Optimizing Suicide Prevention Strategies for Pediatric Primary Care

优化儿科初级保健的自杀预防策略

基本信息

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
项目类别：
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

项目摘要

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/摘要该建议通过优化预防自杀干预措施来应对青年自杀危机可行，可接受且可扩展的小儿初级保健（PPC）的策略。尽管PPC提供商常规识别高风险的青年，不适合预防自杀干预措施这种临床状况需要。在先前的工作中，我们开发并测试了一体的综合有效性青少年预防自杀干预措施，Ichart（综合护理以帮助处于危险的青少年），在受控的，依赖行为健康（BH）提供者的学术PPC设置。 ICHART由：1）筛选向导，基于Web的增强筛选器，以帮助PPC提供者制定治疗决策； 2）Brite，一个由应用程序支持的干预措施指导青年制定一个个性化的，基于智能手机的安全计划； 3） Text2Connect是一种自动发短信干预措施，促使青年遵循提供者的建议。 IChart组件的原始版本显示，年轻人，父母，可行性，可用性和可接受性提供者以及在增强BH推荐，推荐跟进和减少方面的提供商和初步有效性沮丧。但是，在装备前线儿科医生方面仍然存在关键差距，他们通常无法获得现场BH提供商，具有可行，可用且可接受的自杀性干预策略他们的工作流程和环境。该建议旨在通过发展尽可能安全的计算机版本（CASAP）提供所需的ICHART干预的各个方面 BH支持（即有关安全计划的心理教育，认知行为技巧以应对困扰以及促进与父母的合作）。在拟议的研究中，我们将与美国学院合作儿科（AAP）国家PPC实践研究网络，办公室环境中的儿科研究（PRO）为了开发和测试一个可以在PPC设置中提供的ICHART版本，而无需现场BH提供商，称为iChart-casap。在此提案中，我们将借鉴人类计算机的广泛专业知识与青年，父母和PPC提供商的互动（HCI）方法和用户研究，以告知该技术 ASAP（CASAP）的计算机版本的设计，以提供有关安全的青年和父母的信息计划，认知行为技巧以应对困扰以及父母与年轻人的沟通心理健康。然后，我们将进行阶梯楔形飞行员随机试验，60名12-17岁的青年有风险 PPC中确定的自杀（上个月自杀想法/尝试）。我们将将iChart-casap与通常的护理进行比较以及对抑郁和自杀风险的影响为1月，3个月和6个月的随访。试点审判后，我们将与PPC提供商进行混合方法研究，以制定认证实施策略。我们的调查结果将为Pros网络和IN中的未来，全功率的R01有效性试验提供信息与AAP的合作伙伴关系，以测试Ichart-Casap对识别，治疗参与，安全性的影响计划，最终是自杀行为。