Development & Implementation of Culturally Sensitive Safety Planning to Reduce Suicide Risk in Adolescents Seeking Care in Rural Emergency Departments
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 550
- 试验地点
- 7
- 主要终点
- Improved home safety (parent and youth)
研究概览
简要总结
The goal of this observational study is to determine whether implementing a culturally sensitive, tablet-based safety planning program called Plan & Protect (P&P) within rural emergency departments can improve home safety and reduce suicide risk in adolescents presenting with suicidality.
The main questions it aims to answer are:
- Will implementing P&P increase caregiver-reported home safety (reduce access to firearms and unsafe medication storage) for adolescents 12-17 years old presenting to rural EDs with suicidal ideation, self-harm, or mental health crisis?
- Will implementing P&P decrease adolescent-reported perceived suicide risk and related outcomes (e.g., suicide events, and attendance at follow-up mental healthcare)?
Researchers will compare outcomes for adolescents and caregivers receiving P&P (implemented as the new standard of care at sites during the intervention periods) to those receiving usual care (prior to P&P implementation at those hospitals) to see if P&P increases home safety and decreases suicide risk and related healthcare utilization.
Participants will, if clinically appropriate:
- Complete the tablet-based P&P modules during their ED visit
- Complete self-report measures at baseline, ~30 days, and ~3 months post-discharge
- A subset will also participate in semi-structured interviews
详细描述
One-in-five children and adolescents in the United States (US) live in rural areas where they are more likely to live in poverty, have neurodevelopmental, behavioral and mental health conditions, and die during childhood than their urban-residing peers. Suicide is a leading cause of childhood mortality, and rural-residing youth are two times more likely to die from suicide than urban-residing youth. Nearly half of children and adolescents with mental health conditions do not receive treatment, and those in rural areas face unique barriers to care due to geographic isolation, stigma, and shortages of pediatric services and clinicians. Given barriers to community-based mental healthcare, youth with suicidal ideation and/or suicide attempt (hereafter "suicidality") increasingly present to emergency departments (EDs) for care. However, most clinicians practicing in rural EDs are under-prepared and under-resourced to care for this population.
In order to fill this gap, this project aims to improve home safety and decrease suicide risk in youth 12-17 years of age who present to rural EDs with suicidal ideation or attempt, leveraging community-based participatory research approaches and technology to implement, with high fidelity, culturally-sensitive and nationally recommended safety planning procedures. To achieve this goal, we will integrate P&P, a culturally sensitive, tablet-based safety planning program as a quality improvement intervention at 4 hospitals in the Dartmouth Health network using a hospital-randomized stepped wedge design and will evaluate the program using a type 1 hybrid implementation-effectiveness design.
Aim: To determine the effectiveness of P&P compared to usual care for youth with suicidality and their caregivers to increase home safety and decrease suicide risk; evaluate the extent to which these outcomes are mediated by caregiver and youth self-efficacy and expectations of suicide risk; and assess the reach, effectiveness, adoption, implementation and maintenance of P&P using a mixed methods approach.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 12 Years 至 17 Years（Child）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •for children:
- •12-17 years of age (and their parent/caregiver(s))
- •Ability to speak and complete surveys in English
- •History of emergency department visit for suicidality, self-harm or mental health crisis
- •Medically stable
排除标准
- •for children:
- •Cognitive or developmental delays that preclude program participation based on clinical team assessment
- •Diagnosis of psychosis
- •Primary diagnosis of an eating disorder
- •Parent/guardian not able to provide consent in English
- •Clinical team concern for patient or staff safety based upon active behavioral concerns
- •Parent/guardian not available to provide consent (e.g youth is in child protective custody/ward of the state)
- •Inclusion criteria for parents/caregivers:
- •Parent or caregiver of an eligible child
- •18 years old or older
- •Ability to speak and complete surveys in English
- •Exclusion criteria for parents/caregivers:
- •Inability to understand key aspects of the study
研究组 & 干预措施
Plan & Protect
Plan and Protect is a tablet-based program that integrates a youth-facing safety-planning module with a caregiver-facing home safety planning decision aid to create culturally sensitive, locally tailored safety plans and promote caregiver engagement in home safety during rural ED visits for adolescent suicidality
干预措施: Plan & Protect safety planning intervention (Behavioral)
Care as usual
Outcomes for adolescents and their caregivers enrolled during the pre-implementation (usual care) periods at each hospital will be compared to outcomes for those enrolled after their hospital implements the P&P program as quality improvement
干预措施: Care as usual (Behavioral)
结局指标
主要结局
Improved home safety (parent and youth)
时间窗: 30 and 90 days after ED visit
Reduced access to firearms and medications at home. This will be collected with five questions about presence of medications and firearms at home, if they are stored unlocked, and if firearms are loaded. We will measure improvement in safety across the time frame.
Improved home safety (parent and youth)
时间窗: 30 and 90 days after ED visit
Reduced access to firearms and medications at home. This will be collected with five questions about presence of medications and firearms at home, if they are stored unlocked, and if firearms are loaded. We will measure improvement in safety across the time frame.
Concise Health Risk Tracking 9-item measure (youth)
时间窗: 30 and 90 days after ED visit
The Concise Health Risk Tracking (CHRT) is a 9-item survey that assesses suicidal thoughts and behaviors in the past week, with response options ranging 0-4. Total scores range 0-36, with higher scores indicating more severe suicidality.
次要结局
- Suicide Events (youth)(30 and 90 days after ED visit)
- Reduced Access to Medications at Home (parent and youth)(30 and 90 days after ED visit)
- Youth Mental Health Care Utilization (parent and youth)(30 and 90 days following ED visit)
- Suicide Events (youth)(30 and 90 days after ED visit)
- Mental Health Care Utilization (parent and youth)(30 and 90 days following ED visit)
- Reduced Access to Firearms at Home (parent and youth)(30 and 90 days after ED visit)
- Reduced Access to Medications at Home (parent and youth)(30 and 90 days after ED visit)
研究者
JoAnna K. Leyenaar
Professor of Pediatrics, Professor of the Dartmouth Institute
Trustees of Dartmouth College