Document text
Principal Investigator: Maria A Oquendo
Organization: UNIVERSITY OF PENNSYLVANIA
Fiscal Year: 2024
Award: $295,155
Funding agency: National Institute of Mental Health
PROJECT SUMMARY
Suicide is inherently an affectively charged topic and clinicians often experience anxiety and low self-efficacy in
detecting and intervening with those at risk. This anxiety leads to poor implementation of evidence-based suicide
screening, assessment, and interventions (SSAIs). Clinician anxiety and low self-efficacy related to SSAI use
are thus candidate targets for implementation strategy design to optimize SSAI uptake in diverse mental health
settings. This exploratory project brings together an interdisciplinary team to leverage decades of research on
behavior change from exposure theory to design and pilot-test an exposure-based implementation strategy
(EBIS) to target clinician-level anxiety about SSAI use. We will test the effect of EBIS as an implementation
strategy to augment Implementation as Usual (IAU) to enhance SSAI implementation in community mental health
settings. Specifically, Aim 1 will use participatory design methods to develop and refine EBIS in collaboration
with a stakeholder advisory board of clinicians, administrators, and content experts. In Aim 2, we will further
iteratively refine EBIS with up to 15 clinicians in a pilot field test, using rapid cycle prototyping, in collaboration
with the INSPIRE Methods Core. Clinicians in Aim 2 will also provide qualitative feedback on EBIS’ ability to
mitigate anxiety and increase self-efficacy to deliver SSAIs to optimize our ability to engage target mechanisms
of clinician anxiety. Aim 3 will test the refined EBIS in a pilot implementation trial in which 40 community mental
health clinicians will be randomized to receive either IAU or EBIS+IAU. Primary Aim 3 dependent variables are
EBIS acceptability and feasibility, measured through questionnaires, interviews, and recruitment and retention
statistics; this pilot trial is not intended to be powered to detect effects. Secondary outcomes are preliminary
effectiveness of EBIS on implementation outcomes (SSAI adoption and fidelity), and engagement of target
implementation mechanisms (clinician anxiety and self-efficacy related to SSAI use), assessed via mixed
methods (questionnaires, chart-stimulated recall, observer-coded role plays, and interviews). We have two
exploratory hypotheses, which we will evaluate via mixed methods: (1) EBIS will engage target implementation
mechanisms by lowering anxiety and increasing self-efficacy better than IAU; (2) Clinicians randomized to EBIS
will show improved SSAI adoption and fidelity. We also will gather data on other possible implementation
mechanisms using questionnaires and qualitative interviews to probe for contextual implementation barriers to
SSAI use not addressed by EBIS to inform augmentation prior to fully powered evaluation.
This project addresses a major gap in the implementation of suicide prevention evidence-based practices by
developing a novel implementation strategy to augment IAU that targets mutable implementation mechanisms
unique to SSAI use. Study goals are consistent with NIMH research priorities and aligned with the overall mission
of INSPIRE. Results will inform a fully powered R01 to test EBIS’ effect on implementation and patient outcomes.
Terms: <Active Follow-up><Address><Administrator><Adoption><Affective><Anxiety><Assessment instrument><Assessment tool><Augmented Reality><COVID-19><CV-19><Charge><Code><Coding System><Cognition Therapy><Cognitive><Cognitive Psychotherapy><Cognitive Therapy><Cognitive treatment><Collaborations><Combined Modality Therapy><Communities><Complex><Consultations><Coronavirus Infectious Disease 2019><Data><Disparity population><Effectiveness><Evaluation><Evidence based practice><Exposure to><Fear><Feedback><Fright><Goals><Hospital Admission><Hospitalization><Iatrogenesis><Individual><Intervention><Intervention Strategies><Interview><Legal><Life><Measures><Mental Health><Mental Hygiene><Methods><Mission><Modeling><Multimodal Therapy><Multimodal Treatment><NIMH><National Institute of Mental Health><Outcome><Patient outcome><Patient risk><Patient-Centered Outcomes><Patient-Focused Outcomes><Patients><Phase><Play><Preventative intervention><Provider><Psychological Health><Questionnaires><Randomization trial><Randomized><Research><Research Methodology><Research Methods><Research Priority><Risk><Role><Safety><Scientist><Self Efficacy><Severities><Standardization><Stimulus><Suicide><Suicide attempt><Suicide precaution><Suicide prevention><Survey Instrument><Surveys><Technology><Testing><Time><Training><Uncertainty><Work><acceptability and feasibility><active followup><anxious><barriers to implementation><behavior change><behavior influence><behavioral influence><cognitive behavior intervention><cognitive behavior modification><cognitive behavior therapy><cognitive behavioral intervention><cognitive behavioral modification><cognitive behavioral therapy><cognitive behavioral treatment><combination therapy><combined modality treatment><combined treatment><confirmatory efficacy trial><confirmatory trial><consultation><context for implementation><coronavirus disease 2019><coronavirus disease-19><coronavirus infectious disease-19><cost><design><designing><disadvantaged group><disadvantaged individual><disadvantaged people><disadvantaged population><disadvantaged subgroup><disparities across groups><disparity across subgroups><disparity among groups><disparity among subgroups><disparity between groups><disparity between subgroups><doubt><evidence base><experience><fatal attempt><fatal suicide><field based data><field learning><field study><field test><follow up><follow-up><followed up><followup><group disparity><group inequality><group inequity><high risk><iatrogenic><iatrogenically><iatrogenicity><implementation barriers><implementation challenges><implementation context><implementation design><implementation intervention><implementation outcomes><implementation research><implementation research design><implementation strategy><implementation trial><improved><in vivo><inequalities among populations><inequalities between populations><inequalities in populations><inequality across populations><inequality among groups><inequality between groups><inequality in groups><inequities among populations><inequities between populations><inequities in populations><inequity across groups><inequity across populations><inequity between groups><inequity in groups><innovate><innovation><innovative><intent to die><intervention for prevention><interventional strategy><multi-modal therapy><multi-modal treatment><non fatal attempt><nonfatal attempt><novel><patient oriented outcomes><pilot test><pilot trial><population inequality><population inequity><prevent relapse><prevent suicidality><prevent suicide><prevention intervention><preventional intervention strategy><preventive intervention><prototype><provider barriers><provider-level barriers><psychoeducation><randomisation><randomization><randomized trial><randomly assigned><recruit><relapse prevention><research and methods><scale up><screening><screenings><secondary outcome><social role><statistics><strategies for implementation><subgroup disparity><suicidal attempt><suicidal risk><suicidality prevention><suicide intervention><suicide rate><suicide risk><suicides><theories><unequal group><unequal population><uptake><virtual reality>