Youth Nominated Support Team for Suicidal Adolescents at Clinical High Risk for Psychosis

青年提名支持团队，为临床精神病高危自杀青少年提供支持

• 批准号: 10590673
• 负责人: Jordan DeVylder
• 金额: $ 23.86万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-11 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10590673
• 关键词: Address; Adherence; Adolescent; Adolescent and Young Adult; Caring; Client; Clinic; Clinical; Clinical Research; Clinical Trials; Collaborations; Consensus; Coordinated Specialty Care; Data; Development; Diagnosis; Dissemination and Implementation; Distal; Early Intervention; Evidence based practice; Exclusion; Family; Family member; Feasibility Studies; Feeling hopeless; Feeling suicidal; Focus Groups; Friends; Funding; Grant; Health behavior; Impairment; Individual; Intervention; Interview; Manuals; Mental Health; Mental Health Services; Meta-Analysis; Modeling; Participant; Persons; Phase; Population; Practice Guidelines; Preparation; Prevalence; Prevention approach; Protocols documentation; Provider; Psychoses; Psychotic Disorders; Randomized; Randomized, Controlled Trials; Recording of previous events; Recovery; Reporting; Research Personnel; Resources; Safety; Schizophrenia; Self-Injurious Behavior; Services; Signs and Symptoms; Site; Social isolation; Social support; Structure; Suicide; Suicide attempt; Suicide prevention; Testing; Training; Treatment Protocols; United States Substance Abuse and Mental Health Services Administration; Youth; acceptability and feasibility; active control; aged; brief intervention; clinical high risk for psychosis; comparative efficacy; cost effective; depressive symptoms; design; duration of untreated psychosis; efficacy testing; evidence base; experience; feasibility testing; follow-up; health service use; high risk; high risk population; intervention delivery; meetings; mortality; person centered; pilot trial; preference; prevention service; preventive intervention; programs; psychoeducation; psychoeducational; psychosis risk; randomized trial; randomized, clinical trials; reducing suicide; response; social; success; suicidal adolescent; suicidal behavior; suicidal risk; suicide rate; support network; telehealth; treatment risk; young adult

PROJECT SUMMARY / ABSTRACT Psychotic disorders are characterized by high rates of suicidal ideation and behavior, and the risk for suicide appears to be greatest during the earliest stages of psychosis. A recent meta-analysis showed that the majority of youth at clinical high-risk (CHR) for psychosis experience suicidal ideation, and that approximately one in five make at least one suicide attempt. There are, however, no suicide prevention interventions specifically tailored to the needs of transition-aged youth at CHR, and no current best practice guidelines for how to respond to suicide risk in this population. The Youth-Nominated Support Team (YST) intervention has recently been shown to reduce mortality among adolescents and is potentially highly adaptable within the context of existing CHR services. YST is intended as an adjunctive treatment and is primarily delivered towards support persons rather than the youth themselves, and therefore would not interfere or overlap with the already extensive direct services provided in CHR treatment settings. The proposed project intends to adapt the YST intervention for CHR populations and to provide pilot efficacy data for a larger subsequent randomized trial. Specifically, we aim to: (1) adapt YST for CHR based on stakeholder input (i.e., clients, family/friends, clinicians) and to develop a new treatment manual; (2) to implement YST in a single CHR clinic and to revise the intervention based on input from clients, providers, and support persons, and (3) to conduct a pilot randomized clinical trial at four SAMHSA funded CHR sites. For the first stage of this study, we intend to conduct six focus groups (two of clients, two of family members, and two of clinicians) to gather input on needs and preferences regarding suicide prevention. This information will be incorporated into the YST protocol through expert consensus meetings (i.e., study investigators, clinicians, and consultants) and used to develop a treatment manual. During the second stage of the project, we will conduct a small feasibility study using this intervention manual at the primary study site (N=8), and will again gather input from clients, providers, and support persons to further revise the treatment manual. In the final stage, we will conduct a pilot randomized clinical trial of the adapted YST intervention at four CHR clinics (N=70), comparing the adapted YST intervention to an active control condition consisting of safety planning, crisis resources, and means restriction. The proximal targets will be social connectedness, hope, and treatment engagement, and the distal targets suicidal ideation and behavior (e.g., attempts, preparatory actions). This study will provide the first clinical trial data for targeted suicide prevention among the CHR population. Findings will inform best practices for addressing suicide risk in the CHR phase of illness and facilitate the development of a subsequent larger randomized clinical trial incorporating additional CHR clinics to further test the efficacy of the adapted YST intervention and to identify underlying mechanisms of change.

项目摘要/摘要 精神障碍的特点是自杀念头和行为的比率很高， 在精神病的早期阶段，自杀似乎是最严重的。最近的一项荟萃分析 显示大多数精神病临床高危青少年有过自杀的经历。 大约五分之一的人至少有一次自杀企图。然而，有一些， 儿童基金会没有专门针对处于过渡年龄的青年的需要进行自杀预防干预， 而且目前还没有关于如何应对这一人群中的自杀风险的最佳实践指南。这个 最近，青年提名的支持小组(YST)干预被证明可以降低死亡率 在青少年中使用，在现有的儿童权利保护服务的背景下具有很强的适应性。 YST旨在作为一种辅助治疗，主要提供给支持人员，而不是 而不是青年本身，因此不会干扰或重叠已经广泛的 在CHR治疗设置中提供的直接服务。拟议的项目打算对YST进行调整 对慢性阻塞性肺病人群的干预，并为更大规模的后续项目提供试点疗效数据 随机试验。具体地说，我们的目标是：(1)根据利益相关者的意见(即， 客户、家人/朋友、临床医生)，并编写新的治疗手册；(2)在 并根据客户、提供者和支持人员的意见修改干预措施 以及(3)在SAMHSA资助的四个CHR站点进行试点随机临床试验。为 在这项研究的第一阶段，我们打算进行六个焦点小组(两个客户，两个家庭 成员和两名临床医生)收集有关自杀的需求和偏好的信息 预防。这些信息将以专家协商一致的方式纳入YST议定书 会议(即研究调查人员、临床医生和顾问)，并用于开发治疗方法 手动操作。在项目的第二阶段，我们将利用这个项目进行一项小型的可行性研究。 主要研究地点的干预手册(N=8)，并将再次收集客户、提供者、 并支持人员进一步修改治疗手册。在最后阶段，我们将进行试点 在四个CHR诊所(N=70)进行的改良型YST干预的随机临床试验，比较 使YST干预措施适应主动控制条件，包括安全规划、危机资源、 意味着限制。最近的目标将是社会联系、希望和治疗 参与，远端针对自杀念头和行为(例如，未遂、准备 操作)。这项研究将提供首个有针对性的自杀预防的临床试验数据 CHR种群。研究结果将成为解决慢性阻塞性肺病患者自杀风险的最佳做法 疾病和促进随后更大的随机临床试验的发展 增加CHR诊所，以进一步测试调整后的YST干预的有效性，并确定 潜在的变革机制。