Optimizing Suicide Prevention Strategies for Pediatric Primary Care

优化儿科初级保健的自杀预防策略

• 批准号: 10649853
• 负责人: STEPHANIE D STEPP
• 金额: $ 25.61万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-19 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10649853
• 关键词: Academy; Accident and Emergency department; Address; Adolescent; American; Attitude; Behavior; Behavioral; Belief; Cellular Phone; Child; Childhood; Clinical; Cognitive; Collaborations; Communication; Comprehension; Data; Depressed mood; Depression screen; Development; Distress; Effectiveness; Emergency Situation; Feedback; Feeling suicidal; Focus Groups; Future; Goals; Health Personnel; Health Services; Human; Individual; Intervention; Intervention Studies; Interview; Medical; Mental Depression; Mental Health; Methods; Modality; National Institute of Mental Health; Online Systems; Outcome; Parents; Pediatric Research; Pediatrics; Prevention strategy; Primary Care; Provider; Randomized; Recommendation; Research; Research Support; Resources; Risk; Rural; Safety; Severities; Site; Suicide; Suicide prevention; Survey Methodology; Surveys; Technology; Teenagers; Testing; Visit; Work; Youth; adolescent suicide; aged; animation; automated text message; behavioral health; computer human interaction; computerized; coping; cost; depressive symptoms; design; digital; distress tolerance; effectiveness testing; effectiveness/implementation trial; emotion regulation; follow-up; future implementation; high risk; implementation strategy; integrated care; intervention delivery; parental involvement; pediatrician; pilot trial; practice setting; practice-based research network; preference; preventive intervention; primary care practice; primary care provider; primary care setting; prototype; psychoeducation; psychoeducational; randomized trial; recruit; routine provider; screening; service delivery; skills; suburb; suicidal adolescent; suicidal behavior; suicidal risk; suicide rate; text messaging intervention; treatment as usual; usability

PROJECT SUMMARY/ABSTRACT This proposal responds to the youth suicide crisis by optimizing a suicide prevention intervention delivery strategy that is feasible, acceptable, and scalable in pediatric primary care (PPC). Although PPC providers routinely identify at-risk youth, no suicide prevention intervention is suited for the immediate, in-office delivery that this clinical situation demands. In our prior work, we developed and tested the effectiveness of an integrated adolescent suicide prevention intervention, iCHART (integrated Care to Help At-Risk Teens), in a controlled, academic PPC setting that relied on behavioral health (BH) providers. iCHART consists of: 1) Screening Wizard, a web-based enhanced screener to aid PPC providers in treatment decisions; 2) BRITE, an app-supported intervention that guides youth in developing a personalized, smartphone-based safety plan; and 3) Text2Connect, an automated texting intervention that motivates youth to follow providers’ recommendations. The original version of iCHART components showed feasibility, usability, and acceptability across youth, parents, and providers and preliminary effectiveness in enhancing BH referral, referral follow-through, and decreasing depression. However, a critical gap remains in equipping front line pediatricians, who generally lack access to onsite BH providers, with suicide prevention intervention strategies that are feasible, usable, and acceptable for their workflows and in their setting. This proposal aims to address this gap through the development of a computerized version of As Safe As Possible (cASAP) to deliver aspects of the iCHART intervention that required BH support (i.e., psychoeducation about safety planning, cognitive-behavioral skills to cope with distress, and facilitate collaboration with parents). In the proposed study, we will partner with the American Academy of Pediatrics (AAP) national PPC practice-based research network, Pediatric Research in Office Settings (PROS) to develop and test a version of iCHART that can be provided in the PPC setting without onsite BH providers, termed iCHART-cASAP. In this proposal, we will draw upon our extensive expertise in human-computer interaction (HCI) methods and user studies with youth, parents, and PPC providers, to inform the technology design of a computerized version of ASAP (cASAP) to provide youth and parents information about safety planning, cognitive behavioral skills to cope with distress, and parent communication with youth about their mental health. We will then conduct a stepped wedge pilot randomized trial with 60 youth aged 12-17 at risk for suicide (past month suicide ideation/attempt) identified in PPC. We will compare iCHART-cASAP to usual care and the impact on depression and suicide risk at 1-, 3-, and 6-month follow-up. Following the pilot trial, we will conduct a mixed methods study with PPC providers to develop an accompanying implementation strategy. Our findings will inform a future, fully powered R01 effectiveness-implementation trial in the PROS network and in partnership with the AAP to test iCHART-cASAP’s impact on identification, treatment engagement, safety planning, and ultimately, suicidal behavior.

项目摘要/摘要 这项建议通过优化自杀预防干预服务来应对青少年自杀危机 在儿科初级保健(PPC)中可行、可接受和可扩展的策略。尽管购买力平价提供商 常规地识别高危青年，没有自杀预防干预适合立即在办公室内分娩 这是临床情况所要求的。在我们之前的工作中，我们开发并测试了集成的 青少年自杀预防干预，iCHART(帮助高危青少年的综合护理)，在一个受控的， 依赖于行为健康(BH)提供者的学术PPC设置。ICHART包括：1)筛选向导、 基于网络的增强型筛查程序，帮助PPC提供者做出治疗决策；2)应用程序支持的BRITE 指导青年制定个性化的、基于智能手机的安全计划的干预措施；以及3) Text2Connect，一种自动短信干预，鼓励年轻人遵循提供商的建议。 ICHART组件的原始版本显示了可行性、可用性和年轻人、家长、 和提供者，以及加强BH转诊、转诊跟进和减少的初步有效性 抑郁症。然而，在装备一线儿科医生方面仍然存在一个关键差距，这些医生通常无法获得 现场BH提供者，提供可行、可用和可接受的自杀预防干预策略 他们的工作流程和他们的环境。这项提案旨在通过制定一项 尽可能安全的计算机化版本(CASAP)，以提供iCHART干预所需的各个方面 BH支持(即，关于安全规划的心理教育，应对困境的认知-行为技能，以及 促进与家长的合作)。在拟议的研究中，我们将与美国科学院 儿科(AAP)国家PPC实践研究网络，办公室环境中的儿科研究(PROS) 为了开发和测试可以在没有现场BH提供商的情况下在PPC设置中提供的iCHART版本， 名为iCHART-CASAP。在这项建议中，我们将利用我们在人机方面的广泛专业知识 与青少年、家长和PPC提供商的互动(HCI)方法和用户研究，以向技术提供信息 设计计算机版本的ASAP(CASAP)，为青少年和家长提供有关安全的信息 计划，应对痛苦的认知行为技能，以及父母与青少年的沟通 心理健康。然后，我们将对60名12-17岁的青少年进行阶梯式楔形试点随机试验， PPC中确定的自杀(过去一个月的自杀意念/企图)。我们将iCHART-CASAP与常规护理进行比较 以及在1个月、3个月和6个月随访时对抑郁和自杀风险的影响。在试点试验之后，我们将 与PPC提供商进行混合方法研究，以制定相应的实施战略。我们的 调查结果将为未来全面支持R01的有效性提供信息-在PROS网络和 与AAP合作测试iCHART-CASAP对识别、治疗参与和安全性的影响 策划，并最终导致自杀行为。