Planifier et Protéger : Planification de la Sécurité pour Adolescents dans les Services d'Urgence Ruraux
Développement et mise en œuvre d'une planification de sécurité culturellement adaptée pour réduire le risque de suicide chez les adolescents demandant des soins dans les services d'urgence ruraux
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 to the emergency department with suicide-related concerns.
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
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Description détaillée
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, attempt, or mental health crisis, 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 5 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 suicide-related concerns 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.
Type d'étude
Inscription (Estimé)
Phase
- N'est pas applicable
Contacts et emplacements
Coordonnées de l'étude
- Nom: Jacqueline Pogue, MPH
- Numéro de téléphone: 603-646-5614
- E-mail: jacqueline.a.pogue@dartmouth.edu
Lieux d'étude
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New Hampshire
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Claremont, New Hampshire, États-Unis, 03756
- Pas encore de recrutement
- Valley Regional Hospital
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Contact:
- JoAnna Leyenaar, MD
- Numéro de téléphone: 603-650-5000
- E-mail: joanna.k.leyenaar@hitchcock.org
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Keene, New Hampshire, États-Unis, 03431
- Recrutement
- Cheshire Medical Center
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Contact:
- Jacqueline Pogue, MPH
- Numéro de téléphone: 603-646-5614
- E-mail: jacqueline.a.pogue@dartmouth.edu
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Chercheur principal:
- Maia Rutman, MD
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Lebanon, New Hampshire, États-Unis, 03756
- Recrutement
- Dartmouth-Hitchcock Medical Center
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Contact:
- Jacqueline Pogue, MPH
- Numéro de téléphone: 603-646-5614
- E-mail: jacqueline.a.pogue@dartmouth.edu
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Chercheur principal:
- Maia Rutman, MD
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Lebanon, New Hampshire, États-Unis, 03766
- Recrutement
- Alice Peck Day Memorial Hospital
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Chercheur principal:
- Maia Rutman, MD
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Contact:
- Jacqueline A Pogue, MPH
- Numéro de téléphone: 603-646-5614
- E-mail: jacqueline.a.pogue@dartmouth.edu
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New London, New Hampshire, États-Unis, 03257
- Recrutement
- New London Hospital
-
Contact:
- Jacqueline Pogue, MPH
- Numéro de téléphone: 603-646-5614
- E-mail: jacqueline.a.pogue@dartmouth.edu
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Chercheur principal:
- Maia Rutman, MD
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-
Vermont
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Windsor, Vermont, États-Unis, 05089
- Recrutement
- Mount Ascutney Hospital
-
Contact:
- Alexis Cardone, MD
- Numéro de téléphone: 603-650-5000
- E-mail: Alexis.C.Cordone@hitchcock.org
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-
Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
Inclusion criteria 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
Exclusion criteria 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
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Recherche sur les services de santé
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
|
Expérimental: 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 |
Plan and Protect (P&P) is a tablet-based, family-centered quality improvement program targeted to rural Northern New England that combines a youth-facing safety-planning module with a caregiver-facing home safety decision aid and youth safety information. The goal is to help adolescents and their caregivers develop concrete, culturally-sensitive safety plans during emergency department visits. |
|
Autre: 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 |
Adolescents and caregivers will receive treatment as usual at the Emergency Department. |
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Improved Home Safety (caregiver)
Délai: 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. |
30 and 90 days after ED visit
|
|
Suicide Risk (youth)
Délai: 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. Primary outcome will be assessed relative to the baseline assessment assessed at the time of study enrollment. |
30 and 90 days after ED visit
|
Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Suicide Events (youth)
Délai: 30 and 90 days after ED visit
|
A composite measure that includes suicide deaths (ascertained by family report and electronic health record (EHR) review), return ED visits and/or rehospitalization for suicidality (ascertained using survey and EHR review), and suicide attempts (evaluated using four questions from the Youth Risk Behavior Survey augmented by structured EHR review). |
30 and 90 days after ED visit
|
|
Attendance at Follow-up Mental Healthcare (youth and caregiver)
Délai: 30 and 90 days after ED visit
|
Any mental or emotional health care received after their emergency department visit using a checklist adapted from nationally administered healthcare utilization surveys, augmented by EHR review. Survey response categories (primary care, mental health provider, outpatient/urgent care, emergency department, school based care) were derived from health service use domains captured in the Medical Expenditure Panel Survey. |
