素： 格鲁吉亚的CC（n= 235，762）和MC（n= 34，371）的转诊决定，特别关注差异 在历史上获得护理机会较少的群体中。最后，在目标3中，我们将利用格鲁吉亚利用 一种名为护理水平利用系统（LOCUS）的临床决策支持工具，用于检查以下病例： 实际的CC转诊不同于LOCUS建议的最适当的护理水平， 允许发现转诊选择可能有限的病例。这些研究将填补 证据基础，以促进我们对危机服务中预防自杀的最佳做法的理解， 帮助美国为988等重大危机系统转型做好准备。下列数字为 GCAL数据库中2016年1月1日至2018年12月31日期间移动的危机访问的实际次数。