User-centered Design and Evaluation of a Virtual Human Patient to Improve Safety Planning Skills

项目摘要 尽管在过去十年中采取了前所未有的自杀预防措施，但退伍军人和 与9/11之前的时期相比，军队服役人员的人数仍然很高，这突出表明需要改进发展 并为这一高危人群实施有科学依据的干预措施。该项目将开发一个 在线，交互式虚拟标准化患者（VSP），以培训退伍军人事务部（VA）内的提供者， 实施简单的自杀安全计划干预（SPI）。研究表明，SPI是一种可接受的， 对自杀风险高的退伍军人进行可行和有效的干预。然而，进行SPI的培训 有限，目前没有培训提供行为排练和互动的机会， 在提供者方便的情况下，以在线格式进行练习。目前的建议将使用 以用户为中心的设计的最佳实践，以创建标准化的培训工具，帮助提供者开发临床 更有效地实施SPI的技能。该项目将包括两个阶段的研究。第一阶段将包括一个 评估，为VSP的设计提供SPI特定内容的信息，并将涉及基于用户的迭代修订， 来自VA医疗保健提供者的集中设计反馈（N = 10）。一旦VSP的最终版本完成， 在30名VA医疗保健提供者的混合方法试点研究中进行评估，以检查提供者SPI临床 技能、知识、信心和自我效能（第二阶段）。对VSP的评估将鼓励未来的研究， 如果有效的话，传播这一新的培训工具。由此产生的VSP将具有成本效益和高度可扩展性，并将 只需要一台可以访问Internet的台式计算机即可运行。将制定VSP，以针对广泛的 提供者的范围，而不仅仅是那些在心理健康。同样，该技术将得到发展， 分发给谁与退伍军人和非退伍军人患者以外的VA工作的供应商。该培训工具将 对于最初学习SPI的提供者以及希望更新技能的人来说非常有用。我们的提议带来了 两个团队（VA Puget Sound和南加州大学创意技术研究所）一起拥有高影响力的历史 心理健康技术发展。这些团队拥有独特和互补的专业知识， 成功地执行了这个建议。结果有可能对VA医疗保健系统产生重大影响 和高危患者的治疗。接下来的步骤将包括一项完全有效的随机对照试验，以检查 制定了关于提供者行为（临床技能）和患者结局的VSP，然后将VSP传播到 其他VA和非VA部位（如果有效）。

PROJECT SUMMARY Despite unprecedented suicide prevention efforts undertaken in the last decade, suicide rates among veterans and military service members remain elevated relative to the pre-9/11 era, highlighting the need for improved development and implementation of scientifically supported interventions for this at-risk population. This project will develop an online, interactive Virtual Standardized Patient (VSP) to train providers within the Department of Veterans Affairs (VA) to administer the brief suicide Safety Planning Intervention (SPI). Research has demonstrated the SPI to be an acceptable, feasible, and effective intervention for veterans at elevated risk of suicide. However, training to conduct the SPI has been limited and no currently available training provides the opportunity for behavioral rehearsal and interactive practice in an online format available at the convenience of the provider. The current proposal will develop a VSP using best practices in user-centered design to create a standardized training tool to assist providers in developing clinical skills to more effectively implement the SPI. The project will include a two-phase study. Phase I will include a formative evaluation to inform the design of the VSP with SPI specific content and will involve iterative revisions based on user- centered design feedback from VA healthcare providers (N = 10). Once the final version of the VSP is completed, it will be evaluated in a mixed methods pilot study with 30 VA healthcare providers to examine changes in provider SPI clinical skills, knowledge, confidence, and self-efficacy (phase II). This evaluation of the VSP will encourage future research and dissemination of this novel training tool, if effective. The resulting VSP will be cost-effective and highly scalable, and will require only a desktop computer with Internet access to run. The VSP will be developed to target training for a wide range of providers, not just those in mental health. Similarly, the technology will be developed such that it could be disseminated to providers who work with veteran and non-veteran patients outside of the VA. This training tool will be useful for providers initially learning the SPI, as well as those who wish to refresh their skills. Our proposal brings together two teams (VA Puget Sound and the USC Institute for Creative Technologies) with a history of high impact mental health technology development. These teams have unique, and complementary, expertise in order to successfully execute this proposal. Results have the potential to make a substantial impact on the VA healthcare system and its at-risk patients. Next steps will include a fully powered randomized controlled trial to examine the efficacy of the developed VSP on provider behaviors (clinical skills) and patient outcomes, followed by dissemination of the VSP to other VA and non-VA sites, if efficacious.