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1。自杀风险在年轻人中并不是一致的， 而那些参与少年司法系统(JJ)的人更有可能发生自杀行为 他们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环境中为青年进行SB筛查和服务提供更有系统地进行，例如 对于在其社区(即，缓刑环境)受到监督的青年来说，这种做法较为罕见。建议进行的研究 将研究支持e-Connect成功扩展的策略，e-Connect是为数不多的循证自杀之一 社区监督下的青少年行为识别和跨系统联动计划。这 提案来自两位在司法系统、实施科学、临床 决策支持系统，并使用大型管理数据集，并得到强大的多- 纪律团队，以实现学习目标。在网关提供商模型(GPM)和探索的指导下， 准备，实施持续(EPIS)实施框架，我们现在建议延长我们的工作 在e-Connect的基础上，开发和测试扩大实施的“供应商模式”(即e-Connect-scaleup)。在e- 连接-扩大规模，研究团队领导力将作为外部设施支持当地设施，以确保 成功转让在新的JJ系统中交付e-Connect的知识、技能和专业知识，以及 地理环境，利用实施战略支持更广泛、更持续和更严格的 采用e-Connect。在印第安纳州的9个县工作，随机分配到三个浪中的一个- 楔形，实施有效--第二类设计 ，具体目标是 检查临床和成本- E-Connect-Scaleup在(I)确定青少年服务需求(SB和BH相关)方面的效果 (2)跨系统(缓刑-BH机构)转介；以及(3)青年BH服务的使用(初次BH接触； 主要结果)通过将e-Connect的性能与(A)标准缓刑监督官做法进行比较 (基线)和(B)与e-Connect先前功效试验(目标1)中实现的费率相同。我们将研究潜在的 EPIS/GPM内部和外部背景因素的中介或调节作用。我们还将确定是否 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服务的使用(例如，与标准缓刑做法(基线)相比， 将在纽约复制e-Connect缩小差距的性能(目标2)。最后，我们将研究 在保真度和可接受性方面实施e-Connect扩展，并通过 从实施到维持的9个县的实施阶段，以证明可行性 在纽约以外的试用环境中扩大e-Connect的规模(目标3)。我们将阐明内在和外在层面 EPIS和GPM衍生的促进或阻碍执行战略和做法交付的因素 更改为通知在各种环境中向上扩展。

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