Pilot Effectiveness Trial of THRIVE in Crisis Stabilization Centers: Promoting Connection, Recovery, and Treatment Linkage after Suicide Crisis

摘要 美国正准备在我们的心理健康危机系统中进行增长和投资， 启动热线，同时为危机服务提供新的资金。600多个危机稳定中心 美国各地的CSC为自杀客户提供了一个更舒适，成本更低的替代方案， 急诊科（艾德）护理。鉴于需求不断增加，迫切需要可行的、 有效的、人际的、以康复为导向的干预措施。这项研究改编并测试了一部小说 在从CSC出院之前和之后进行分娩干预。THRIVE运用人际关系理论， 自杀作为一个框架，以加强社会联系和反感知负担。 初步数据显示了可喜的成果。但是，CSC工作流和文化需要特定于上下文的 适应本研究利用适应设计和影响模型来适应CSC的THRIVE， 测试可行性、可接受性和适当性，并在两个CSC中进行试点RCT。CSC适应 干预解决自杀风险的人际驱动因素，并加强安全，恢复和社区 通过以下方式建立联系：（a）在社区支助中心停留期间，建立一个“归属和给予”小组，（B）进行为期4周的康复辅导 出院后，和（c）一个可选的电话应用程序，提供加强和资源的连接。 飞行员将比较THRIVE +出院/安全计划（D/SP）与单独的D/SP，检查 THRIVE在出院后一个月和三个月参与有针对性的变化机制。 目标1.使用MADI调整THRIVE并完成CSC特定手册。 目标2.测试THRIVE用于CSC的可行性、可接受性和适当性。 CSC客人（n = 20）。75%的客人将参加一个THRIVE组和至少一个后续活动 出院后一个月内出院。可接受性和满意度评分为75%。 CSC工作人员（n = 4）。小组和辅导电话录音的保真度等级至少为 75%为所有提供繁荣的员工。 CSC管理员将对CSC的THRIVE的可接受性和适当性进行评分，评分为75%。 目标3.进行一项随机初步有效性试验（n = 162），以评估THRIVE对 治疗启动和自杀的关键人际驱动因素-自杀倾向和负担。我们 假设接受THRIVE + D/SP与单独D/SP服务CSC客人将： H1：CSC出院后1个月和3个月开始治疗的比率较高。 H2。出院后1个月和3个月时，肥胖程度增加，负担减轻。 我们将探讨干预对治疗参与，急性护理精神病的影响， 再入院，自杀意念和自杀行为超过3个月随访。在研究结束时， THRIVE for CSC将准备在预防自杀行为的有效性试验中进行测试。

Abstract The US is poised for growth and investment in our mental health crisis system, with a national phone/text line launching, accompanied by new funding for crisis services. More than 600 Crisis Stabilization Centers (CSCs) across the US provide suicidal clients with a more comfortable and less costly alternative to Emergency Department (ED) care. In light of rising demand, there is an urgent need for feasible, effective, interpersonal, recovery-oriented interventions. This study adapts and tests a novel intervention for delivery prior to and after discharge from CSCs. THRIVE uses the Interpersonal Theory of Suicide as a framework to bolster social connectedness and counter perceived burdensomeness. Preliminary data shows promising results. However, CSC workflows and culture require context-specific adaptation. This study leverages the Model for Adaptation Design and Impact to adapt THRIVE for CSCs, test feasibility, acceptability, and appropriateness, and conduct a pilot RCT in two CSCs. The CSC-adapted intervention addresses interpersonal drivers of suicide risk and bolsters safety, recovery, and community linkage through: (a) a `belonging and giving' group during CSC stay, (b) recovery coaching calls for 4 weeks post-discharge, and (c) an optional phone app that provides reinforcement and resources for connection. The pilot will compare THRIVE + Discharge/Safety Planning (D/SP) to D/SP alone, examining the degree to which THRIVE engages the targeted mechanisms of change at one- and three-months post-discharge. Aim 1. Adapt THRIVE and complete CSC-specific manual using MADI. Aim 2. Test feasibility, acceptability, appropriateness of THRIVE for CSCs. CSC Guests (n = 20). 75% of guests will participate in a THRIVE group and at least one follow-up session within one month of discharge. Ratings of acceptability and satisfaction will be ≧ 75%. CSC Staff (n = 4). Fidelity ratings of audio recordings of group and coaching calls with be at least ≧ 75% for all staff who deliver THRIVE. CSC Administrators will rate acceptability and appropriateness of THRIVE for CSCs as ≧ 75%. Aim 3. Conduct a randomized pilot effectiveness trial (n = 162) to assess the effect of THRIVE on treatment initiation and on key interpersonal drivers of suicide – belongingness and burdensomeness. We hypothesize that CSC guests who receive THRIVE + D/SP vs. D/SP alone will have: H1: Higher rates of treatment initiation at 1 month and 3 months from CSC discharge. H2. Increased belongingness and decreased burdensomeness at 1 and 3 months after discharge. We will explore the effect of the intervention on treatment engagement, acute care psychiatric readmissions, and suicidal ideation and suicidal behavior over 3-month follow-up. At the end of the study, THRIVE for CSCs will be ready to test in an effectiveness trial for preventing suicidal behavior.