Youth Nominated Support Team for Suicidal Adolescents at Clinical High Risk for Psychosis

项目总结/摘要 精神疾病的特征是自杀念头和行为的发生率很高，并且有自杀的风险。 自杀似乎在精神病的早期阶段最为严重。最近的一项荟萃分析 研究表明，大多数处于精神病临床高风险的年轻人都有自杀经历， 有五分之一的人至少有一次自杀企图。然而， 没有专门针对过渡年龄青年的自杀预防干预措施， 目前还没有关于如何应对这一人群自杀风险的最佳实践指南。的 青年提名支持小组（YST）的干预措施最近被证明可以降低死亡率 在青少年中，它在现有的预防性教育服务中具有很高的适应性。 YST旨在作为一种预防性治疗，主要针对支持人员，而不是 而不是年轻人自己，因此不会干扰或重叠已经广泛的 在戒毒治疗机构提供的直接服务。建议的工程计划拟对元朗段进行适应化修改， 为更大规模的后续研究提供试点疗效数据， 随机试验具体来说，我们的目标是：（1）根据利益相关者的意见（即， （2）在一个有需要的地方推行YST， 一个单一的治疗诊所，并根据客户，提供者和支持的输入修改干预措施 人，和（3）进行试点随机临床试验在四个SAMHSA资助的研究中心。为 在这项研究的第一阶段，我们打算进行六个焦点小组（两个客户，两个家庭 成员和两名临床医生）收集有关自杀的需求和偏好的信息 预防这些信息将通过专家共识纳入YST方案 会议（即，研究者、临床医生和顾问），并用于开发治疗方法 手册.在项目的第二阶段，我们将利用这一点进行小型可行性研究。 干预手册在主要研究中心（N=8），并将再次收集来自客户，供应商， 并支持人员进一步修订治疗手册。在最后阶段，我们将进行试点 在四个临床试验中心（N=70）进行的适应性YST干预的随机临床试验， 将YST干预调整为主动控制条件，包括安全规划，危机资源， 意味着限制。最近的目标将是社会联系、希望和治疗 参与，以及远端目标自杀意念和行为（例如，企图、预备 行动）。这项研究将提供针对性自杀预防的第一个临床试验数据， 人口众多。调查结果将为在自杀风险评估阶段解决自杀风险提供最佳实践。 并促进后续更大规模的随机临床试验的发展， 增加门诊部，以进一步测试调整后的YST干预措施的有效性， 变化的基本机制。

PROJECT SUMMARY / ABSTRACT Psychotic disorders are characterized by high rates of suicidal ideation and behavior, and the risk for suicide appears to be greatest during the earliest stages of psychosis. A recent meta-analysis showed that the majority of youth at clinical high-risk (CHR) for psychosis experience suicidal ideation, and that approximately one in five make at least one suicide attempt. There are, however, no suicide prevention interventions specifically tailored to the needs of transition-aged youth at CHR, and no current best practice guidelines for how to respond to suicide risk in this population. The Youth-Nominated Support Team (YST) intervention has recently been shown to reduce mortality among adolescents and is potentially highly adaptable within the context of existing CHR services. YST is intended as an adjunctive treatment and is primarily delivered towards support persons rather than the youth themselves, and therefore would not interfere or overlap with the already extensive direct services provided in CHR treatment settings. The proposed project intends to adapt the YST intervention for CHR populations and to provide pilot efficacy data for a larger subsequent randomized trial. Specifically, we aim to: (1) adapt YST for CHR based on stakeholder input (i.e., clients, family/friends, clinicians) and to develop a new treatment manual; (2) to implement YST in a single CHR clinic and to revise the intervention based on input from clients, providers, and support persons, and (3) to conduct a pilot randomized clinical trial at four SAMHSA funded CHR sites. For the first stage of this study, we intend to conduct six focus groups (two of clients, two of family members, and two of clinicians) to gather input on needs and preferences regarding suicide prevention. This information will be incorporated into the YST protocol through expert consensus meetings (i.e., study investigators, clinicians, and consultants) and used to develop a treatment manual. During the second stage of the project, we will conduct a small feasibility study using this intervention manual at the primary study site (N=8), and will again gather input from clients, providers, and support persons to further revise the treatment manual. In the final stage, we will conduct a pilot randomized clinical trial of the adapted YST intervention at four CHR clinics (N=70), comparing the adapted YST intervention to an active control condition consisting of safety planning, crisis resources, and means restriction. The proximal targets will be social connectedness, hope, and treatment engagement, and the distal targets suicidal ideation and behavior (e.g., attempts, preparatory actions). This study will provide the first clinical trial data for targeted suicide prevention among the CHR population. Findings will inform best practices for addressing suicide risk in the CHR phase of illness and facilitate the development of a subsequent larger randomized clinical trial incorporating additional CHR clinics to further test the efficacy of the adapted YST intervention and to identify underlying mechanisms of change.