Adolescent Emergency Patients: Suicide Risk Detection and Treatment Facilitation

自杀是美国青少年死亡的第三大原因;然而，超过50%的自杀青少年从未获得任何心理健康服务。根据《预防自杀国家战略》（2001年）的建议，这一R34探索性研究项目将制定一项干预措施，有可能向每年寻求紧急服务的数千名有风险的青少年提供。我们将开发并试点测试一种理论驱动的干预措施，青少年改变选择（TOC），旨在改善问题识别，改变准备和治疗联系，在城市弱势青少年中，由于（1）同时发生抑郁症和酒精滥用，或（2）最近的自杀倾向（自杀企图或严重的自杀意念）而有自杀风险。TOC结合了动机访谈原则，并以健康行为促进模型为基础。干预的组成部分包括一个适应性动机访谈（AMI）与个性化的反馈，为青少年，一个简短的联合AMI专注于父母和青少年的可用治疗，使用文化定制的服务信息和决策援助，个性化的后续说明。具体目标是：（1）编制TOC材料（干预手册;文化定制的服务信息和决策辅助;治疗师培训和忠诚度评估程序）;（2）进行可行性试点研究，以完善随机对照试验的干预和程序;（3）进行试点随机对照试验，比较TOC和增强的常规治疗。这项试验将使我们能够（a）估计条件下主要和次要结局的分布和变异性;（B）确定TOC的社会接受度和有效性。在本试验中，将筛选1120名青少年，以确定109名符合自杀风险标准并同意（经父母同意）参与的青少年。在2个月时评估的主要结局是寻求治疗（根据参与程度二分定义）。二次分析将解决（1）对寻求治疗的干预效果，调整其他可能的预测因素，如年龄，性别和指标疾病的严重程度;（2）寻求治疗对青少年结局的影响程度。该项目利用了我们跨学科团队在自杀青少年干预，酒精滥用紧急干预，动机访谈和健康行为文化定制决策指南的发展方面的丰富经验。该小组在青少年自杀风险管理方面的丰富经验加强了该项目的可行性。

DESCRIPTION (provided by applicant): Suicide is the 3rd leading cause of death among adolescents in the United States; however, more than fifty percent of adolescents who die from suicide have never obtained any mental health services. In keeping with recommendations in the National Strategy for Suicide Prevention (2001), this R34 Exploratory Research Project will develop an intervention that has the potential to be delivered to thousands of at risk adolescents seeking emergency services each year. We will develop and pilot test a theoretically-driven intervention, Teen Options for Change (TOC), which is designed to improve problem recognition, readiness for change, and treatment linkage among disadvantaged urban adolescents at risk for suicide due to either (1) co-occurring depression and alcohol misuse, or (2) recent suicidality (suicide attempt or severe suicidal ideation). TOC incorporates motivational interviewing principles and is based on health behavior promotion models. Intervention components include an Adapted Motivational Interview (AMI) with Personalized Feedback for the adolescent, a brief conjoint AMI focusing on available treatments for the parent and adolescent, use of a culturally tailored Services Information and Decision Aid, and Personalized Follow-Up Notes. Specific aims are: (1) to develop TOC materials (intervention manual; culturally tailored Services Information and Decision Aid; therapist training and fidelity assessment procedures); (2) to conduct a feasibility pilot study to refine the intervention and procedures for the randomized controlled trial; and (3) to conduct a pilot randomized controlled trial comparing TOC to enhanced treatment-as-usual. This trial will enable us (a) to estimate the distribution and variability of primary and secondary outcomes within conditions; and (b) to determine the social acceptance and validity of TOC. In this trial, 1120 adolescents will be screened to identify 109 who meet suicide risk criteria and assent (with parental consent) to participate. The primary outcome, assessed at 2-months, is treatment seeking (defined dichotomously and by level of engagement). Secondary analyses will address (1) the intervention effect on treatment seeking, adjusting for other possible predictors such as age, gender, and severity of index condition; and (2) the extent to which treatment-seeking impacts adolescent outcomes. This project capitalizes upon our interdisciplinary team's substantial experience with interventions for suicidal adolescents, emergency-based interventions for alcohol misuse, motivational interviewing, and the development of culturally tailored decision guides for health behaviors. The project's feasibility is strengthened by the team's extensive experience with adolescent suicide risk management.