Scaling up eConnect in Juvenile Probation Settings: a hybrid implementation-effectiveness trial of a digital suicide risk/behavior identification and linkage-to-treatment system

在青少年缓刑环境中扩大 eConnect：数字自杀风险/行为识别和与治疗系统联系的混合实施有效性试验

• 批准号: 10516385
• 负责人: Matthew Aalsma
• 金额: $ 158.5万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 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 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10516385
• 关键词: Address; Adolescent; Adoption; African American; Caring; Classification; Clinical; Clinical Decision Support Systems; Clinical effectiveness; Collaborations; Communities; County; Data; Data Set; Ensure; Ethnic Origin; Evaluation; Evidence based intervention; Exploration Preparation Implementation and Sustainment; Firearms; Gender; General Population; Geography; Goals; Health; Health Services; Health Services Needs; Health system; Home; Indiana; Intervention; Justice; Knowledge; Leadership; Mediating; Minority; Modeling; Moods; National Institute of Mental Health; New York; Online Systems; Outcome; Performance; Positioning Attribute; Prevalence; Prevention; Protocols documentation; Provider; Public Health; Race; Randomized; Research; Risk; Risk Behaviors; Secure; Service provision; Services; Substance Use Disorder; Suicide; Suicide attempt; Suicide prevention; Supervision; System; Testing; Time; Work; Youth; adolescent suicide; behavioral health; community setting; cost effectiveness; design; digital; disparity reduction; effectiveness implementation study; effectiveness trial; efficacy testing; efficacy trial; evidence base; health disparity; health service use; hybrid type 2 design; implementation framework; implementation science; implementation strategy; improved; juvenile justice system; multidisciplinary; prevent; primary outcome; probation; probationer; programs; racial and ethnic disparities; racial disparity; scale up; screening; service delivery; skills; suicidal adolescent; suicidal behavior; suicidal risk; tool; trauma exposure; treatment comparison; uptake

Among US adolescents, suicide is the second leading cause of death1. Suicide risk is not uniform across youth, and those involved in the juvenile justice (JJ) system are at even greater risk for suicidal behavior (SB) given their increased prevalence of mood and substance use disorders, trauma exposure, and access to firearms. While SB screening and service provision for youth in secure JJ settings occurs more systematically, such practices are rarer for youth who are supervised in their community (i.e., probation settings). The proposed study will examine strategies to bolster the successful scale-up of e-Connect, one of the few evidence-based suicide behavior identification and cross-system linkage programs for youth on under community supervision. This proposal is from two PIs with complimentary expertise in the justice system, implementation science, clinical decision support systems, and use of large administrative data sets, and is supported by a strong multi- disciplinary team to achieve study aims. Guided by the Gateway Provider Model (GPM) and the Exploration, Preparation, Implementation Sustainment (EPIS) implementation framework, we now propose to extend ourwork of e-Connect, to develop and test a “purveyor model” of implementation scale-up (i.e., e-Connect-scaleup). In e- Connect-scaleup, researchteamleadershipwill serveas External Facilitatorsto support Local Facilitators to ensure the successful transfer of knowledge, skill and expertise in delivering e-Connect in a new JJ system and geographic context, utilizing implementation strategies to support the more widespread, sustained and rigorous adoption of e-Connect. Working in 9 Indiana counties, randomly assigned to one of three waves in a stepped- wedge, implementation-effectivenesshybrid type-2 design ,the specificaims are to examine the clinical and cost- effectiveness of e-Connect-scaleup on (i) identification of youth service need (SB and BH correlates) in juvenile probationers; (ii) cross-system (probation-BH agency) referral; and (iii) youth BH service use (initial BH contact; primary outcome) by comparing the performance of e-Connect to (a) standard probation officer practice (baseline) and (b) to rates achieved in the prior efficacy trial of e-Connect (Aim 1). We will examine potential mediating or moderating effects of EPIS/GPM inner and outer context factors. We will also determine whether e-Connect-scaleup can reduce race or gender health disparities in SB/BH service need identification, cross- system referral and youth SB/BH service use (e.g. as compared to standard probation practice (baseline), which would replicate the disparity-reducing performance of e-Connect in NYS (Aim 2). Finally, we will examine the implementation of e-Connect-scaleup in terms of fidelity and acceptability and compare advancement through the stages of implementation through to sustainment across the 9 counties in order to demonstrate the feasibility of scaling-up e-Connect in probation settings beyond NYS (Aim 3). We will elucidate the inner- and outer-level EPIS- and GPM- derived factors that promote or hinder delivery of implementation strategies and practice change to inform scale up across a variety of contexts.

在美国青少年中，自杀是第二大死因。青少年的自杀风险并不一致，

项目成果

Transforming systems mistrust and poor communication to improve behavioural health care uptake among youth on probation.

改变不信任和沟通不畅的系统，以提高缓刑青少年对行为保健的接受程度。

• DOI: 10.1080/17538068.2023.2253620
• 发表时间: 2023
• 期刊: Journal of communication in healthcare
• 作者: Sichel,CoriannaE;Elkington,KatherineS
• 通讯作者: Elkington,KatherineS