Exploratory-Project 2

项目摘要 自杀本质上是一个充满情感的话题，临床医生在治疗过程中经常会感到焦虑和自我效能感低下。 发现并干预那些有风险的人。这种焦虑导致循证自杀的实施效果不佳 筛查、评估和干预（SSAIs）。与SSAI使用相关的临床医生焦虑和低自我效能 因此，是实施战略设计的候选目标，以优化SSAI在不同心理健康领域的吸收 设置.这个探索性的项目汇集了一个跨学科的团队，利用数十年的研究， 从暴露理论到设计和试点测试基于风险的实施策略的行为改变 （EBIS）针对临床医生对SSAI使用的焦虑。我们将测试EBIS作为实现的效果 战略，以加强实施作为指导（IAU），以加强社区精神卫生的SSAI实施 设置.具体来说，目标1将使用参与式设计方法，以开发和完善EBIS的合作 由临床医生、管理人员和内容专家组成的利益相关者咨询委员会。在目标2中，我们将进一步 在试点现场测试中，使用快速循环原型，与多达15名临床医生合作， INSPIRE方法核心Aim 2的临床医生还将提供关于EBIS能力的定性反馈， 减轻焦虑，提高自我效能，以提供SSAI，优化我们参与目标机制的能力 临床医生的焦虑目标3将在一个试点实施试验中测试改进的EBIS，其中40个社区精神病患者 健康临床医生将随机接受IAU或EBIS+IAU。主要目标3因变量为 EBIS的可接受性和可行性，通过问卷调查，访谈，招聘和保留来衡量 统计学;该试点试验的目的不是为了检测效果。次要结局为初步结局 EBIS对实施结果（SSAI采用和忠诚度）的有效性，以及目标的参与 实施机制（与SSAI使用相关的临床医生焦虑和自我效能），通过混合评估 方法（问卷调查，图表刺激回忆，转换器编码的角色扮演和访谈）。我们有两 探索性假设，我们将通过混合方法进行评估：（1）EBIS将参与目标实现 通过降低焦虑和提高自我效能比IAU更好的机制;（2）随机分配到EBIS的临床医生 将显示改进的SSAI采用和保真度。我们还将收集其他可能实施的数据 使用问卷和定性访谈来调查上下文实施障碍的机制， EBIS未解决SSAI用于在完全把握度评价之前告知增强。 该项目通过以下方式解决了实施自杀预防循证实践中的一个主要差距： 开发一种新的实施战略，以增强针对可变实施机制的IAU 唯一的SSAI使用。研究目标与NIMH的研究重点一致，并与总体使命保持一致 的灵感。结果将通知一个完全动力的R 01，以测试EBIS对实施和患者结局的影响。

PROJECT SUMMARY Suicide is inherently an affectively charged topic and clinicians often experience anxiety and low self-efficacy in detecting and intervening with those at risk. This anxiety leads to poor implementation of evidence-based suicide screening, assessment, and interventions (SSAIs). Clinician anxiety and low self-efficacy related to SSAI use are thus candidate targets for implementation strategy design to optimize SSAI uptake in diverse mental health settings. This exploratory project brings together an interdisciplinary team to leverage decades of research on behavior change from exposure theory to design and pilot-test an exposure-based implementation strategy (EBIS) to target clinician-level anxiety about SSAI use. We will test the effect of EBIS as an implementation strategy to augment Implementation as Usual (IAU) to enhance SSAI implementation in community mental health settings. Specifically, Aim 1 will use participatory design methods to develop and refine EBIS in collaboration with a stakeholder advisory board of clinicians, administrators, and content experts. In Aim 2, we will further iteratively refine EBIS with up to 15 clinicians in a pilot field test, using rapid cycle prototyping, in collaboration with the INSPIRE Methods Core. Clinicians in Aim 2 will also provide qualitative feedback on EBIS’ ability to mitigate anxiety and increase self-efficacy to deliver SSAIs to optimize our ability to engage target mechanisms of clinician anxiety. Aim 3 will test the refined EBIS in a pilot implementation trial in which 40 community mental health clinicians will be randomized to receive either IAU or EBIS+IAU. Primary Aim 3 dependent variables are EBIS acceptability and feasibility, measured through questionnaires, interviews, and recruitment and retention statistics; this pilot trial is not intended to be powered to detect effects. Secondary outcomes are preliminary effectiveness of EBIS on implementation outcomes (SSAI adoption and fidelity), and engagement of target implementation mechanisms (clinician anxiety and self-efficacy related to SSAI use), assessed via mixed methods (questionnaires, chart-stimulated recall, observer-coded role plays, and interviews). We have two exploratory hypotheses, which we will evaluate via mixed methods: (1) EBIS will engage target implementation mechanisms by lowering anxiety and increasing self-efficacy better than IAU; (2) Clinicians randomized to EBIS will show improved SSAI adoption and fidelity. We also will gather data on other possible implementation mechanisms using questionnaires and qualitative interviews to probe for contextual implementation barriers to SSAI use not addressed by EBIS to inform augmentation prior to fully powered evaluation. This project addresses a major gap in the implementation of suicide prevention evidence-based practices by developing a novel implementation strategy to augment IAU that targets mutable implementation mechanisms unique to SSAI use. Study goals are consistent with NIMH research priorities and aligned with the overall mission of INSPIRE. Results will inform a fully powered R01 to test EBIS’ effect on implementation and patient outcomes.