Project 1: Syncing Screening and Services for Suicide Prevention across Health and Justice Systems

项目总结 随着美国自杀率持续上升，自杀死亡人数接近5万人，自杀人数超过100万人 根据最新数据，自杀未遂每年都受到越来越多的关注，如何最好地整合和 协调多个部门的自杀风险识别和预防，在这些部门，我们最脆弱的一些人 社区成员在连续的护理过程中“跌落在裂缝中”。也许没有任何地方需要这种 协调和融合比美国监狱系统的十字路口更明显，超过1000万 每年的入院人数和社区医疗保健系统；已知的拦截影响个人在 自杀风险高得不成比例。鉴于美国约10%的自杀者已知 情况发生在最近的刑事法律压力(通常是逮捕和监狱拘留)之后，减少了自杀 监狱拘留后一年的风险可能会对全国自杀率产生明显影响。因此，有一个至关重要的 需要开发监狱和医疗保健系统之间的自杀风险护理路径，以提供即时访问 关心。然而，这一进程因数据和临床信息集成方面的重大裂痕而受阻 监狱和卫生系统之间的冲突，阻碍了这些社区部门之间的护理工作的有效协调。 为了满足这些需要，拟议的签名项目是一种混合第一类效力--执行试验 这协调了当地监狱预订和释放数据与两个大型医疗保健系统的医疗记录 明尼苏达州和密歇根州，以识别出狱的医疗系统患者，并将数据配对 与随机进入常规护理或多层次卫生系统自杀预防护理途径的联系 (由护理协调、安全规划、护理联系和远程保健提供的长期应对- 积极自杀计划的期限)。在这样做的过程中，这个项目利用了研究小组在健康方面的经验 NIMH资助的精神卫生研究网络中的系统数据链接，参与该网络的 选择了医疗保健系统，以及在监禁和拘留期间预防自杀 释放(即在SPIRIT试验中)和基于电话的自杀预防干预(即在ED-SAFE中)。 拟议的项目将在两个地点随机选择1050人进行5S干预(相比之下， 比60,000人在平时的看护下没有接触(对比手臂)。关于自杀未遂和死亡的调查结果 结果、医疗保健利用机制、成本效益和实施因素将提供数据 用于未来的全面实施试验和在社区环境中的广泛采用。值得注意的是， 拟议的签名项目将是全面卫生系统干预的第一次试验，以防止 自杀是对患者正义介入的回应。

PROJECT SUMMARY As suicide rates in the United States continue to rise, with nearly 50,000 suicide deaths and over 1 million suicide attempts annually per most recent data, increased attention has been paid to how to best integrate and coordinate suicide risk identification and prevention across multiple sectors, where some of our most vulnerable community members “fall through the cracks” in the continuum of care. Perhaps nowhere is this need for coordination and integration more pronounced than at the intersection of the US jail system, with over 10 million admissions per year, and the community healthcare system; an intercept known to impact individuals at disproportionately high risk for suicide. Given that roughly 10% of all suicides in the US with known circumstances occur following a recent criminal legal stressor (often arrest and jail detention), reducing suicide risk in the year after jail detention could have a noticeable impact on national suicide rates. There is thus a vital need to develop suicide risk care pathways between jails and healthcare systems to offer immediate access to care. Yet this process has been stymied by major fissures in the integration of data and clinical information between jails and health systems, preventing effective coordination of care between these community sectors. To address these needs, the proposed Signature Project is a Hybrid Type I effectiveness-implementation trial that harmonizes local jail booking and release data with healthcare records at two large healthcare systems in Minnesota and Michigan, to identify health system patients who are released from jail, and to pair the data linkage with randomization into usual care or a multi-level health system suicide prevention care pathway (consisting of care coordination, Safety Planning, Caring Contacts, and a telehealth delivered Coping Long- Term with Active Suicide Program). In so doing, this project leverages the study team’s experience in health system data linkage in the NIMH-funded Mental Health Research Network, from which the participating healthcare systems were chosen, as well as in suicide prevention around the period of jail detention and release (i.e., in the SPIRIT Trial), and in telephone-based suicide prevention intervention (i.e., in ED-SAFE). The proposed project will randomize 1050 individuals into the 5S intervention at both sites (comparing to more than 60,000 people in a usual care no contact comparison arm). Findings on suicide attempt and death outcomes, healthcare utilization mechanisms, cost- effectiveness, and implementation factors will provide data for a future fully scaled implementation trial and widespread adoption in community settings. Notably, the proposed Signature Project will be the first trial of a comprehensive health system intervention to prevent suicide in response to patients’ justice involvement.