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处于极端自杀危机的情况下出现在急诊科（ED），但其他有自杀风险的患者在急诊科没有被发现，因此没有得到治疗。一旦出院，30%的有自杀倾向的青少年在前哨事件发生后的六个月内再次出现危机。目前，没有基于证据的标准，以适当的筛查和筛查后的干预措施，以改善出现在急诊科的自杀行为风险升高的患者的结果。这两个站点R01应用程序测试了一个简短的治疗参与干预的有效性，称为自杀青少年在ED访问后获得治疗（STAT-ED），用于在ED寻求非精神问题治疗的青少年，但通过系统筛选确定为有自杀风险。在这个独特的为期3年的提案中，来自两个机构（辛辛那提儿童医院医学中心[CCHMC]和全国儿童医院[NCH]）的研究人员将招募并随机分配160名青少年（每个地点80人）进行(a) stated干预或(b)强化常规护理（EUC）作为比较条件。EUC包括简短的咨询和心理健康转诊。STAT-ED干预的目标是家庭参与，解决问题，协助转诊和有限的病例管理，从ED过渡到门诊护理，目标是最大限度地开始心理健康治疗和对以前未被认识到的自杀风险筛查呈阳性的青少年的后续护理。该应用程序建立在一项试点研究的基础上

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.