1/2 Brief Intervention for Suicide Risk Reduction in High Risk Adolescents

描述（由申请方提供）：我们提出了一项2中心R34，用于开发一种简短、灵活、手动干预，支持手机应用程序，以降低从住院治疗过渡到门诊治疗期间具有高度自杀意念或近期自杀企图的青少年的自杀行为风险。这个过渡期是自杀未遂和自杀未遂的最高风险期。自杀是青少年死亡的第三大原因，目前还没有针对自杀青少年的既定干预措施。通过开发一种可以在过渡到门诊治疗之前在住院部提供的治疗，我们预计 能够降低自杀风险并增加参与者参加后续门诊治疗的可能性。为了与NIMH的优先事项保持一致，这种旨在降低自杀和自杀行为风险的干预措施将被诊断。我们称之为“尽快”干预，包括预期的组成部分：（1）坚持-通过动机访谈促进参与和坚持治疗;（2）安全计划;（3）情感保护-从一系列保持积极情感的技术中选择（例如，品味和转换策略，动员社会支持，保持清醒，改善睡眠）。这些组件中的每一个都将在动机访谈框架内提供，以增强变革的内在动机。治疗是短暂的（6-8小时），并灵活地提供住院单位或在开始门诊治疗之前的家访。ASAP增加了防止复发性自杀行为的保护因素，并将家庭纳入治疗。安全计划 还将开发手机应用程序，以扩大治疗的影响。创新的特点包括：（1）在自杀风险最高的时间和地点提供干预措施;（2）加强 预防复发性自杀行为的保护因素，特别是通过促进积极情感的发展，健康的睡眠和社会支持;（3）安全计划手机应用程序，以扩大治疗的影响;（4）与门诊治疗师联系，以确保护理的连续性。具体目标是5个治疗开发阶段：（1）在每个研究中心与5名自杀青少年及其父母和5名临床医生进行开放式半结构化访谈，了解拟议治疗的拟议内容和背景;（2）开发ASAP模块、依从性/能力测量和电话应用程序，并重复开放式访谈;（3）在10名青少年中进行ASAP开放试验（4）听取患者和家属、住院和门诊服务提供者的汇报， 对自杀风险的近端指标进行治疗，并进行相应的修订;（5）在80名自杀青少年中进行ASAP后护理（AC）与AC单独治疗的RCT（两个站点），以确定ASAP的可行性，可接受性，对近端目标的影响（例如，坚持门诊治疗、睡眠、积极情感、物质使用）、自杀意念和行为。ASAP是与社区临床医生共同开发的，并旨在为社区临床医生提供服务，它有可能成为一种可持续的干预措施，以减轻青少年自杀的负担。

DESCRIPTION (provided by applicant): We propose a 2-site R34 to develop a brief, flexible, manualized intervention with supporting phone app to reduce the risk of suicidal behavior in adolescents with high suicidal ideation or a recent suicide attempt, during the transition from inpatient to outpatient care. This transition period is the highest risk period for attempted and completed suicide. Suicide is the 3rd leading cause of adolescent mortality, and there are currently no established interventions for suicidal teens. By developing a treatment that can be delivered on an inpatient unit prior to the transition to outpatient treatment, we anticipate being able to lower suicidal risk and increase the likelihood that participants will attend subsequent outpatient treatment. In keeping with the priorities of NIMH, this intervention aimed at reducing the risk of suicide and suicidal behavior will be trans-diagnostic. We term the intervention ASAP, with anticipated components: (1) Adherence- promoting engagement and adherence to treatment through motivational interviewing; (2) Safety planning; and (3) Affect Protection- selecting from a menu of techniques for maintaining positive affect (e.g. savoring and switching strategies, mobilizing social support, maintaining sobriety, and improving sleep). Each of these components will be delivered within a Motivational Interviewing framework for enhancing intrinsic motivation for change. Treatment is brief (6-8 hours), and flexibly delivered on inpatien units or in home visits prior to initiation of outpatient treatment. ASAP augments protective factors against recurrent suicidal behavior and includes the family in the treatment. A safety plan phone app to extend the impact of treatment will also be developed. Innovative features include: (1) delivery of an intervention at a time and place when suicidal risk is highest; (2) augmentation of protective factors against recurrent suicidal behavior, specifically by promoting development of positive affect, healthy sleep and social support; (3) a Safety plan phone app to extend the impact of treatment; and (4) liaison with the outpatient therapist to ensure continuity of care. Th specific aims are 5 treatment development phases: (1) Open semi-structured interviews with 5 suicidal teens and parents and 5 clinicians at each site on the proposed content and context of the proposed treatment; (2) Develop the ASAP modules, adherence/competence measures, and phone app, and repeat open interviews; (3) Open trial of ASAP in 10 adolescents (5 at each site); (4) Debrief patients and families, inpatient and outpatient providers, examine the impact of treatment on proximal indicators of suicidal risk, and revise accordingly; (5) Conduct an RCT of ASAP followed by Aftercare (AC) vs. AC alone in 80 suicidal teens (across both sites) to determine ASAP's feasibility, acceptability, impact on proximal targets (e.g., adherence to outpatient care, sleep, positive affect, substance use), suicidal ideation and behavior. ASAP, developed with and intended for community clinicians, has the potential to be a sustainable intervention to reduce the burden of adolescent suicidality.