Exploratory-Project 2

项目总结 自杀本质上是一个充满情感的话题，临床医生经常在自杀中经历焦虑和低自我效能 检测和干预那些处于危险中的人。这种焦虑导致循证自杀的实施不力 筛查、评估和干预(SSAIs)。与SSAI使用相关的临床医生焦虑和低自我效能感 因此是实施战略设计的候选目标，以优化不同精神健康状况下的SSAI摄入量 设置。这个探索性项目汇集了一个跨学科的团队，以利用数十年的研究成果 从暴露理论到设计和试点测试基于暴露的实施策略的行为变化 (EBIS)针对临床医生对SSAI使用的焦虑。我们将测试EBIS作为实现的效果 加强实施照常(IAU)的战略，以加强社区精神卫生中SSAI的实施 设置。具体地说，AIM 1将使用参与式设计方法来合作开发和改进EBIS 拥有由临床医生、管理人员和内容专家组成的利益相关者咨询委员会。在目标2中，我们将进一步 在试点现场测试中与多达15名临床医生合作，使用快速循环原型技术反复改进EBIS 使用INSPIRE方法核心。AIM 2的临床医生还将就EBIS的能力提供定性反馈 缓解焦虑和提高自我效能，以提供SSAI，以优化我们参与目标机制的能力 临床医生的焦虑。目标3将在试点实施试验中测试改进的EBIS，在该试验中，40名社区心理 健康临床医生将随机接受IAU或EBIS+IAU。主要目标3个因变量为 EBIS的可接受性和可行性，通过问卷调查、访谈以及招聘和保留来衡量 统计数据；这项试点试验并不是为了检测效果。次要结果是初步的 EBIS在执行成果(采用SSAI和保真度)和目标参与方面的有效性 实施机制(与使用SSAI相关的临床医生焦虑和自我效能)，通过MIXED进行评估 方法(问卷调查、图表刺激回忆、观察者编码角色扮演和访谈)。我们有两个 探索性假设，我们将通过混合方法进行评估：(1)EBIS将实施目标 降低焦虑和提高自我效能感的机制优于IAU；(2)临床医生随机选择EBIS 将显示改进的SSAI采用率和保真度。我们还将收集有关其他可能实施的数据 使用问卷和定性访谈的机制，以探索背景实施障碍 在全面评估之前，SSAI使用EBIS未解决的信息来通知增强。 该项目解决了在实施自杀预防循证做法方面的一个主要差距，方法是 开发一种新的实现策略，以增强针对可变实现机制的IAU 这是SSAI所独有的。研究目标与NIMH研究优先事项一致，并与总体任务保持一致 灵感之源。结果将通知全功率R01，以测试EBIS对实施和患者结果的影响。

PROJECT SUMMARY Suicide is inherently an affectively charged topic and clinicians often experience anxiety and low self-efficacy in detecting and intervening with those at risk. This anxiety leads to poor implementation of evidence-based suicide screening, assessment, and interventions (SSAIs). Clinician anxiety and low self-efficacy related to SSAI use are thus candidate targets for implementation strategy design to optimize SSAI uptake in diverse mental health settings. This exploratory project brings together an interdisciplinary team to leverage decades of research on behavior change from exposure theory to design and pilot-test an exposure-based implementation strategy (EBIS) to target clinician-level anxiety about SSAI use. We will test the effect of EBIS as an implementation strategy to augment Implementation as Usual (IAU) to enhance SSAI implementation in community mental health settings. Specifically, Aim 1 will use participatory design methods to develop and refine EBIS in collaboration with a stakeholder advisory board of clinicians, administrators, and content experts. In Aim 2, we will further iteratively refine EBIS with up to 15 clinicians in a pilot field test, using rapid cycle prototyping, in collaboration with the INSPIRE Methods Core. Clinicians in Aim 2 will also provide qualitative feedback on EBIS’ ability to mitigate anxiety and increase self-efficacy to deliver SSAIs to optimize our ability to engage target mechanisms of clinician anxiety. Aim 3 will test the refined EBIS in a pilot implementation trial in which 40 community mental health clinicians will be randomized to receive either IAU or EBIS+IAU. Primary Aim 3 dependent variables are EBIS acceptability and feasibility, measured through questionnaires, interviews, and recruitment and retention statistics; this pilot trial is not intended to be powered to detect effects. Secondary outcomes are preliminary effectiveness of EBIS on implementation outcomes (SSAI adoption and fidelity), and engagement of target implementation mechanisms (clinician anxiety and self-efficacy related to SSAI use), assessed via mixed methods (questionnaires, chart-stimulated recall, observer-coded role plays, and interviews). We have two exploratory hypotheses, which we will evaluate via mixed methods: (1) EBIS will engage target implementation mechanisms by lowering anxiety and increasing self-efficacy better than IAU; (2) Clinicians randomized to EBIS will show improved SSAI adoption and fidelity. We also will gather data on other possible implementation mechanisms using questionnaires and qualitative interviews to probe for contextual implementation barriers to SSAI use not addressed by EBIS to inform augmentation prior to fully powered evaluation. This project addresses a major gap in the implementation of suicide prevention evidence-based practices by developing a novel implementation strategy to augment IAU that targets mutable implementation mechanisms unique to SSAI use. Study goals are consistent with NIMH research priorities and aligned with the overall mission of INSPIRE. Results will inform a fully powered R01 to test EBIS’ effect on implementation and patient outcomes.