Developing an Adaptive Intervention for Suicidal Adolescents Following Inpatient Hospitalization: A Pilot SMART

摘要 这个为期4年的K23指导职业发展奖申请提出了一个重点研究计划 和培训，以促进申请人的过渡到一个独立的职业生涯，以病人为导向的研究与 专门从事针对有自杀风险的青年的适应性和技术强化干预。背景： 尽管青少年自杀的公共卫生意义，有效的干预自杀青少年缺乏。 特别是，迫切需要对精神病住院青少年进行有效的干预， 重复自杀行为和相关危机的风险很高。因为自杀的年轻人 在不同水平的出院后自杀风险和对干预的反应方面， 出院后的结果（防止自杀危机复发）需要个性化的方法。自适应 干预措施（AI）可以个性化治疗的类型，强度和时间，非常适合 解决这种异质性。此外，鉴于移动的通信的普遍性和年轻人的偏好， (text信息），整合技术以加强对自杀青年的干预， 他们的影响研究策略：为自杀的技术增强AI的发展提供信息 青少年，申请人建议进行顺序，多重分配，随机试验（SMART）试点 动机访谈（MI）-增强安全规划干预（MI-SafeCope）。基础上 申请人的试点研究，目标1将侧重于最终确定干预组成部分（MI增强安全计划 住院时提供;出院后每日短信助推器;出院后电话助推器 电话）、实施协议和保真度评估工具，为SMART试点做准备。具体地说， 申请人将通过迭代细化的过程来开发文本消息助推器组件 来自专家和青少年焦点小组的反馈（N=20）。目标2将侧重于开展SMART 对自杀青少年住院患者（13-17岁）进行试点（N=80），以完善和证明可接受性， 研究程序和MI-SafeCope组件及其顺序的可行性，以指导实施 全尺寸SMART（R 01提案）。全面的SMART将反过来导致人工智能的建设， 急诊护理后有自杀倾向的青少年。培训目标：帮助申请人实现职业目标， 独立的临床科学家开发干预措施，以防止青少年自杀，具体的培训目标是 （1）获得干预科学的专业知识，重点是开发，实施和评估AI， 有自杀风险的青年;（2）发展综合技术的技能，以加强和提供干预措施， 这些年轻人;（3）获得SMART研究分析策略和分析方法的培训， 了解AI的发展。这些目标将通过专家的密切指导来实现， 这些内容领域;通过精心挑选的教学活动和会议出席;通过应用研究 经验;以及通过手稿和赠款提案（即R 01用于完全强大的SMART）准备。

ABSTRACT This 4-year K23 Mentored Career Development Award application proposes a program of focused research and training to facilitate the applicant's transition to an independent career in patient-oriented research with a specialization in adaptive and technology-enhanced interventions for youth at risk for suicide. CONTEXT: Despite the public health significance of youth suicide, efficacious interventions for suicidal teens are lacking. In particular, a critical need exists for effective interventions for psychiatrically hospitalized adolescents who are at a high risk for repeated suicidal behavior and related crises. Because suicidal youth are highly heterogeneous in terms of varying levels of post-discharge suicide risk and response to intervention, optimizing post-discharge outcomes (preventing relapse of suicidal crises) requires a personalized approach. Adaptive interventions (AIs), which can individualize the type, intensity, and timing of treatment, are ideally suited for addressing this heterogeneity. In addition, given the ubiquity and youth preferences for mobile communication (text messaging), integrating technology to augment interventions for suicidal youth can potentially strengthen their impact. RESEARCH STRATEGY: To inform the development of a technology-augmented AI for suicidal teens, the applicant proposes to conduct a Sequential, Multiple Assignment, Randomized Trial (SMART) pilot of a Motivational Interview (MI)-enhanced safety planning intervention (MI-SafeCope). Building on the applicant's pilot research, Aim 1 will focus on finalizing the intervention components (MI-enhanced safety plan delivered at hospitalization; post-discharge daily text message boosters; post-discharge telephone booster call), implementation protocol, and fidelity assessment tools in preparation for the SMART pilot. Specifically, the applicant will develop the text message booster component through a process of iterative refinement based on feedback from experts and adolescent focus groups (N=20). Aim 2 will focus on conducting the SMART pilot (N=80) with suicidal adolescent inpatients (ages 13-17) to refine and demonstrate acceptability and feasibility of study procedures and MI-SafeCope components and their sequence to guide the implementation of a full-scale SMART (R01 proposal). The full-scale SMART will, in turn, lead to the construction of the AI for suicidal teens following acute care. TRAINING PLAN: To facilitate the applicant's career goal of becoming an independent clinical scientist developing interventions to prevent youth suicide, the specific training goals are to: (1) gain expertise in intervention science with a focus on developing, implementing, and evaluating AIs for youth at risk for suicide; (2) develop skills in integrating technology to augment and deliver interventions for these youth; and (3) obtain training in analytic strategies for SMART studies and analytic approaches that can inform the development of AIs. These goals will be accomplished through close mentorship from experts in these content areas; via carefully selected didactic activities and conference attendance; via applied research experiences; and via manuscript and grant proposal (i.e. an R01 for a fully-powered SMART) preparation.