This integrated research and training plan will prepare Dr. Ranney, a fellowship-trained, practicing emergency physician, to become an independently funded physician-researcher with expertise in emergency department (ED)-based mental health interventions. Dr. Ranney's long-term research goal is to become an expert in developing effective, easily-disseminated, technology-augmented mental health interventions for high-risk ED patients. Her short-term goals, for this K23 Mentored Patient Oriented Career Development Award, are to (1) gain expertise in the development and evaluation of technology-augmented ED depression interventions, and (2) to test the hypothesis that a brief in-ED + longitudinal text-message (""""""""ED+text"""""""") indicated depression prevention intervention is acceptable and feasible for high-risk youth. Depressive symptoms and peer violence are common, significant, and strongly correlated causes of morbidity, mortality, and ED visits among adolescents. The ED is often the primary source of care for high-risk youth with depressive symptoms and history of peer violence. The ED is well established as a location for mental health intervention, yet few resources are available to high-risk youth. Most adolescent ED patients use text-messaging. Text-message behavioral change has been shown effective. In this project, Dr. Ranney and mentors will develop and pilot a single-session in-ED + 8 week longitudinal text-message program (""""""""ED+text"""""""") to reduce depressive symptoms, for adolescent ED patients with depressive symptoms and a history of peer violence. Under the guidance of a strong mentorship team of NIH-funded researchers, Dr. Ranney will achieve five specific training goals: (1) Gain advanced training in ED-based mental health research, focusing on the link between depression and violence;(2) Develop expertise in use of technology, particularly text-messaging, to enhance intervention delivery and evaluation;(3) Become a skilled user of qualitative research methodology to inform intervention development;(4) Learn how to design and conduct a clinical trial of an ED-based depression prevention intervention;(5) Develop skills in longitudinal data analysis for clinical trials. Dr. Ranney's training activities will be complemented by an innovative research plan allowing practical application of her new skills. Using a staged approach, Dr. Ranney will, first, conduct focus groups to develop our innovative """"""""ED+text"""""""" intervention content;next, refine the intervention through an iterative process of open trials;finally, test the acceptability and feasibility of the intervention through a randomized piot study (n=100). This work is a crucial step toward preventing depression and co-occurring disorders among a high-risk population that does not typically seek out services. It addresses a current lack of easily-accessible preventive interventions, addressing NIMH Strategic Objectives 3 (treatment development for diverse populations) and 4 (strengthening public health impact), as well as critical Adolescent and Mental Health objectives of Healthy People 2020.

Public Health Relevance

Depression and peer violence are significant, interrelated public health problems for adolescents. Although NIMH and Healthy People 2020 call for their prevention, this high-risk population is difficult to engage in traditional mental health care. Thi career development grant will allow Dr. Ranney to develop an innovative technology-augmented depression prevention intervention for high-risk adolescents seen in the emergency department.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (SERV)
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Hill, Lauren D
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Rhode Island Hospital
United States
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Ranney, Megan L; Patena, John V; Nugent, Nicole et al. (2016) PTSD, cyberbullying and peer violence: prevalence and correlates among adolescent emergency department patients. Gen Hosp Psychiatry 39:32-8
Ranney, Megan L; Freeman, Joshua R; Connell, Gerianne et al. (2016) A Depression Prevention Intervention for Adolescents in the Emergency Department. J Adolesc Health 59:401-10
Birnbaum, Faith; Lewis, Dana; Rosen, Rochelle K et al. (2015) Patient engagement and the design of digital health. Acad Emerg Med 22:754-6
Choo, Esther K; Garro, Aris C; Ranney, Megan L et al. (2015) Qualitative Research in Emergency Care Part I: Research Principles and Common Applications. Acad Emerg Med 22:1096-102
Ranney, Megan L; Meisel, Zachary F; Choo, Esther K et al. (2015) Interview-based Qualitative Research in Emergency Care Part II: Data Collection, Analysis and Results Reporting. Acad Emerg Med 22:1103-12
Carreiro, Stephanie; Smelson, David; Ranney, Megan et al. (2015) Real-time mobile detection of drug use with wearable biosensors: a pilot study. J Med Toxicol 11:73-9
Bohnert, Kipling M; Walton, Maureen A; Ranney, Megan et al. (2015) Understanding the service needs of assault-injured, drug-using youth presenting for care in an urban Emergency Department. Addict Behav 41:97-105
Ranney, Megan L; Limkakeng Jr, Alexander T; Carr, Brendan et al. (2015) Improving the Emergency Care Research Investigator Pipeline: SAEM/ACEP Recommendations. Acad Emerg Med 22:849-51
Cunningham, Rebecca M; Carter, Patrick M; Ranney, Megan et al. (2015) Violent reinjury and mortality among youth seeking emergency department care for assault-related injury: a 2-year prospective cohort study. JAMA Pediatr 169:63-70
Ranney, Megan L; Suffoletto, Brian (2014) Extending our reach: use of mHealth to support patients after emergency care. Ann Emerg Med 63:755-6

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