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Randomized Trial of Stepped Care for Suicide Prevention in Teens and Young Adults

青少年和年轻人预防自杀的阶梯式护理的随机试验

基本信息

批准号：
9750801
负责人：
Joan Rosenbaum Asarnow
金额：
$ 105.04万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-01 至 2021-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9750801
关键词：
Accidents Accounting Acute Adolescence Adolescent and Young Adult Adopted Adoption Age Algorithms Applied Research Behavior Caring Case Manager Cause of Death Cessation of life Clinical Computerized Medical Record Continuity of Patient Care Cost Effectiveness Analysis Data Decision Making Development Direct Costs Economic Policy Elderly Emergency Care Emergency Situation Emergency department visit Emergency medical service Enrollment Evaluation Event Facilities and Administrative Costs Feedback Feeling suicidal Gender Goals Health Health Information System Health Sciences Health Services Health system Healthcare Healthcare Systems Homicide Hospitalization Hospitals Hour Income Individual Infrastructure Internet Intervention Intervention Studies Measures Medical Mental Depression Outcome Pathway interactions Patient Monitoring Patient-Focused Outcomes Patients Persons Population Preventive Intervention Preventive care Primary Health Care Process Quality of life Quality-Adjusted Life Years Randomized Randomized Controlled Trials Research Risk Risk Assessment Risk Factors Savings Science Self-Injurious Behavior Services Suicide Suicide attempt Suicide prevention System Teenagers Testing Therapeutic Time Training Support Triage Violence Visit Youth age group base behavioral health behavioral health intervention collaborative care cost cost effectiveness cost-effectiveness evaluation depressive symptoms effective intervention evidence base health care quality high risk improved innovation inpatient service intervention effect member mortality non-suicidal self injury premature primary care services primary outcome programs randomized trial reducing suicide research data dissemination screening secondary outcome skills skills training suicidal suicidal behavior suicidal morbidity suicidal risk suicide rate young adult

项目摘要

Abstract We propose a rigorous randomized trial to evaluate an innovative stepped care for suicide prevention intervention for adolescents and young adults, compared to a ZS program initiated by a health system. An effective ZS strategy for this age group is critically needed because this is a developmental period when: 1) suicide is the second leading cause of death, accounting for more deaths than any medical illness; 2) suicidal tendencies and behaviors often first occur in this age span; 3) rates of suicide and suicide attempts (SAs) increase dramatically; and 4) effective intervention can reduce risk, suffering, and costs over lifetimes. The project combines a partnership with a health system that has strong infrastructure and commitment to quality improvement for ZS with a research team that has successfully implemented collaborative stepped care interventions in health systems and has expertise in clinical, health services, economics, and policy research and dissemination. We will identify and enroll 300 youths ages 12-24 with elevated suicide and SA risk using a multi-stage screening process. Eligible youths will be randomized to: 1) zero suicide best practices, which emphasizes health system quality improvement using the zero suicide toolkit (ZSBP, www.sprc.org); or 2) ZSBP+ stepped care for suicide prevention, which integrates evidence-based suicide prevention with primary care and emergency services. Prior research demonstrates the value of similar integrated medical- behavioral health interventions for improving patient outcomes, rates of care, and continuity of care- a critical issue for ZS efforts, as many youths discontinue care prematurely despite continuing risk. The ZSBP+ approach uses: 1) risk assessments to triage youths to appropriate care levels; 2) Care Managers to deliver CBT and DBT skills training and support primary care and emergency clinicians with patient evaluation and treatment; 3) internet eCBT and therapeutic DBT skills video plus access to coaching support (24/7) for lower risk youths, with stepped up in-person group and/or individual treatment added for higher risk youths; and 4) regular monitoring of patient outcomes, with real-time feedback to clinicians to facilitate decision-making and use of the stepped care algorithms. The intervention period is 12 months: 6 months of acute treatment; and 6 months of continuation treatment. Outcomes are assessed at baseline and at 3, 6 and 12-month follow-ups. We hypothesize that, compared to youths in ZSBP, youths randomized to ZSBP+ will have significantly lower rates of fatal and nonfatal SAs over time (primary outcome) and will show improvements on secondary outcomes (suicide events over time, self-harm episodes, depressive symptoms). We will also conduct cost effectiveness analyses. Results will provide critical information for health systems and science regarding the potential to achieve ZS goals by integrating state of the art science with practice quality improvement. ZSBP+ stepped care for suicide prevention has potential for broader sustained adoption within the health system and national dissemination, enhancing our capacity to meet the ZS challenge.

摘要