30 and 90 days after ED visit
|
|
Reduced Access to Firearms at Home (caregiver)
Délai: 30 and 90 days after ED visit
|
Improved home safety with respect to firearm access. This will be collected with three questions about presence of firearms at home, if they are stored unlocked, and if they are loaded. We will measure improvement in safety across the time frame. |
30 and 90 days after ED visit
|
|
Reduced Access to Medications at Home (caregiver)
Délai: 30 and 90 days after ED visit
|
Improved home safety with safer storage of medications. This will be collected with two questions about presence of medications at home and if they are stored unlocked. We will measure improvement in safety across the time frame. |
30 and 90 days after ED visit
|
|
Pessimism (youth)
Délai: 30 and 90 days post-ED visit
|
A 2-item subscale of the Concise Health Risk Tracking (CHRT) that measures negative outlook, with response options ranging 0-4. Total scores range 0-8, with higher scores indicating greater pessimism. |
30 and 90 days post-ED visit
|
|
Helplessness (youth)
Délai: 30 and 90 days after ED visit
|
A 2-item subscale of the Concise Health Risk Tracking (CHRT) that measures perceived lack of self-control, with response options ranging 0-4. Total scores range 0-8, with higher scores indicating greater feelings of helplessness. |
30 and 90 days after ED visit
|
|
Despair (youth)
Délai: 30 and 90 days after ED visit
|
A 2-item subscale of the Concise Health Risk Tracking (CHRT) that measures despair, with response options ranging 0-4. Total scores range 0-8, with higher scores indicating more severe discouragement. |
30 and 90 days after ED visit
|
|
Suicidal thoughts (youth)
Délai: 30 and 90 days after ED visit
|
A 3-item subscale of the Concise Health Risk Tracking (CHRT) that measures suicidal thoughts and planning, with response options ranging 0-4. Total scores range 0-12, with higher scores indicating increased suicidal thoughts and planning. |
30 and 90 days after ED visit
|
Autres mesures de résultats
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Change in Efficacy to Cope with Suicidal Thoughts and Urges Scale (primary target mechanism)
Délai: 30 and 90 days after ED visit
|
The Efficacy to Cope with Suicidal Thoughts and Urges Scale was designed to measure children's abilities to manage suicide-related thoughts and impulses. It contains 10 coping skills and children rate their confidence in their ability to use each coping skill to manage their suicidality. Responses range from 0 to 10 with 0 = Not at all confident, 5 = Somewhat confident, and 10 = Extremely confident. |
30 and 90 days after ED visit
|
|
Change in Parental Perceptions of Teen Suicide Risk (secondary target mechanism)
Délai: 30 and 90 days after ED visit
|
This 3-item measure looks at parental understanding of their teen's suicide risk. Answer choices range from 0 (not at all confident) to 10 (completely confident), with an anchor of 5 (somewhat confident). |
30 and 90 days after ED visit
|
|
Change in Patient Perceptions of Their Own Suicide Risk (secondary target mechanism)
Délai: 30 and 90 days after ED visit
|
This 3-item self-report measure examines how at risk a patient believes they are. It is scored on a 5-point Likert from 0-4 where higher = greater perceived risk and has a total possible score of 15. |
30 and 90 days after ED visit
|
|
Change in Parental Self-Efficacy to Support Teens During a Suicidal Crisis (secondary target mechanism)
Délai: 30 and 90 days after ED visit
|
This 9-item scale measures parent confidence regarding their ability to engage in activities to prevent or assist their child in managing a suicidal crisis. Answer choices range from 0 (not at all confident) to 10 (completely confident), with an anchor of 5 (somewhat confident). |
30 and 90 days after ED visit
|
Collaborateurs et enquêteurs
Parrainer
Les enquêteurs
- Chercheur principal: JoAnna K Leyenaar, MD, PhD, MPH, Dartmouth College
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude (Réel)
Achèvement primaire (Estimé)
Achèvement de l'étude (Estimé)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Réel)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- STUDY02002568
- 5R01NR021638-02 (Subvention/contrat des NIH des États-Unis)
Plan pour les données individuelles des participants (IPD)
Prévoyez-vous de partager les données individuelles des participants (DPI) ?
Description du régime IPD
Data will be uploaded into the NIMH Data Archive (NDA).
Data will be collected from approximately 275 adolescents 12-17 years of age and 275 parents or caregivers. Measures include:
- Sociodemographic characteristics of adolescents and caregivers
- Follow-up mental health care
- DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure for Youth Self-report
- Efficacy to Cope with Suicidal Thoughts and Urges Scale for Youth Self-report
- Self-Assessed Expectations of Suicide Risk for Youth
- Parental Self-Efficacy to Support Teens During a Suicidal Crisis
- Concise Health Risk Tracking - Self-Report (CHRT-SR)
- Caregiver and adolescent-reported firearms in home/on property (yes/no) and firearm storage practices
- Caregiver- and adolescent-reported medications in home (yes/no) and medication storage practices
Délai de partage IPD
All data will be deposited to NDA starting 12 months after the award begins and will be deposited every six months thereafter following the usual NDA data submission dates.
Critères d'accès au partage IPD
Per NDA access requirements and protocols.
Type d'informations de prise en charge du partage d'IPD
- PROTOCOLE D'ÉTUDE
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