Development and testing of a digitally assisted risk reduction platform for youth at high risk for suicide

摘要 尽管努力防止自杀，但美国的自杀率仍在攀升，自杀是第二大死因 在年轻人中间。尽管对高危青少年进行预防性干预是有希望的方法 对于自杀，它们表现出适度的益处，最近的审查得出结论，新的发展是 要求不仅促进更高的有效性，而且还提高治疗参与度、依从性和 为这些年轻人提供持续的护理。数字工具，尤其是个人智能手机，前景看好 解决这些问题的途径，并可用于提供对近端风险因素的独特了解， 包括心理困扰、快感缺乏和行为戒断，以及睡眠障碍 有风险的个人。此外，数字化方法可以提供持续的支持性患者联系，以支持 降低自杀风险。这项快速通道SBIR建议的总体目标是增强以下方面的有效性 为接受门诊精神卫生护理的青少年提供有选择和有针对性的预防，通过发展和 测试全面的数字平台，允许从业者将客观的移动传感和 将符合HIPAA标准的客户沟通工具纳入他们对这些年轻人的管理中。我们有 开发了这些产品的初始MVP版本，在第一阶段将利用以用户为中心的设计原则 为了增强产品与医疗保健组织中的典型服务交付系统的匹配性， 高危人群(即密集的门诊服务)。第二阶段的目标是进一步优化这些 并对产品的有效性、可行性和可接受性进行务实的临床试验 在现实世界中，密集的门诊临床服务。我们将利用这次试验产生的数据来改进 在实施科学的指导下，采用、实施保真度和持续使用这些工具 框架。

ABSTRACT Despite efforts to prevent suicide, US rates are climbing, and suicide is the second leading cause of death amongst youth. Although promising approaches are available for preventative interventions with youth at-risk for suicide, they demonstrate modest benefit, and recent reviews have concluded that new developments are required that facilitate not only greater effectiveness, but also enhance treatment engagement, adherence, and continuity of care amongst these young people. Digital tools, especially personal smartphones, are promising avenues to address these issues and can be used to provide a unique understanding of proximal risk factors, including psychological distress, anhedonia and behavioral withdrawal, and sleep disturbance amongst high- risk individuals. Furthermore, digital methods can provide ongoing supportive patient contact to support the reduction of suicide risk. The overall aim of this Fast-track SBIR proposal is to enhance the effectiveness of selective and indicated prevention for youth who are received outpatient mental health care by developing and testing a comprehensive digital platform that allows practitioners to integrate objective mobile sensing and HIPAA compliant client communication tools into their management of these young people. We have developed an initial MVP version of these products, and in Phase I will utilize user-centered design principles to enhance the product fit with typical service delivery systems found in healthcare organizations working with high-risk individuals (i.e., intensive outpatient services). The aim of Phase II is to further optimize these products and conduct a pragmatic clinical trial of the effectiveness, feasibility, and acceptability of the products in a real world intensive outpatient clinical service. We will utilize the data generated by this trial to improve adoption, implementation fidelity, and sustained use of these tools, guided by an implementation science framework.