Safety Planning Intervention Telehealth Service Model in Emergency Departments

Официальное название

A Safety Planning Intervention and Follow-up Telehealth Service Model for Suicidal Individuals in Emergency Department Settings

Обзор

The purpose of this study is to evaluate the effectiveness and implementation of a suicide prevention strategy delivered via telehealth in Emergency Departments. We will compare implementation of the Safety Planning Intervention plus follow-up calls (SPI+) delivered by Emergency Department (ED) staff to SPI+ delivered via ED referral to an off-site Suicide Prevention Consultation Center (SPCC).

Подробное описание

Individuals at high risk for suicide often present to acute care settings, such as emergency departments (EDs), and then typically are hospitalized or referred for outpatient mental health treatment. Patients are at increased risk of suicide attempts and suicide following an ED visit and nearly half do not attend outpatient treatment. Brief, evidence-based clinical interventions, such as the Safety Planning Intervention with post-discharge telephone follow-up (SPI+), can reduce suicide risk, decrease hospitalizations, and increase engagement in outpatient services for suicidal patients discharged from the ED. Leveraging insights from implementation science and collaborative care, we propose a model in which ED staff will connect patients at risk for suicide to ED-credentialed mental health clinicians who are located external to the ED. These off-site clinicians will provide SPI+ via telehealth for ED patients prior to discharge and provide follow-up services after ED discharge as part of an innovative Suicide Prevention Consultation Center (SPCC). All participating EDs will begin in the Enhanced Usual Care phase, in which ED staff will deliver SPI+ to suicidal patients. EDs will then be randomized in pairs to begin referral to the SPCC in 3 month intervals. We will also conduct a cost evaluation to help determine scalability and sustainability.

Вмешательства

• Поведенческое SPI+ Delivered by ED Staff
  ED staff will deliver SPI+ (Safety Planning Intervention plus follow-up phone calls) to patients at risk for suicide in the ED who are not admitted to an inpatient unit.
• Поведенческое SPI+ Delivered by SPCC Clinicians
  The Suicide Prevention Consultation Center (SPCC) will be located external to the Emergency Department (ED). ED staff will be able to refer patients at risk for suicide to the SPCC. Licensed and credentialed mental health clinicians will deliver SPI+ (Safety Planning Intervention plus follow-up phone calls) via telehealth to patients at risk for suicide in the ED who are not admitted to an inpatient unit.

Первичные конечные точки

• Suicide Behavior Composite [Срок оценки: 6 months after index ED visit]
• Outpatient Treatment Engagement - Count [Срок оценки: 6 months after index ED visit]
• Outpatient Treatment Engagement - Type [Срок оценки: 6 months after index ED visit]
• Safety Planning Intervention Scoring Algorithm (SPISA) [Срок оценки: At index ED visit]
• Fidelity of Follow-up Calls [Срок оценки: 1 month after index ED visit]
• Reach/Penetration of Safety Plans [Срок оценки: At index ED visit]
• Reach/Penetration of Follow-up Calls [Срок оценки: 1 month after index ED visit]

Вторичные конечные точки (9)

• Suicide-related ED Visits and Psychiatric Hospitalizations [Срок оценки: 6 months after index ED visit]
• Suicide Attempts [Срок оценки: 6 months after index ED visit]
• Adoption [Срок оценки: At index ED visit]
• Utilization of Screening of Suicide Risk Among ED Patients [Срок оценки: At index ED visit]
• Index ED Visit Inpatient Admission Disposition [Срок оценки: At index ED visit]
• Feasibility of SPCC [Срок оценки: 9-12 months after ED crosses over to SPCC condition]
• Acceptability of SPCC [Срок оценки: 9-12 months after ED crosses over to SPCC condition]
• Cost to Emergency Department of SPCC [Срок оценки: After ED crosses over to SPCC condition (2.25 - 3 year range, average of 2.625 years)]
• Cost to Emergency Department of EUC [Срок оценки: Before ED crosses over to SPC condition (1 - 1.75 year range, average of 1.375 years)]

Критерии участия

Aim 1/Aim 3:

Критерии включения

• ED visit at one of our participating sites for a suicide-related event or determined to be at risk for suicide per the Electronic Health Record (EHR) and ED clinical staff
• 18 years of age or older
• Not admitted to an inpatient hospital following the index ED visit as documented in the EHR

Критерии исключения

\- Inpatient admission following the index ED visit per the EHR

Aim 2:

Критерии включения

• ED clinician or leader at one of our participating sites, or ED patient who was referred to the SPCC
• 18 years of age or older
• Able to communicate in English
• Willing to give informed consent

Критерии исключения

• Patients who are at imminent risk of suicide or acutely psychotic at the time of the interview, requiring emergency services and/or precluding ability to provide informed consent
• Patients without a phone for contact

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Перекрёстный дизайн

Маскирование

Простое слепое

Основная цель

Организация здравоохранения

Центры проведения

США · 1 центр

• University of Pennsylvania Health System — Philadelphia

Идентификаторы

NCT: NCT05307432 · 850636 · 1P50MH127511-01

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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