Promoting Healthy Relationships among At-Risk Adolescents: A Feasibility Trial in the Emergency Department

促进高危青少年之间的健康关系：急诊科的可行性试验

• 批准号: 10360603
• 负责人: Kimberly Anne Randell
• 金额: $ 15.8万
• 依托单位: CHILDREN'S MERCY HOSP (KANSAS CITY, MO)
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-03-11 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10360603
• 关键词: Academic achievement; Accident and Emergency department; Address; Adolescent; Age; Behavior; Behavior Therapy; Behavioral Research; Clinical Research; Clinical Trials; Complement; Consensus; Counseling; Data; Development; Development Plans; Disclosure; Dropout; Eating Disorders; Education; Educational Intervention; Emergency Care; Emergency Department evaluation; Emergency Department-based Intervention; Emergency Medicine; Emergency department visit; Evaluation; Evidence based intervention; Feasibility Studies; Female Adolescents; Generations; Goals; Harm Reduction; Health; Health Services; Healthcare; Healthy People 2020; High Prevalence; Homicide; Hybrids; Individual; Intervention; K-Series Research Career Programs; Knowledge; Life Cycle Stages; Link; Male Adolescents; Manuals; Measures; Mental Depression; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Mission; Modeling; Modification; National Institute of Child Health and Human Development; Outcome; Parents; Participant; Patients; Performance; Physicians; Population; Populations at Risk; Pregnancy; Provider; Public Health; Randomized Controlled Trials; Recommendation; Reporting; Research; Research Ethics; Resources; Risk; Risk Factors; School Drop-Outs; Schools; Sexual Health; Sexually Transmitted Diseases; Societies; Speed; Structure; Suicide; Teenagers; Testing; Training; Training Activity; Translations; Treatment Efficacy; United States Dept. of Health and Human Services; United States National Institutes of Health; Victimization; Violence; Work; Youth; base; behavior change; brief intervention; care providers; care seeking; career; career development; clinical practice; community engagement; community setting; condoms; cost; design; early childbearing; effective intervention; efficacy implementation trial; efficacy testing; emergency contraception; emotional abuse; experience; feasibility trial; follow-up; high-risk adolescents; implementation science; implementation study; improved; motivational enhancement therapy; novel; patient oriented; pediatric emergency; point of care; prevent; primary outcome; programs; reproductive coercion; response; school health; skills; theories; treatment as usual; trial comparing

Adolescent relationship victimization (ARV), characterized by physical, sexual, cyber or psychological abuse, reproductive coercion, or sexual exploitation, remains highly prevalent despite implementation of evidence- based interventions in schools and community settings. Negative outcomes, including suboptimal academic achievement, pregnancy, sexually transmitted infections, disordered eating, suicidality, and homicide, result in significant costs to individuals and society. The emergency department (ED) offers unique opportunities to promote healthy relationships and mitigate negative impact of ARV among an at-risk adolescent population. However, current ED-based relationship interventions are limited by 1) disclosure-based delivery, 2) addressing limited forms of abuse, 3) limited efficacy, and 4) missed opportunities to provide point-of-care harm reduction resources. The Healthcare Education Assessment and Response for Adolescent Relationships (HEART) intervention may address these concerns through 1) universal delivery of education and counseling, and 2) comprehensively addressing the full range of ARV. Previous study by Dr. Miller (co-mentor) demonstrated efficacy of HEART to decrease ARV. However, HEART requires adaptation for the ED setting, given significant contextual differences between the ED and the originally intended setting, school health centers. Dr. Randell, a pediatric emergency medicine physician and candidate for this career development award, is committed to a patient oriented clinical research career targeting interventions to promote healthy adolescent relationships. Her five-year career development plan includes structured mentoring and formal didactics to address critical gaps in her training through acquisition of expertise in theories of behavior change, clinical trials for adolescent behavioral research, implementation science, and adolescent research ethics. The proposed study complements other training activities by enabling hands-on experience in intervention adaptation and a randomized control trial. Following identification of enhancements necessary for HEART in the ED setting, Dr. Randell will conduct a randomized controlled trial to enable evaluation of eight feasibility constructs. The hypothesis is that HEART in the ED will be feasible as defined by primary outcomes of acceptability and efficacy to decrease ARV. The rationale is that this study will produce the first ED-based intervention to utilize universal education to comprehensively address ARV in conjunction with provision of point-of-care harm reduction resources. Study findings will inform the development of a larger hybrid efficacy- implementation study, supported by an R01 submission during the K23 award period. This training and research plan are consistent with the mission of the National Institutes of Health and the National Institute of Child Health and Human Development, the Healthy People 2020 objectives from the United States Department of Health and Human Services, and the 2009 Academic Emergency Medicine consensus recommendations for addressing public health problems in the ED setting.

以身体、性、网络或心理虐待为特征的青少年关系受害， 生殖胁迫或性剥削仍然非常普遍，尽管实施了证据- 在学校和社区环境中进行干预。负面结果，包括不理想的学术 成就，怀孕，性传播感染，饮食失调，自杀和杀人，导致 给个人和社会带来巨大的成本。急诊科（艾德）提供了独特的机会， 促进健康的关系，减轻抗逆转录病毒药物对高危青少年的负面影响。 然而，目前基于ED的关系干预受到以下限制：1）基于信任的交付，2） 解决有限形式的虐待，3）疗效有限，以及4）错过提供即时护理的机会 减少危害的资源。青少年人际关系健康教育评估与回应 （心脏）干预可以通过以下方式解决这些问题：1）普及教育和咨询， （2）全面解决抗逆转录病毒药物的所有问题。米勒博士（共同导师）的既往研究 证明了HEART降低ARV的有效性。然而，HEART需要适应艾德设置， 鉴于艾德与最初预期的环境之间存在重大差异， 中心.兰德尔博士，儿科急诊医生和候选人的职业发展 奖项，致力于以患者为导向的临床研究事业，以干预措施为目标，以促进健康 青少年的关系。她的五年职业发展计划包括结构化的指导和正式的 教学法，以解决关键差距，她的培训，通过收购的专业知识，在理论的行为改变， 青少年行为研究、实施科学和青少年研究伦理的临床试验。的 拟议的研究补充了其他培训活动，使人们能够亲身体验干预措施 适应和随机对照试验。在确定HEART的必要增强功能之后， 在艾德环境中，Randell博士将进行一项随机对照试验，以评估八种可行性 结构。假设在艾德中使用HEART是可行的，主要结局为 减少抗逆转录病毒药物的可接受性和有效性。理由是，这项研究将产生第一个基于ED的 采取干预措施，利用普及教育，结合提供 减少医疗点伤害的资源。研究结果将为开发更大的混合功效提供信息- 在K23授标期内，由R01提交材料支持的实施研究。本培训和 研究计划与美国国立卫生研究院和美国国立卫生研究院的使命一致。 儿童健康和人类发展，健康的人2020年的目标，从美国部 2009年，美国卫生与公众服务部，以及2009年学术急诊医学共识建议， 解决艾德环境中的公共卫生问题。