1/2 Brief Intervention for Suicide Risk Reduction in High Risk Adolescents

描述(由申请人提供)：我们建议一个2-Site R34，通过支持手机应用程序开发一种简短、灵活、手动的干预措施，以减少在从住院到门诊护理过渡期间具有高度自杀意念或最近自杀未遂的青少年的自杀行为风险。这一过渡期是自杀未遂和已自杀风险最高的时期。自杀是青少年死亡的第三大原因，目前还没有针对自杀青少年的既定干预措施。通过开发一种可以在过渡到门诊治疗之前在住院病房提供的治疗方法，我们预计 能够降低自杀风险，并增加参与者随后接受门诊治疗的可能性。为了与NIMH的优先事项保持一致，这种旨在降低自杀和自杀行为风险的干预将是跨诊断的。我们将干预称为尽快干预，预期的组成部分包括：(1)坚持-通过激励性访谈促进参与和坚持治疗；(2)安全规划；(3)情感保护-从保持积极情感的技术菜单中进行选择(例如，品尝和转换策略、动员社会支持、保持清醒和改善睡眠)。这些内容中的每一个都将在激励性面谈框架内提供，以加强内在的变革动机。治疗时间短(6-8小时)，并在门诊治疗开始前在住院病房或家访中灵活提供。ASAP增加了防止自杀行为复发的保护因素，并将家庭纳入治疗范围。安全计划 还将开发延长治疗影响的手机APP。创新特征包括：(1)在自杀风险最高的时间和地点提供干预；(2)增强 针对自杀行为复发的防护因素，特别是通过促进积极情绪、健康睡眠和社会支持的发展；(3)安全计划电话应用程序，以扩大治疗的影响；以及(4)与门诊治疗师联络，以确保护理的连续性。具体目标是5个治疗发展阶段：(1)就拟议的治疗内容和背景，对每个地点的5名自杀青少年、父母和5名临床医生进行开放式半结构化访谈；(2)开发ASAP模块、依从性/能力测量和电话应用程序，并重复开放访谈；(3)在10名青少年(每个地点5人)中进行ASAP的公开试验；(4)向患者和家属、住院患者和门诊提供者汇报ASAP的影响 (5)对80名自杀青少年(两个地点)进行ASAP+后续护理(AC)的随机对照试验(RCT)，以确定ASAP的可行性、可接受性、对近期目标的影响(例如，坚持门诊护理、睡眠、积极情绪、药物使用)、自杀意念和行为。与社区临床医生共同开发并面向社区临床医生的ASAP具有成为减轻青少年自杀负担的可持续干预措施的潜力。

DESCRIPTION (provided by applicant): We propose a 2-site R34 to develop a brief, flexible, manualized intervention with supporting phone app to reduce the risk of suicidal behavior in adolescents with high suicidal ideation or a recent suicide attempt, during the transition from inpatient to outpatient care. This transition period is the highest risk period for attempted and completed suicide. Suicide is the 3rd leading cause of adolescent mortality, and there are currently no established interventions for suicidal teens. By developing a treatment that can be delivered on an inpatient unit prior to the transition to outpatient treatment, we anticipate being able to lower suicidal risk and increase the likelihood that participants will attend subsequent outpatient treatment. In keeping with the priorities of NIMH, this intervention aimed at reducing the risk of suicide and suicidal behavior will be trans-diagnostic. We term the intervention ASAP, with anticipated components: (1) Adherence- promoting engagement and adherence to treatment through motivational interviewing; (2) Safety planning; and (3) Affect Protection- selecting from a menu of techniques for maintaining positive affect (e.g. savoring and switching strategies, mobilizing social support, maintaining sobriety, and improving sleep). Each of these components will be delivered within a Motivational Interviewing framework for enhancing intrinsic motivation for change. Treatment is brief (6-8 hours), and flexibly delivered on inpatien units or in home visits prior to initiation of outpatient treatment. ASAP augments protective factors against recurrent suicidal behavior and includes the family in the treatment. A safety plan phone app to extend the impact of treatment will also be developed. Innovative features include: (1) delivery of an intervention at a time and place when suicidal risk is highest; (2) augmentation of protective factors against recurrent suicidal behavior, specifically by promoting development of positive affect, healthy sleep and social support; (3) a Safety plan phone app to extend the impact of treatment; and (4) liaison with the outpatient therapist to ensure continuity of care. Th specific aims are 5 treatment development phases: (1) Open semi-structured interviews with 5 suicidal teens and parents and 5 clinicians at each site on the proposed content and context of the proposed treatment; (2) Develop the ASAP modules, adherence/competence measures, and phone app, and repeat open interviews; (3) Open trial of ASAP in 10 adolescents (5 at each site); (4) Debrief patients and families, inpatient and outpatient providers, examine the impact of treatment on proximal indicators of suicidal risk, and revise accordingly; (5) Conduct an RCT of ASAP followed by Aftercare (AC) vs. AC alone in 80 suicidal teens (across both sites) to determine ASAP's feasibility, acceptability, impact on proximal targets (e.g., adherence to outpatient care, sleep, positive affect, substance use), suicidal ideation and behavior. ASAP, developed with and intended for community clinicians, has the potential to be a sustainable intervention to reduce the burden of adolescent suicidality.