Feasibility, acceptability, and preliminary effectiveness of a cognitive-behavioral suicide prevention-focused intervention tailored to adults diagnosed with schizophrenia spectrum disorders2019

自杀是成年精神分裂症患者死亡的主要原因之一，风险估计超过8 比一般人多一倍。虽然研究主要集中在抑郁症和 绝望，越来越多的人支持精神病症状（如幻觉）在 自杀风险此外，由于缺乏自杀率，这种高自杀率仍然是一个主要的公共卫生问题。 以证据为基础的干预措施，以减少这一人群的自杀行为。我们建议修改和评估 精神病认知行为自杀预防（CBSPp）的可接受性和初步有效性， 有希望的干预措施，需要修改方案和实施，以增加其在社区中的效用 心理健康（CMH）。根据客户和供应商的反馈，将进行以下修改：1） 修改和缩短治疗; 2）开发混合技术辅助的提供者培训;以及，3）开发 客户端文本助推器进一步的创新将通过与利益攸关方的接触来了解， CMH审查方案并获得反馈。因此，本研究的目的是：1）修改CBSPp为客户 接受CMH服务的精神分裂症谱系和其他精神病性障碍（SSPD），以及2）评估 在一项随机试验中，与服务即服务相比， 通常（SAU）。目标1将涉及：1）开发混合技术辅助的CBSPp提供者培训， 文本助推器; 2）深入的定性访谈，以评估CBSPp材料和交付协议， 利益相关者，包括1015名在3个月内患有SSPD和自杀意念和/或企图（SI/A）的成人 筛选和1000名CMH工作人员，提供者，董事和领导人; 3）学者专家小组的投入， CBSPp方案和交付、混合提供者培训和文本助推器的修改; 4）开放试点试验 与8名客户和2名供应商; 5）与CBSPp交付供应商（n=2）和105名工作人员，领导， 和CMH的董事，探讨CBSPp实施的提供商经验和组织影响， 研究地点（华盛顿县社区精神卫生; WCCMH）;以及，6）在 Aim 2试验目标2将涉及一项试验，以测试经修改的CBSPp的初步有效性和实施情况 （与常规服务相比; SAU）在筛选前3个月内患有SSPD和SI/SA的成人中（n=60）。A 4- 波形设计将包括基线（T1）、中期测试（T2）、测试后（T3）和随访时的定量评估 (T4)在T4进行深入的定性访谈，随机抽取CBSPp组的成年人（n=10）。 提供者（n=8）将接受培训，以提供CBSPp，并接受T1-T4评估，以评价实施过程， 包括T4的深入定性访谈。我们将监控以下内容的保真度、可接受性、可用性和可行性： 修改后的CBSPp。本提案是对RFA-MH-18-706《治疗的初步有效性试验》的回应， 和服务干预，并遵循NIMH的战略计划，制定方法， 优化成果的新干预措施（3.2）和测试干预措施在社区实践中的有效性（3.3）。

Suicide is among the leading causes of death for adults with schizophrenia, with risk estimates being over eight times greater than among the general population. While research has largely focused on depression and hopelessness, there is growing support for the role that symptoms of psychosis (e.g. hallucinations) play in suicide risk. Further, this high suicide rate continues to be a major public health concern given the paucity of evidence-based interventions to reduce suicidality in this population. We propose to modify and evaluate the acceptability and preliminary effectiveness of Cognitive Behavioral Suicide Prevention for psychosis (CBSPp), a promising intervention requiring protocol and implementation modifications to increase its utility in community mental health (CMH). The following modifications will be pursued given feedback from clients and providers: 1) modify and shorten treatment; 2) develop a hybrid technology-assisted provider training; and, 3) develop a between-session client text booster. Further innovations will be informed by engagement with stakeholders in CMH to review and gain feedback on the protocol. Accordingly, the study aims to: 1) modify CBSPp for clients with schizophrenia spectrum and other psychotic disorders (SSPD) receiving CMH services, and 2) evaluate the feasibility and preliminary effectiveness of modified CBSPp in a randomized trial in comparison to services-as- usual (SAU). Aim 1 will involve: 1) the development of a hybrid technology-assisted CBSPp provider training, text boosters; 2) in-depth qualitative interviews to evaluate CBSPp materials and delivery protocol with stakeholders, including 15 adults with SSPD and suicidal ideation and/or attempt (SI/A) within 3 months of screening and 10 CMH staff, providers, directors, and leaders; 3) input from an expert panel of scholars prior to modifications for CBSPp protocol and delivery, hybrid provider training, and text booster; 4) an open pilot trial with 8 clients and 2 providers; 5) qualitative interviews with CBSPp delivery providers (n=2) and 5 staff, leaders, and directors in CMH to explore provider experiences and organizational impact of CBSPp implementation at the research site (Washtenaw County Community Mental Health; WCCMH); and, 6) final modifications prior to the Aim 2 trial. Aim 2 will involve a trial to test preliminary effectiveness and implementation of modified CBSPp (versus services as usual; SAU) among adults with SSPD and SI/SA within 3 months of screening (n=60). A 4- wave design will include quantitative assessments at baseline (T1), mid-test (T2), post-test (T3), and follow-up (T4) with in-depth qualitative interviews at T4 for a random sample of adults in the CBSPp group (n=10). Providers (n=8) will be trained to deliver CBSPp and be assessed T1-T4 to evaluate the implementation process, including in-depth qualitative interviews at T4. We will monitor fidelity, acceptability, usability, and feasibility of the modified CBSPp. This proposal is in response to RFA-MH-18-706, Pilot Effectiveness Trials for Treatment, Preventative and Services Interventions, and follows NIMH’s strategic plan to develop ways to tailor existing and new interventions to optimize outcomes (3.2) and test interventions for effectiveness in community practice (3.3).