Pilot Effectiveness Trial of THRIVE in Crisis Stabilization Centers: Promoting Connection, Recovery, and Treatment Linkage after Suicide Crisis

摘要 美国准备发展和投资我们的精神健康危机系统，有一个全国性的电话/短信 项目启动，同时为危机服务提供新的资金。600多个危机稳定中心 全美范围内的(CSC)为自杀客户提供了一种更舒适、成本更低的替代方案 急诊科(ED)护理。鉴于不断增长的需求，迫切需要可行的、 有效的、人际关系的、注重恢复的干预措施。这项研究改编并测试了一部小说 出院前后对分娩的干预。Thrive使用人际关系理论 自杀作为一种框架，以加强社会联系和对抗感知的负担。 初步数据显示出了令人振奋的结果。但是，CSC工作流和文化需要特定于环境 适应。这项研究利用适应设计和影响模型来适应CSC的Thrive， 测试可行性、可接受性和适当性，并在两个CSC中进行RCT试点。CSC改编的 干预措施解决了自杀风险的人际驱动因素，并促进了安全、康复和社区 通过以下方式建立联系：(A)在CSC逗留期间设立一个“奉献与奉献”小组，(B)为期4周的康复辅导电话 出院后，以及(C)可选的手机应用程序，为连接提供增援和资源。 试点将比较Thrive+排放/安全计划(D/SP)和单独使用D/SP，检查程度 Thrive在出院后一个月和三个月采用有针对性的变化机制。 目标1.使用MADI改编、繁荣和完善CSC专用手册。 目的2.检验Thrive对CSCs的可行性、可接受性和适宜性。 CSC客人(n=20)。75%的客人将参加一个欣欣向荣的小组和至少一次后续行动 在出院后一个月内休会。可接受性和满意度评分将为≧75%。 CSC工作人员(n=4)。至少具有BE的团体和教练通话录音的保真度评级 为所有交付Thrive的员工提供75%的≧。 CSC管理员会将Thrive对CSC的可接受性和适当性评分为≧75%。 目的3.进行随机先导有效性试验(n=162)，以评估Thrive对 治疗启动和自杀的关键人际驱动因素-归属感和负担。我们 假设获得Thrive+D/SP与单独获得D/SP的CSC来宾将拥有： H1：在CSC出院后1个月和3个月开始治疗的比率较高。 H2。出院后1个月和3个月归属感增加，负重减轻。 我们将探讨干预对治疗参与度、急性护理精神病患者的影响。 3个月以上的再入院、自杀意念和自杀行为。在研究结束时， Thrive for CSCs将准备在预防自杀行为的有效性试验中进行测试。

Abstract The US is poised for growth and investment in our mental health crisis system, with a national phone/text line launching, accompanied by new funding for crisis services. More than 600 Crisis Stabilization Centers (CSCs) across the US provide suicidal clients with a more comfortable and less costly alternative to Emergency Department (ED) care. In light of rising demand, there is an urgent need for feasible, effective, interpersonal, recovery-oriented interventions. This study adapts and tests a novel intervention for delivery prior to and after discharge from CSCs. THRIVE uses the Interpersonal Theory of Suicide as a framework to bolster social connectedness and counter perceived burdensomeness. Preliminary data shows promising results. However, CSC workflows and culture require context-specific adaptation. This study leverages the Model for Adaptation Design and Impact to adapt THRIVE for CSCs, test feasibility, acceptability, and appropriateness, and conduct a pilot RCT in two CSCs. The CSC-adapted intervention addresses interpersonal drivers of suicide risk and bolsters safety, recovery, and community linkage through: (a) a `belonging and giving' group during CSC stay, (b) recovery coaching calls for 4 weeks post-discharge, and (c) an optional phone app that provides reinforcement and resources for connection. The pilot will compare THRIVE + Discharge/Safety Planning (D/SP) to D/SP alone, examining the degree to which THRIVE engages the targeted mechanisms of change at one- and three-months post-discharge. Aim 1. Adapt THRIVE and complete CSC-specific manual using MADI. Aim 2. Test feasibility, acceptability, appropriateness of THRIVE for CSCs. CSC Guests (n = 20). 75% of guests will participate in a THRIVE group and at least one follow-up session within one month of discharge. Ratings of acceptability and satisfaction will be ≧ 75%. CSC Staff (n = 4). Fidelity ratings of audio recordings of group and coaching calls with be at least ≧ 75% for all staff who deliver THRIVE. CSC Administrators will rate acceptability and appropriateness of THRIVE for CSCs as ≧ 75%. Aim 3. Conduct a randomized pilot effectiveness trial (n = 162) to assess the effect of THRIVE on treatment initiation and on key interpersonal drivers of suicide – belongingness and burdensomeness. We hypothesize that CSC guests who receive THRIVE + D/SP vs. D/SP alone will have: H1: Higher rates of treatment initiation at 1 month and 3 months from CSC discharge. H2. Increased belongingness and decreased burdensomeness at 1 and 3 months after discharge. We will explore the effect of the intervention on treatment engagement, acute care psychiatric readmissions, and suicidal ideation and suicidal behavior over 3-month follow-up. At the end of the study, THRIVE for CSCs will be ready to test in an effectiveness trial for preventing suicidal behavior.