Intensive Crisis Intervention

自杀是美国青少年的第二大死因。自杀风险最高的青少年通常是 当社区的安全无法维持时，被送往住院精神病室。但是，访问 在过去的几十年里，随着青少年住院精神病医生的提供- RIC床位一直在稳步下降。在此背景下，住院患者因自杀行为和故意 从2006年到2015年，年轻人的自我伤害增加了一倍多。对这些产品的获取和需求有限 服务创造了提供短期危机干预和稳定的额外选择的需要 在安全的环境中提供服务。作为对PAR-20-286的直接回应，本提案审查了高影响力的做法- 基于近期潜力的研究，以解决NIMH自杀预防的优先事项。我们之前开发了- 开放教育强化危机干预(ICI)，一种结合了家庭治疗的简短、循证的治疗方法。 父母培训、认知行为疗法和动机访谈在家庭再就业中的作用 导致青少年自杀行为。我们的青年危机稳定部队(YCSU)恶魔的公开试点试验- 表明ICI是可行的、可接受的，并与3个月随访的临床结果改善有关。 上行期。此外，接受ICI的青少年的平均住院时间比接受ICI的青少年短5.8天。 接受传统的精神科住院治疗。在再住院率或时间上没有显著差异 在两种情况下重新入院。我们现在建议进一步开发和测试ICI。我们将招募80名- 青少年向全国儿童医院(NCH)精神病危机科提出自杀想法- 符合NCH YCSU和青少年精神科住院患者入院条件的行为和行为 单位。在第一年，20名青少年和他们的一名父母/监护人将参加一个非随机的 案件系列。对患者、父母和提供者的深入定性访谈将用于进一步完善 ICI手册、培训和监督协议以及忠诚度/遵守措施，并确定障碍， 以及执行和可持续性的促进者。在二年级和三年级，60名青少年将参加一项- 控制对照试验(RCT)比较ICI和传统住院精神疗法。该项目的主要内容 目标是检查可行性、可接受性、研究实施程序和初步有效性 使用混合方法对ICI进行评估。我们假设ICI将被家庭接受，并显示 与传统的家庭功能相比，我们提议的变革机制--家庭功能--有了更大的改进 患者出院时治疗，30天，3个月随访。二级目标将评估初步治疗- ICI对自杀意念、自杀未遂、ED/住院、绝望和治疗障碍的影响 昂斯。此应用程序直接基于我们最初有希望的发现构建，作为加强 ICI作为青少年护理的有效模式的研究证据和实用临床材料 自杀行为可以在不同的儿科环境中实施和持续，以帮助拯救生命。

Suicide is the second leading cause of death for US adolescents. Youth at highest risk of suicide are often ad- mitted to inpatient psychiatric units when safety in the community is unable to be maintained. However, access to these services has decreased over the last several decades as availability of adolescent inpatient psychiat- ric beds has steadily declined. Against this backdrop, inpatient admissions for suicidal behavior and intentional self-injury among youth have more than doubled from 2006 to 2015. Limited access to, and demand for these services has created the need for additional options to provide short-term crisis intervention and stabilization services in a secure setting. In direct response to PAR-20-286, this proposal examines high-impact practice- based research with near-term potential to address NIMH suicide prevention priorities. We previously devel- oped Intensive Crisis Intervention (ICI), a brief, evidence-based treatment that incorporates Family Therapy/ Parent Training, Cognitive Behavioral Therapy and Motivational Interviewing to target family functioning in re- ducing adolescent suicidal behavior. An open pilot trial on our Youth Crisis Stabilization Unit (YCSU) demon- strated that ICI is feasible, acceptable, and associated with improved clinical outcomes over a 3-month follow- up period. In addition, average length of stay for adolescents receiving ICI was 5.8 days briefer than those re- ceiving traditional psychiatric inpatient care. There were no significant differences in readmission rates or time to readmission across the two settings. We now propose to further develop and test ICI. We will recruit 80 ado- lescents presenting to Nationwide Children’s Hospital (NCH) Psychiatric Crisis Department with suicidal idea- tion and behavior that are eligible for admission to both the NCH YCSU and Adolescent Psychiatric Inpatient Unit. During Year 1, 20 adolescents and one of their parents/guardians will be enrolled in a nonrandomized case series. In-depth qualitative interviews with patients, parents, and providers will be used to further refine the ICI manual, training and supervision protocols, and fidelity/adherence measures, and identify barriers to, and facilitators of implementation and sustainability. In Years 2 and 3, 60 adolescents will be enrolled in a ran- domized controlled trial (RCT) comparing ICI with traditional inpatient psychiatric treatment. The project’s main goal is to examine feasibility, acceptability, research implementation procedures, and preliminary effectiveness of ICI using a mixed-methods approach. We hypothesize that ICI will be acceptable to families and show greater improvements in our proposed mechanism of change, family functioning, compared with traditional in- patient treatment at discharge, 30 days, and 3-month follow-up. Secondary aims will assess preliminary treat- ment effects of ICI on suicidal ideation, attempts, ED/hospital admission, hopelessness and therapeutic alli- ance. This application builds directly from our initial promising findings as the next step in strengthening the research evidence base and pragmatic clinical materials for ICI as an effective model of care for adolescent suicidal behavior that can be implemented and sustained across diverse pediatric settings to help save lives.