IntERact: Preventing Risky Firearm Behaviors Among Urban Youth Seeking Emergency Department Care

Interact：预防寻求急诊科护理的城市青少年的危险枪支行为

• 批准号: 10268942
• 负责人: Patrick M. Carter
• 金额: $ 65万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2023-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10268942
• 关键词: IntERact; Preventing; Risky; Firearm; Behaviors

Firearms are the leading cause of death for U.S. youth. National organizations have highlighted the need for prevention programs focused on decreasing interpersonal firearm violence. Urban EDs are an underutilized setting for such programs, as they provide access to at-risk youth engaged in risky firearm behaviors (RFBs). Intervening early with youth in this setting may decrease subsequent firearm violence and related consequences. Despite the importance of this problem, evidence-based interventions to decrease RFBs are lacking. Given our prior work showing that single session ED interventions (i.e., SafERteens) integrating motivational interviewing (MI) and cognitive behavioral therapy (CBT) are efficacious reducing violence among lower risk youth, the application of this behavioral therapy, expanded to address greater problem severity over multiple sessions and enhanced by adding care management (CM), represents a potentially efficacious approach for decreasing RFBs. Our pilot of this integrated approach was found to be feasible among high-risk youth engaged in violence. Utilizing centralized remote therapy to address identified in-person therapy barriers (e.g., transportation) and supporting the intervention with an APP may be a promising way of enhancing session attendance, intervention dose, and engagement, while considering future implementation issues. This proposal addresses Objective Two (Funding Option B) of the CDC NOFO as it focuses on collecting new data on strategies to decrease firearm violence. We propose a 2-arm randomized control trial (RCT) enrolling ED youth (age 16-24) reporting past 3-month firearm carriage and smartphone ownership, randomizing them to either: (1) IntERact; or, (2) an enhanced usual care + assessment (EUC+A) condition where they will receive a resource brochure and daily assessments. The IntERact condition will receive: (1) 6 remotely delivered behavioral therapy sessions integrating MI, CBT, and CM; and, (2) an smartphone APP supporting the therapy by facilitating therapist contact, conducting automated daily assessments, delivering between session tailored MI/CBT content, delivering just-in-time GPS-triggered notifications upon entry into high-risk locations, and aiding with CM resources. Specific aims are: (1) To conduct an RCT enrolling 400 eligible youth (200/group) to examine IntERact efficacy; and, (2) To conduct a cost evaluation, comparing resource costs for intervention delivery to costs for outcomes averted. As a secondary aim, we will examine mediators/moderators of efficacy. Outcomes will be assessed at 3- and 6-months. Primary outcomes include: (1) risky firearm behaviors (RFBs); (2) firearm carriage; and, (3) violence (i.e., aggression; victimization; consequences). Secondary Outcomes include: (1) ED visits for violent injury (e.g., firearm injuries); (2) substance use; (3) mental health symptoms (i.e., anxiety, depression, PTSD); and, (4) criminal justice involvement (i.e., arrests). Given elevated rates of RFBs among socio-disadvantaged youth with disparities in access to services, the proposed IntERact intervention, if found to be efficacious, has the potential for significant public health impact.

枪支是导致美国年轻人死亡的主要原因。国家组织已经强调有必要 预防方案的重点是减少人际枪支暴力。城市EDS是一个未得到充分利用的 为这类方案提供环境，因为它们为从事危险枪支行为(RFB)的高危青年提供机会。 在这种情况下对青少年进行早期干预可能会减少随后的枪支暴力和相关 后果。尽管这个问题很重要，但减少RFB的循证干预措施是 缺乏。鉴于我们之前的工作表明，单次会议ED干预(即，安全青少年)整合 动机访谈(MI)和认知行为疗法(CBT)有效地减少了 低风险青年，这种行为疗法的应用，扩大到解决更严重的问题 多次会话并通过增加护理管理(CM)进行增强，代表了一种潜在的有效 减少RFB的方法。我们对这种综合方法的试点被发现在高风险人群中是可行的 从事暴力活动的青年。利用集中式远程治疗解决已确定的面对面治疗障碍 (例如，交通)，并使用应用程序支持干预可能是一种很有前途的增强 会议出席率、干预剂量和参与度，同时考虑未来的实施问题。这 提案涉及CDC NOFO的目标二(供资选项B)，因为它侧重于收集新的 关于减少枪支暴力战略的数据。我们提出了一项双臂随机对照试验(RCT) Ed青年(16-24岁)报告过去3个月携带枪支和拥有智能手机的情况，对他们进行随机调查 以：(1)互动；或(2)增强的日常护理+评估(EUC+A)条件，其中他们将接受 一份资源手册和每日评估。交互条件将接收：(1)6个远程传送 集成MI、CBT和CM的行为治疗课程；以及(2)支持该疗法的智能手机应用程序 通过促进治疗师联系、进行自动化的日常评估、在两次会议之间提供量身定制的服务 MI/CBT内容，在进入高危位置时提供及时的GPS触发通知，以及 协助配置管理资源。具体目标是：(1)开展一项招募400名符合条件的青年(200人/组)的RCT 检查互动效果；以及(2)进行成本评估，比较干预资源成本 避免了交付到成本的结果。作为次要目标，我们将审查调解人/主持人 功效。结果将在3个月和6个月时进行评估。主要结果包括：(1)危险的枪支 行为(RFB)；(2)携带枪支；(3)暴力(即侵略；受害；后果)。 次要结果包括：(1)因暴力伤害(如枪伤)就诊；(2)药物使用；(3) 精神健康症状(即焦虑、抑郁、创伤后应激障碍)；以及(4)刑事司法参与(即逮捕)。 鉴于在获得服务方面存在差距的社会弱势青年的RFB比率较高， 拟议的互动干预如果被发现是有效的，可能会对公共卫生产生重大影响。