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.

抽象的 自杀是青少年和年轻人 (AYA) 死亡率的第二大原因 过去几年来，这个年龄段的自杀者和因自杀未遂而到急诊室就诊的人数一直在增加 过去十年。1-3 门诊医疗机构可​​以作为安全网，以改善检测、管理、 以及有自杀意念的 AYA 的结果。4-8 改善结果需要以下干预措施和工具： 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 建议在积极的自杀筛查之后进行全面的评估和安全规划。9-11 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，我们建议与 AYA、家长和家长一起使用以人为本的设计策略12 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 在儿科门诊医疗机构中自杀意念筛查呈阳性的人。该工具将包括：1）安全 评估，2) 为 HCP 提供风险分层和决策支持的算法，以指导后续护理步骤，3) 用于通过经济手段限制咨询完成协作安全计划的综合工具，以及 4) 创建 登记以改善跟踪和跟进。然后，我们对 100 名 AYA（13-21 岁）进行了一项试点研究，分为三个阶段 门诊诊所，将 ISSP 工具的使用与西雅图儿童临床路径的常规护理进行比较 AYA 自杀相关应对、父母自杀预防自我效能和提供者的主要结果 使用前后设计的自杀管理自我效能。家长和 AYA 将在以下时间完成调查： 基线以及 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： 控制期前、控制期后、干预期后。 ISSP 提供了让利益相关者参与并共同设计解决关键问题的技术的机会 在医疗环境中评估自杀意念的挑战：超越筛查，关注重点 以赋予 AYA、HCP 和家长权力的方式提高筛查的完成率。如果成功的话，这个工具 具有未来广泛传播的潜力，包括适应其他医疗环境并与 其他年龄段。我们提案的一个关键优势是在干预的同时注重实施需求 开发将缩短 R01 试验功效测试以及未来传播的时间 努力。