Development of a mobile heath augmented brief suicide prevention intervention for people with SMI accessing community care

项目总结/摘要 双相情感障碍和精神分裂症都是严重的精神疾病， 自杀死亡，但研究是缺乏自杀的具体干预措施，在这个庞大的人口。步入式 紧急护理诊所是增加SMI获得精神卫生保健的最佳做法，许多人 患有重度精神分裂症的人到这些诊所就诊，自杀的风险会增加。然而，只有50%的患者 从紧急护理转来的人不参加后续门诊预约。因此，无需预约的诊所提供了 重要和新颖的设置，其中部署自杀特异性干预措施， 紧急门诊护理。该干预发展研究项目评估了可行性， 可接受性，以及针对SMI的简短认知行为干预的初步影响，即 在紧急护理评估和后续门诊护理之间的差距期间提供。安全和 恢复治疗（START）是一种由移动的技术增强的4节认知行为干预， 它在诊所外提供自动化和个性化的适应性应对行为强化， 设置. START建立在与社区精神病服务组织合作发展的基础上， 以及我们在SMI人群中的初步数据，这些数据支持简短， 移动的增强认知行为干预。初步数据也支持了移动的 增强CBT在提高治疗依从性和应对自我效能，沿着提供新的 通过密集的纵向数据对自杀相关急性加重的近期动态的见解。在一个3- 一年的发展研究，我们的部署重点的方法将首先完善干预程序，安全 和护理连续性协议，并与部署设置相适应， 社区提供者、项目工作人员、顾问和患者倡导者。我们接下来将进行一个随机的试点， 对照试验，70例诊断为双相情感障碍或精神分裂症的患者， 社区分诊提供者在无预约诊所接受START。入组患有SMI的患者 诊断和当前主动自杀意念和/或自杀企图在过去3个月。参与者 随机分配至两种活动条件之一：START +移动的增强或单独START。我们将评估 门诊治疗参与率和危机服务使用率的可行性、可接受性和提高 与抽样人群相比。我们还将研究务实的机制，其中包括门诊 治疗参与和应对自我效能，对自杀意念严重程度和危机服务使用的变化 沿着移动的增强的初步影响。在这项发展研究之后， 这里开发的干预措施可以很容易地扩展到更广泛的无预约诊所网络， SMI致力于降低这一弱势群体的高自杀率。

PROJECT SUMMARY/ABSTRACT Bipolar disorder and schizophrenia, both serious mental illnesses (SMIs), are present in up to one third of suicide deaths, and yet research is lacking on suicide-specific interventions in this large population. Walk-in urgent care clinics are a best practice in increasing access to mental health care for SMI, and many people with SMI who present to such clinics are at elevated risk for suicide. Yet, only 50% of patients who are referred from urgent care do not attend follow up outpatient appointments. Thus, walk-in clinics provide an important and novel setting in which to deploy suicide-specific interventions that bridge the transition from urgent to outpatient care. This intervention development research project evaluates the feasibility, acceptability, and preliminary impact of a brief cognitive behavioral intervention, tailored to SMI, that is delivered during the gap period between urgent care evaluation and follow-up outpatient care. SafeTy and Recovery Therapy (START) is a 4-session cognitive behavioral intervention augmented by mobile technology, which delivers automated and personalized reinforcement of adaptive coping behavior outside of the clinic setting. START builds from collaborative development alongside a community psychiatric service organization, and our preliminary data in the SMI population that supports the feasibility, acceptability, and impact of brief, mobile augmented cognitive behavioral intervention. Preliminary data also support the impact of mobile augmented CBT in enhancing treatment adherence and coping self-efficacy, along with providing novel insights on the near term dynamics of suicide-related exacerbations through intensive longitudinal data. In a 3- year developmental study, our deployment focused approach will first refine intervention procedures, safety and care continuity protocols, and fit with the deployment setting with a series of collaborative contacts with community providers, project staff, advisors, and patient advocates. We will next conduct a pilot randomized controlled trial with 70 patients diagnosed with either bipolar disorder or schizophrenia rapidly referred by community triage providers to receive START in the walk-in clinic setting. Patients are enrolled who have SMI diagnoses and current active suicidal ideation and/or a suicide attempt in the prior 3 months. Participants are randomized to one of two active conditions: START + Mobile augmentation or START alone. We will evaluate feasibility, acceptability, and enhancement of rates of outpatient treatment engagement and crisis service use in comparison to the sample population. We will also examine pragmatic mechanisms, which include outpatient treatment engagement and coping self-efficacy, on change in suicidal ideation severity and crisis service use along with the preliminary impact of mobile augmentation. Subsequent to this developmental research, the intervention developed here could be readily scaled to the wider network of walk-in clinics serving people with SMI in effort to reduce the high rate of suicide in this vulnerable population.