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，自杀是第二大死亡原因1。自杀风险在年轻人中并不一致， 而那些参与青少年司法（JJ）系统的人有更大的自杀行为（SB）的风险， 他们的情绪和物质使用障碍，创伤暴露和获得枪支的患病率增加。 虽然在安全的JJ环境中为青少年进行SB筛查和提供服务的情况更为系统， 对于在社区中受到监督的青年来说，这种做法更为罕见（即，试用设置）。拟定研究 将研究支持e-Connect成功扩大规模的策略，e-Connect是为数不多的基于证据的自杀之一。 在社区监督下为青少年开展行为识别和跨系统联系方案。这 该提案来自两名在司法系统、实施科学、临床 决策支持系统，并使用大型行政数据集，并得到强大的多 学科团队实现学习目标。在网关提供商模型（GPM）和探索的指导下， 准备，实施支持（EPIS）实施框架，我们现在建议扩大我们的工作 开发和测试扩大实施规模的“供应商模式”（即，e-Connect-scaleup）。在e- 连接-扩大规模，研究团队领导将作为外部促进者支持本地促进者，以确保 在新的强生系统中成功转移提供电子连接的知识、技能和专业知识， 地理背景，利用执行战略支持更广泛、持续和严格的 采用e-Connect。在9个印第安纳州县工作，随机分配到三个波浪中的一个， 楔形，实施有效性混合2型设计 具体目标是 检查临床和成本- e-Connect-scale-up在（i）识别青少年服务需要（SB和BH相关）方面成效 （ii）跨系统（感化院-感化院机构）转介;及（iii）青少年感化院服务使用（感化院初次接触）; 通过比较e-Connect的性能（a）标准缓刑监督官实践 （基线）和（B）与e-Connect既往疗效试验（目标1）中达到的比率。我们将研究潜在的 EPIS/GPM内部和外部环境因素的中介或调节作用。我们还将确定 e-Connect-scaleup可以减少SB/BH服务中的种族或性别健康差异， 系统转介和青年SB/BH服务使用（例如，与标准缓刑实践（基线）相比， 将复制纽约证券交易所e-Connect降低风险的表现（目标2）。最后，我们将研究 实施电子连接-在保真度和可接受性方面扩大规模， 9个州的实施阶段直至维持阶段，以证明可行性 在纽约州以外的试用环境中扩大电子连接（目标3）。我们将阐明内部和外部层面 环境绩效信息系统和全球项目管理衍生的促进或阻碍实施战略和做法的因素 在各种情况下，为扩大规模提供信息的变化。

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