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 自杀是青少年和年轻人（AYA）死亡的第二大原因， 在这一年龄组中，自杀和因自杀未遂而到急诊室就诊的人数一直在增加。 1 -3门诊医疗机构可以作为一个安全网，以改善检测，管理， 4 -8改善结果需要干预措施和工具， 专为快节奏的门诊医疗环境而设计。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。 然而，门诊医疗机构的医疗保健提供者很少有支持来完成这项工作。 在这个R34应用程序中，我们建议使用以人为本的设计策略12与AYA，父母， 医疗保健提供者为AYA构建和优化综合筛查和安全规划（ISSP）工具 在儿科门诊医疗环境中自杀意念筛查呈阳性的人。该工具将包括：1）安全 评估，2）HCP的风险分层和决策支持算法，以指导下一步护理，3） 用于协作安全计划完成与手段限制咨询的集成工具，以及4）创建 登记册，以改善跟踪和后续行动。然后，我们进行了一项试点研究，100名AYA（13-21岁）在三个 门诊，比较ISSP工具的使用与常规护理西雅图儿童临床路径的使用， 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局 自杀管理自我效能使用前后设计。家长和AYA将完成调查， 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： 在对照期之前、在对照期之后和在干预期之后。 ISSP为利益相关者提供了参与和共同设计技术的机会， 在医疗环境中评估自杀意念的挑战：超越筛查， 以增强AYA、HCP和家长能力的方式改进筛查的完成情况。如果成功，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和与 其他年龄组。我们的建议的一个关键优势是在干预的同时关注实施需求 缩短R 01试验中有效性测试的时间轴以及未来传播的开发 努力