Intensive Crisis Intervention

自杀是美国青少年死亡的第二大原因。自杀风险最高的青少年往往是- 当社区的安全无法维持时，被送往住院精神科。然而， 在过去的几十年里，由于青少年住院精神病患者的可用性，这些服务的使用率有所下降， 河床在不断减少。在这种背景下，住院的自杀行为和故意 从2006年到2015年，年轻人的自我伤害增加了一倍多。获得这些服务的机会有限， 服务业需要更多的选择来提供短期危机干预和稳定 在安全的环境中提供服务。作为对PAR-20-286的直接回应，本提案审查了高影响力实践- 基于近期潜在的研究，以解决NIMH自杀预防的优先事项。我们以前开发过- 强化危机干预（ICI），一种简短的，以证据为基础的治疗，结合家庭治疗/ 家长培训，认知行为疗法和动机访谈，以目标家庭功能，在重新- 导致青少年自杀行为。一个关于我们的青年危机稳定股（YCSU）恶魔的公开试点试验- 证明ICI是可行的，可接受的，并与3个月随访的临床结局改善相关。 上时期。此外，接受ICI的青少年平均住院时间比接受ICI的青少年短5.8天。 接受传统的精神病住院治疗在再入院率和再入院时间上没有显著差异 在两种情况下重新入院。我们现在建议进一步开发和测试ICI。我们将招募80名- 向全国儿童医院（NCH）精神病危机部门提出自杀想法的学生- 有资格进入NCH YCSU和青少年精神病住院的行为和行为 单位在第1年，20名青少年及其父母/监护人将入组一项非随机 案例系列深入定性访谈患者，家长和供应商将被用来进一步完善 ICI手册、培训和监督协议以及忠诚/遵守措施，并确定障碍， 以及执行和可持续性的促进者。在第2年和第3年，60名青少年将参加一项研究， 比较ICI与传统住院精神病治疗的国内对照试验（RCT）。该项目的主要 目标是检查可行性、可接受性、研究实施程序和初步有效性 使用混合方法的ICI。我们假设ICI对家庭来说是可以接受的， 与传统的家庭功能相比，我们提出的改变机制有了更大的改善， 出院时、30天和3个月随访时的患者治疗。次要目标将评估初步治疗- ICI对自杀意念、企图、艾德/住院、绝望和治疗性过敏的影响。 安斯。该应用程序直接建立在我们最初的有希望的发现基础上，作为加强 ICI作为青少年护理有效模式的研究证据基础和实用临床材料 自杀行为可以在不同的儿科环境中实施和持续，以帮助挽救生命。

Suicide is the second leading cause of death for US adolescents. Youth at highest risk of suicide are often ad- mitted to inpatient psychiatric units when safety in the community is unable to be maintained. However, access to these services has decreased over the last several decades as availability of adolescent inpatient psychiat- ric beds has steadily declined. Against this backdrop, inpatient admissions for suicidal behavior and intentional self-injury among youth have more than doubled from 2006 to 2015. Limited access to, and demand for these services has created the need for additional options to provide short-term crisis intervention and stabilization services in a secure setting. In direct response to PAR-20-286, this proposal examines high-impact practice- based research with near-term potential to address NIMH suicide prevention priorities. We previously devel- oped Intensive Crisis Intervention (ICI), a brief, evidence-based treatment that incorporates Family Therapy/ Parent Training, Cognitive Behavioral Therapy and Motivational Interviewing to target family functioning in re- ducing adolescent suicidal behavior. An open pilot trial on our Youth Crisis Stabilization Unit (YCSU) demon- strated that ICI is feasible, acceptable, and associated with improved clinical outcomes over a 3-month follow- up period. In addition, average length of stay for adolescents receiving ICI was 5.8 days briefer than those re- ceiving traditional psychiatric inpatient care. There were no significant differences in readmission rates or time to readmission across the two settings. We now propose to further develop and test ICI. We will recruit 80 ado- lescents presenting to Nationwide Children’s Hospital (NCH) Psychiatric Crisis Department with suicidal idea- tion and behavior that are eligible for admission to both the NCH YCSU and Adolescent Psychiatric Inpatient Unit. During Year 1, 20 adolescents and one of their parents/guardians will be enrolled in a nonrandomized case series. In-depth qualitative interviews with patients, parents, and providers will be used to further refine the ICI manual, training and supervision protocols, and fidelity/adherence measures, and identify barriers to, and facilitators of implementation and sustainability. In Years 2 and 3, 60 adolescents will be enrolled in a ran- domized controlled trial (RCT) comparing ICI with traditional inpatient psychiatric treatment. The project’s main goal is to examine feasibility, acceptability, research implementation procedures, and preliminary effectiveness of ICI using a mixed-methods approach. We hypothesize that ICI will be acceptable to families and show greater improvements in our proposed mechanism of change, family functioning, compared with traditional in- patient treatment at discharge, 30 days, and 3-month follow-up. Secondary aims will assess preliminary treat- ment effects of ICI on suicidal ideation, attempts, ED/hospital admission, hopelessness and therapeutic alli- ance. This application builds directly from our initial promising findings as the next step in strengthening the research evidence base and pragmatic clinical materials for ICI as an effective model of care for adolescent suicidal behavior that can be implemented and sustained across diverse pediatric settings to help save lives.