I-CARE: The Effectiveness of a Modular Digital Intervention to Reduce Suicidal Ideation and Emotional Distress during Pediatric Psychiatric Boarding

I-CARE：模块化数字干预对减少儿科精神科寄宿期间的自杀意念和情绪困扰的有效性

• 批准号: 10756733
• 负责人: JoAnna Leyenaar
• 金额: $ 103.78万
• 依托单位: DARTMOUTH-HITCHCOCK CLINIC
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10756733
• 关键词: Acceleration; Accident and Emergency department; Address; Admission activity; Adolescent; Anxiety; Beds; COVID-19; COVID-19 pandemic; Caregivers; Caring; Cause of Death; Child; Childhood; Clinical; Cognitive Therapy; Data; Discipline of Nursing; Distal; Distress; Education; Effectiveness; Evaluation; Event; Exercise; Family; Feeling suicidal; Focus Groups; Frequencies; Goals; Head Start Program; Health Professional; Health system; Healthcare; High School Student; Hospitalization; Hospitals; Hybrids; Improve Access; Inpatients; Intervention; Joints; Licensing; Location; Measures; Mediating; Medical; Mental Depression; Mental Health; Mental Health Services; Methods; Modeling; Motivation; Online Systems; Outcome; Participant; Patients; Population; Process; Program Evaluation; Psychologist; Psychotherapy; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Recovery; Reporting; Research; Resources; Safety; Sentinel; Series; Social Workers; Suicide; Suicide attempt; Surveys; Time; Training; Training and Education; United States; Variant; Youth; active method; acute care; adolescent suicide; animation; design; digital intervention; digital tool; effectiveness evaluation; effectiveness testing; effectiveness trial; emotional distress; evidence base; experience; health care delivery; hospital care; implementation science; improved; inpatient psychiatric treatment; multidisciplinary; novel; pandemic disease; pediatrician; pre-pandemic; programs; psychosocial; reducing suicide; safety supervision; skills; standard of care; suicidal; suicidal morbidity; treatment as usual; trend

PROJECT SUMMARY The COVID-19 pandemic has contributed to a substantial increase in suicidal ideation, suicide attempts, and suicide deaths among US adolescents. Emergency departments (EDs) at acute care hospitals increasingly serve as gateways to care for youth with suicidality; this trend has been further exacerbated during COVID-19. When youth with suicidal ideation or attempt are deemed to require inpatient psychiatric care, the demand for beds often exceeds supply, leading to psychiatric boarding. During this time, youth may wait days to weeks in an ED or inpatient medical unit until psychiatric admission; boarding frequencies and durations have both increased during COVID-19. Youth experiencing boarding rarely receive evidence-based psychotherapies given a national shortage and uneven distribution of mental health professionals. To address this gap, a multidisciplinary team of pediatricians, psychologists, clinical social workers and patient partners developed a modular digital intervention to deliver evidence-based psychosocial skills to youth with suicidality during boarding. This program, called I-CARE (Improving Care, Accelerating Recovery & Education), consists of a series of web-based animated videos and activities grounded in cognitive behavioral therapy, prioritized through a rigorous Delphi process. I-CARE is designed to be facilitated by safety attendants who currently provide 1-on-1 safety supervision for youth during boarding. Accordingly, I-CARE requires minimal additional resources beyond those already available at acute care hospitals. In a pilot program evaluation, I-CARE has been shown to be feasible to implement and acceptable to youth, clinicians, and their caregivers, with levels of emotional distress significantly decreased following participation. Building on this preliminary data, this Hybrid Type 1 effectiveness trial will use a cluster randomized stepped wedge design at 6 hospitals (960 youth 12-17 years with suicidal ideation or attempt) to: (i) apply the Dynamic Adaptation Process to optimize I-CARE training and implementation while maintaining intervention fidelity and taking into account COVID-19 and variation across hospitals; (ii) determine the effectiveness of I-CARE to reduce emotional distress, suicidal ideation and suicide attempts using validated measures compared to usual care, assess the effects of I-CARE on motivation for change (target mechanism), and determine whether greater motivation for change mediates I-CARE effects on emotional distress, suicidal ideation and attempts, and (iii) apply the RE-AIM framework to identify barriers to and facilitators of I-CARE reach, effectiveness, adoption, implementation and maintenance from the perspectives of youth, caregivers, and clinicians. The results of this study have the potential to transform healthcare delivery for a population currently underserved by the health system, increasing access to mental health services during a period of tremendous vulnerability while applying a novel digital intervention with substantial potential for scalability.

项目总结 新冠肺炎大流行导致自杀念头、自杀企图和 美国青少年自杀死亡人数。急诊医院的急诊科越来越多 充当关爱有自杀倾向的青少年的门户；在新冠肺炎期间，这一趋势进一步加剧。 当有自杀念头或企图自杀的青少年被认为需要住院精神护理时， 床位经常供不应求，导致精神寄宿。在这段时间里，年轻人可能会等上几天到几周 精神科住院前的急诊室或住院医疗单元；登机频率和持续时间都有 在新冠肺炎期间增加。经历过寄宿的年轻人很少接受循证心理治疗 鉴于全国精神卫生专业人员短缺和分布不均。为了解决这一差距，一个 由儿科医生、心理学家、临床社会工作者和患者合作伙伴组成的多学科团队开发了一种 模块化数字干预，向自杀青少年提供循证心理社会技能 登机。这项名为i-care(改善护理、加速康复和教育)的计划由 以认知行为疗法为基础的一系列网络动画视频和活动，按优先顺序排列 通过严格的德尔福流程。I-care旨在由目前正在工作的安全管理员提供便利 为青少年在登机期间提供一对一的安全监督。因此，i-care只需要最少的额外费用 急症护理医院现有资源以外的资源。在一项试点计划评估中，i-care 已被证明是可行的，并为青年、临床医生和他们的照顾者所接受， 参与后，情绪困扰显著降低。在这个初步数据的基础上，这款混合动力车 类型1有效性试验将在6家医院(960名12-17岁的青年)使用整群随机阶梯楔形设计 有自杀念头或企图自杀的年份)：(1)应用动态适应进程，以优化保健服务 在保持干预保真度的同时进行培训和实施，并考虑到新冠肺炎和 不同医院之间的差异；(2)确定i-care减少情绪困扰、自杀的有效性 与常规护理相比，使用有效措施的构思和自杀企图，评估i-care的效果 关于变革的动力(目标机制)，并确定更大的变革动力是否起到中介作用 I-care对情绪困扰、自杀意念和自杀企图的影响，以及(Iii)将RE-AIM框架应用于 确定i-care覆盖范围、有效性、采用、实施和维护的障碍和促进者 从青年、照顾者和临床医生的角度。这项研究的结果有可能 为目前未得到医疗体系服务的人群转变医疗保健服务，增加获得 在应用新的数字干预的同时，在巨大脆弱性时期的精神健康服务 具有巨大的可伸缩性潜力。