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

THRIVE 在危机稳定中心的试点有效性试验：促进自杀危机后的联系、康复和治疗联系

• 批准号: 10577034
• 负责人: Jennifer Lockman
• 金额: $ 32.14万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-19 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10577034
• 关键词: Accident and Emergency department; Acute; Address; Adherence; Administrator; Ambulatory Care; Caring; Cessation of life; Client; Code; Communities; Data; Emergency Care; Feeling suicidal; Funding; Growth; Health Services Accessibility; Healthcare; Human Resources; Individual; Inpatients; Intervention; Investments; Life; Light; Mainstreaming; Manuals; Mental Health; Modeling; Patients; Philosophy; Psychiatric therapeutic procedure; Psychological reinforcement; Randomized; Recovery; Research; Resources; Safety; Services; Suicide; Suicide attempt; Suicide prevention; System; Telephone; Testing; Text; Training; acute care; cohort; cost; design; effective intervention; effectiveness testing; effectiveness trial; feasibility testing; follow-up; hospital readmission; intervention delivery; intervention effect; novel; pilot test; pilot trial; psychosocial; randomized trial; reducing suicide; satisfaction; social; suicidal; suicidal behavior; suicidal morbidity; suicidal risk; telephone coaching; theories; therapy design; trial readiness

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.

抽象的 美国在我们的心理健康危机系统中的增长和投资中毒，并提供了国家电话/文字 线路启动，并伴随着新的危机服务资金。超过600个危机稳定中心 （CSC）美国各地为自杀客户提供更舒适，更昂贵的替代方案 急诊科（ED）护理。鉴于需求的增加，迫切需要可行， 有效，人际关系，面向恢复的干预措施。这项研究适应并测试了一本小说 从CSC出院前后的干预措施。 Thrive使用人际理论 自杀作为加强社会联系和反感染负担的框架。 初步数据显示出令人鼓舞的结果。但是，CSC的工作流和文化需要特定于上下文 适应。这项研究利用模型进行适应设计和影响，以适应CSC的壮成长， 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 干预措施解决了自杀风险的人际关系驱动因素和泡沫的安全，恢复和社区 通过：（a）CSC停留期间的“归属和给予”组，（b）恢复教练打电话4周 送货后，以及（c）可选的电话应用程序，可提供连接的增强和资源。 飞行员将比较Thrive +出院/安全计划（D/SP）与D/SP单独进行检查，并检查学位 壮成长在分期内和三个月内的靶向变化机制。 AIM 1。使用MADI调整繁荣和完整的CSC特定手册。 目标2。测试可行性，可接受性，CSC繁荣的适当性。 CSC来宾（n = 20）。 75％的客人将参加一个繁荣的小组和至少一项随访 出院一个月内会议。可接受性和满意度的评级将为75％。 CSC工作人员（n = 4）。小组和教练电话的忠实评级至少是 ≧为所有交付繁荣的员工而言，有75％。 CSC管理员将对CSC的繁荣的可接受性和适当性为75％。 目标3。进行随机的飞行员有效性试验（n = 162），以评估繁荣的影响 治疗计划以及自杀的关键人际关系驱动因素 - 归属感和抛光。我们 假设获得Thrive + D/SP与D/SP的CSC客人将有： H1：在CSC出院后1个月零3个月的治疗率较高。 H2。出院后1和3个月时，归属感和下降降低。 我们将探讨干预对治疗参与，急性护理精神病的影响 在3个月的随访中，再入院，自杀念头和自杀行为。在研究结束时， CSC蓬勃发展将准备在有效试验中测试，以防止自杀行为。