STAT-ED Suicidal Teens Accessing Treatment after an Emergency Department Visit

描述（由申请人提供）：虽然许多有自杀风险的年轻患者在自杀未遂或极端自杀危机的情况下前往急诊室（艾德），但其他有自杀风险的患者在急诊室未被识别，因此未得到治疗。一旦出院，30%的自杀青少年在哨兵事件发生后6个月内因另一次危机返回艾德。目前，没有证据为基础的标准存在适当的筛选和筛选后的干预措施，以改善在ED谁是自杀行为的风险升高的患者的结果。该双中心R 01应用程序测试了一种称为“艾德访视后自杀青少年自杀治疗”（STAT-艾德）的简短治疗参与干预措施对因非精神问题在艾德寻求治疗但通过系统筛查确定为有自杀风险的青少年的有效性。在这项独特的3年计划中，来自两家机构（辛辛那提儿童医院医疗中心[CCHMC]和全国儿童医院[NCH]）的研究者将招募160名青少年（每个研究中心80名）并随机分配至（a）STAT-ED干预或（B）作为比较条件的加强常规护理（EUC）。EUC包括简短的咨询和心理健康转诊。STAT-艾德干预措施的目标是在从艾德向门诊治疗过渡期间，家庭参与、解决问题、协助转诊和有限的病例管理，目标是最大限度地启动对先前未被识别的自杀风险筛查呈阳性的青年的心理健康治疗和善后护理。该应用程序基于一项试点研究， STAT-ED被患者、家属和临床医生广泛接受，比EUC更有效。我们现在建议在两个地理位置不同的城市儿科ED（辛辛那提和哥伦布，俄亥俄州）的更大、更多样化的样本中测试STAT-ED干预对EUC的影响。第二个目的是比较STAT-艾德和EUC在减少艾德出院后自杀意念和抑郁症状方面的有效性。其基本原理是，通过使用儿科艾德来识别和治疗未识别的自杀风险，青少年将来不太可能过度使用艾德服务，生活质量更好，最终发病率和死亡率的风险降低。如果成功的话，它将提供一个简短和可持续的干预，可以在不同的儿科艾德设置实施。这项研究将有助于疾病预防控制中心的使命，提高我们的能力，以确定“最佳做法”的筛选，评估和实施实际的自杀预防干预措施，在儿科艾德设置。 公共卫生相关性：公共卫生相关性。通过向被艾德工作人员确定为自杀风险较高的青少年提供简短的治疗参与干预，该研究将首次测试门诊心理健康护理的吸收和治疗出勤率是否可以在不对儿科艾德设置的工作流程和资源造成过度负担的情况下得到改善。

DESCRIPTION (provided by applicant): While many young patients at risk for suicide present to the emergency department (ED) following suicide attempts or in situations of extreme suicidal crises, other patients at risk for suicide go unrecognized, and therefore untreated, in the ED. Once discharged, 30% of suicidal adolescents return to the ED with another crisis within six months of the sentinel event. Currently, no evidence-based standards exist for appropriate screening and post-screening interventions in order to improve outcomes for patients presenting in EDs who are at elevated risk for suicidal behavior. This two-site R01 application tests the effectiveness of a brief treatment engagement intervention termed Suicidal Teens Accessing Treatment after an ED Visit (STAT-ED) for adolescents seeking treatment in the ED for non-psychiatric concerns but identified via systematic screening as being at risk for suicide. In this unique 3-year proposal, investigators from two institutions (Cincinnati Children's Hospital Medical Center [CCHMC] and Nationwide Children's Hospital [NCH]) will recruit and randomize 160 adolescents (80 per site) to (a) the STAT-ED intervention or (b) enhanced usual care (EUC) as a comparison condition. EUC consists of a brief consultation and a mental health referral. The STAT-ED intervention targets family engagement, problem solving, assistance with referral and limited case management during the transition from the ED to outpatient care with the goal of maximizing the initiation of mental health treatment and aftercare among youth screening positive for previously unrecognized suicide risk. The application builds on a pilot study in which STAT-ED was well- accepted by patients, families, and clinicians and was more effective than EUC. We now propose to test the STAT-ED intervention against EUC in a larger, more diverse sample from two geographically separate, urban pediatric EDs serving broad populations (Cincinnati and Columbus, Ohio). A second aim is to compare the effectiveness of STAT-ED and EUC in reducing suicidal ideation and depression symptoms after ED discharge. The rationale is that by using the pediatric ED to identify and treat unrecognized suicide risk, adolescents will be less likely to overuse ED services in the future, have a better quality of life and ultimately have a reduced risk of morbidity and mortality. If successful, it will provide a brif and sustainable intervention that can be implemented across diverse pediatric ED settings. This study will contribute to the mission of the CDC by improving our capacity to identify "best practices" for screening, assessing, and implementing practical suicide prevention interventions in the pediatric ED setting. PUBLIC HEALTH RELEVANCE: Public Health Relevance. By providing a brief treatment engagement intervention to youth identified by ED staff as being at elevated risk for suicide, the study will be the first to test whether outpatient mental health care uptake and treatment attendance can be improved without undue burden on the work flow and resources of the pediatric ED setting.