Study 3: Guide2Brite

自杀和自杀行为是青少年死亡和发病的主要原因之一。的 大多数自杀死亡者最后一次与初级保健有临床联系，但我们缺乏经验支持 当青年出现急性自杀时，初级保健临床医生可以部署的治疗策略 风险在以前的工作中，我们开发了一个智能手机安全规划应用程序，BRITE精神病住院 自杀的青少年，支持干预，减少了42%的出院后自杀事件。我们 现在计划通过提供逐步指导，使BRITE适用于初级保健， 非心理健康临床医生如何制定一个自杀青少年的安全计划，并加载此计划的 青少年患者的智能手机Guide 2BRITE（G2 B）的干预措施旨在提高 初级保健临床医生有效地评估和管理青少年急性自杀风险，通过指导30 与青少年和家长一起制定安全计划。在第一阶段，我们将开发 以及应用程序支持的干预的预测试组件，包括虚拟治疗手册、用户 与5名初级保健临床医生进行接口，并介绍逐步说明和由此产生的安全计划， 以青少年患者及其家长为原型进行试验，随后开放试验15例。对于第二阶段， 将进一步修订G2 B，然后在6例儿童原发性骨髓瘤中使用随机阶梯楔形设计进行测试。 在100名年龄在12.0-17.11岁之间的青少年中进行G2 B筛查的有效性的初步测试 PHQ-9第9项急性自杀风险阳性（>2）。G2 B将为临床医生提供逐步 使用个人定制的安全计划填充青少年应用程序的说明，包括以下内容 组成部分：（1）评估致命性和限制获得手段;（2）确定自杀的可能触发因素 和自我伤害的冲动，以及如何避免和科普他们;（3）通过建模和角色扮演教学技能， 科普自杀和自我伤害的冲动（情绪调节，危机生存技能，并利用现有的社会 （4）在其他应付危机的方法失效时，找出专业资源。在 在干预会议结束时，我们将确定G2 B对青少年痛苦的直接影响， 自杀冲动和临床医生转诊到医院和急诊室。此外，我们将评估6-，12-， 和24周的结果从多个角度：（1）主要结果，自杀意念的轨迹， 行为和非自杀性自伤;（2）提供者、患者和父母对可用性和满意度的评级;以及 (3)对火器储存、损伤、就诊费用以及使用急诊和医院服务的影响。以来 自杀意念是最终自杀行为的最强预测因子之一， 传播，低成本的干预，可用于非专业的心理健康可能有很大的 对青少年自杀行为的人口负担的影响。此外，G2 B是创新的，因为它是第一个 自杀预防应用程序，旨在指导临床医生的干预措施。

Suicide and suicidal behavior are among the leading causes of adolescent mortality and morbidity. The majority of suicide decedents have their last clinical contact with primary care yet we lack empirically supported treatment strategies that can be deployed by primary care clinicians when youth present with acute suicide risk. In previous work, we developed a smartphone safety planning app, BRITE for psychiatrically hospitalized suicidal adolescents that supported an intervention that reduced suicidal events post-discharge by 42%. We now plan to adapt BRITE to use in primary care by providing step-by-step guidance to a primary care-based, non-mental health clinician on how to develop a safety plan for a suicidal adolescent and load this plan on the adolescent patient’s smartphone. This intervention, Guide2BRITE (G2B) aims to enhance the capability of primary care clinicians to effectively assess and manage acute suicide risk in adolescents via a guided 30 minute intervention to develop a safety plan with the adolescent and parent. During Phase 1, we will develop and pre-test components of the app-supported intervention including the virtual treatment manual, user interface, and presentation of step-by-step instructions and resulting safety plan with 5 primary care clinicians, adolescent patients and their parents to test the prototype, followed by an open pilot of 15 cases. For Phase 2, G2B will be further revised, and then tested using a randomized stepped wedge design in 6 pediatric primary care practices to pilot test the effectiveness of G2B among 100 adolescents aged 12.0-17.11 years who screen positive for acute suicide risk on the PHQ-9 item 9 (>2). G2B will provide the clinician with step-by-step instructions to populate the adolescents’ app with a personally tailored safety plan, including the following components: (1) assessing lethality and restricting access to means; (2) identifying likely triggers of suicidal and self-harm urges and how to avoid and cope with them; (3) teaching skills via modeling and role-play to cope with suicidal and self-harm urges (emotion regulation, crisis survival skills, and utilizing existing social supports); and (4) identifying professional resources to access in a crisis should others means of coping fail. At the end of the intervention session, we will determine the immediate impact of G2B on adolescent distress and suicidal urges and clinician referrals to hospitals and emergency departments. Further, we will evaluate 6-, 12-, and 24-week outcomes from multiple perspectives: (1) the primary outcomes, trajectory of suicidal ideation, behavior, and non-suicidal self-injury; (2) provider, patient, and parent rating of usability and satisfaction; and (3) impact on firearms storage, impairment, visit cost, and use of emergency and hospital services. Since suicidal ideation is one of the strongest predictors of eventual suicidal behavior, the development of an easily disseminated, low-cost intervention that could be used by non-specialty mental health could have a large impact on the population burden of adolescent suicidal behavior. Moreover, G2B is innovative, as it is the first suicide prevention app geared to guide clinicians’ interventions.