Exploratory-Project 2

点击翻译按钮获取中文摘要

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.