Development and Pilot Testing of an Integrated Suicide Assessment and Safety Plan Digital Tool for Adolescent Outpatients

针对青少年门诊患者的综合自杀评估和安全计划数字工具的开发和试点测试

• 批准号: 10575212
• 负责人: LAURA P RICHARDSON
• 金额: $ 27.34万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-17 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10575212
• 关键词: Address; Adolescent; Adolescent Risk Behavior; Adolescent and Young Adult; Age; Algorithms; Ambulatory Care Facilities; Attention; Behavior; Caring; Child; Childhood; Clinic; Clinical Pathways; Counseling; Detection; Development; Electronics; Emergency department visit; Environment; Feeling suicidal; Future; Goals; Health Personnel; High School Student; Intervention; Medical; Mental Health; Monitor; Outcome; Outpatients; Parents; Pathway interactions; Pilot Projects; Practice Guidelines; Prevention Research; Procedures; Process; Provider; Qualitative Research; Recommendation; Registries; Reporting; Research; Risk Management; Safety; Screening Result; Screening procedure; Self Efficacy; Self Management; Specialist; Suicide; Suicide attempt; Suicide prevention; Surveys; System; Technology; Testing; Time; Training; Work; acceptability and feasibility; age group; clinical care; coping; design; digital platform; digital tool; efficacy testing; empowerment; follow-up; human centered design; implementation design; improved; improved outcome; mortality; pilot test; primary outcome; prototype; risk stratification; safety assessment; safety net; screening; shared decision making; suicide rate; therapy development; timeline; tool; treatment as usual; usability

ABSTRACT Suicide is the second leading cause of mortality among adolescents and young adults (AYA) and rates of suicide and emergency department visits for suicide attempts have been increasing in this age group over the past decade.1-3 Outpatient medical settings may serve as a safety net to improve the detection, management, and outcomes for AYA with suicidal ideation.4-8 Improving outcomes requires interventions and tools that are designed for implementation in the fast-paced outpatient medical setting. Practice guidelines and toolkits recommend that a positive suicide screening be followed by a full assessment and safety planning.9-11 However, healthcare providers in outpatient medical settings have few supports to complete this work. In this R34 application, we propose to use Human-Centered Design strategies12 with AYA, parents, and healthcare providers to build and optimize an Integrated Screening and Safety Planning (ISSP) tool for AYA who screen positive for suicidal ideation in pediatric outpatient medical settings. The tool will include: 1) safety assessment, 2) algorithms for risk stratification and decision support for HCPs to guide next steps of care, 3) integrated tools for collaborative safety plan completion with means restriction counseling, and 4) creation of a registry to improve tracking and follow-up. We then conduct a pilot study with 100 AYA (ages 13-21) in three outpatient clinics, comparing use of the ISSP tool to the usual care Seattle Children's clinical pathway on the primary outcomes of AYA Suicide-Related Coping, Parent Suicide Prevention Self-Efficacy, and Provider Suicide Management Self-Efficacy using a pre-post design. Parents and AYA will complete surveys at baseline, and 1- and 2-month follow ups, and healthcare providers will complete surveys at three time points: prior to the control period, after the control period, and after the intervention period. ISSP provides the opportunity to engage stakeholders and co-design technology that addresses a key challenge in the assessment of suicidal ideation in medical settings: moving beyond screening to a focus on improving the completion of screening in a way that empowers AYA, HCPs and parents. If successful, this tool has the potential for future broad dissemination including adaptations to other medical settings and for use with other age groups. A key strength of our proposal is the focus on implementation needs alongside intervention development which will shorten the timeline for tests of efficacy in an R01 trial as well as future dissemination efforts.

摘要 自杀是青少年死亡的第二大原因。 在这个年龄段，自杀和试图自杀的急诊科就诊人数一直在增加。 过去十年1-3门诊医疗设施可以作为一张安全网，以提高检测、管理、 有自杀意念的阿亚的结果。4-8改善结果需要以下干预和工具： 专为在快节奏的门诊医疗环境中实施而设计。实践指南和工具包 建议在进行积极的自杀筛查之后，进行全面的评估和安全规划。 然而，门诊医疗环境中的医疗保健提供者几乎没有支持来完成这项工作。 在此R34应用程序中，我们建议将以人为本的设计策略12与Aya、家长和 医疗保健提供商为Aya构建和优化综合筛查和安全规划(ISSP)工具 世卫组织在儿科门诊医疗机构筛查自杀意念呈阳性。该工具将包括：1)安全 评估，2)针对初级保健计划的风险分层和决策支持的算法，以指导下一步的护理，3) 集成工具，用于通过手段限制咨询完成协作安全计划，以及4)创建 登记，以改进跟踪和后续行动。然后，我们对100名阿雅(13-21岁)进行了一项初步研究 门诊，将ISSP工具的使用与西雅图儿童常规护理的临床路径进行比较 Aya自杀相关应对、父母预防自杀自我效能感和供养者的主要结局 自杀管理自我效能感采用事前、事后设计。家长和阿雅将在以下时间完成调查 基线、1个月和2个月的随访，医疗保健提供者将在三个时间点完成调查： 在控制期之前、控制期之后和干预期之后。 ISSP提供了与利益相关者接触并共同设计技术的机会，以解决 在医疗环境中评估自杀意念的挑战：超越筛查而专注于 提高筛查的完成率，以增强阿亚、初级保健方案和家长的能力。如果成功，则此工具 具有未来广泛传播的潜力，包括适应其他医疗环境并用于 其他年龄段。我们建议的一个关键优点是在干预的同时注重实施需求 开发将缩短R01试验中的有效性测试以及未来传播的时间线 努力。