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

描述(由申请人提供)：虽然许多有自杀危险的年轻病人在自杀未遂或处于极端自杀危机的情况下到急诊科就诊，但其他有自杀危险的病人在急诊科得不到承认，因此得不到治疗。出院后，30%的有自杀倾向的青少年会在前哨事件发生后6个月内，带着另一次危机回到教育署。目前，没有循证标准用于适当的筛查和筛查后干预，以改善出现在急诊室的自杀行为风险较高的患者的预后。这一两个站点的R01应用程序测试了一种名为自杀青少年在急诊室就诊后获得治疗的简短治疗参与干预措施(STAT-ED)的有效性，该干预措施适用于因非精神问题在ED寻求治疗但经系统筛查确定为有自杀风险的青少年。在这项独特的为期3年的计划中，来自两个机构(辛辛那提儿童医院医疗中心[CCHMC]和全国儿童医院[NCH])的研究人员将招募160名青少年(每个地点80名)，并将其随机分配到(A)统计教育干预或(B)加强日常护理(EUC)作为对照条件。EUC包括一个简短的咨询和一个心理健康转介。STAT-ED干预措施的目标是家庭参与、解决问题、在从ED过渡到门诊期间协助转介和有限的病例管理，目的是最大限度地启动对以前未发现的自杀风险筛查阳性的青少年的精神健康治疗和善后护理。该应用程序建立在一项试点研究的基础上，在该研究中 STAT-ED得到了患者、家属和临床医生的广泛接受，比EUC更有效。我们现在建议在一个更大、更多样化的样本中测试STAT-ED对EUC的干预，样本来自两个地理上分离的城市儿科急诊室，服务于广泛的人群(辛辛那提和俄亥俄州哥伦布)。第二个目的是比较STAT-ED和EUC在减少ED出院后自杀意念和抑郁症状方面的有效性。其理论基础是，通过使用儿科ED来识别和治疗未被识别的自杀风险，青少年将不太可能在未来过度使用ED服务，拥有更好的生活质量，并最终降低发病和死亡的风险。如果成功，它将提供一种简单和可持续的干预措施，可以在不同的儿科急诊环境中实施。这项研究将通过提高我们在儿科急诊科环境中确定筛查、评估和实施实用自杀预防干预措施的“最佳实践”的能力，为疾控中心的使命做出贡献。 公共卫生相关性：公共卫生相关性。通过为被教育署工作人员认定为自杀风险较高的青少年提供简短的治疗参与干预，这项研究将首次测试能否在不对儿科急诊科的工作流程和资源造成不必要负担的情况下，改善门诊患者的精神健康护理和治疗就诊情况。

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.