SIGNIFICANCE: Our research team has published strong evidence supporting the efficacy and cost- effectiveness of the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) intervention, a brief suicide-specific intervention that begins in the emergency department (ED) and continues after the ED visit through telephone coaching. However, until we address barriers preventing ready adoption of ED-SAFE and other suicide interventions into routine clinical practice, they will remain ?on the shelf,? and suicides that otherwise could have been prevented will continue to occur. This R34 will directly address translation barriers through developing the Technology-Assisted Systems Change for Suicide Prevention (TASCS). INVESTIGATORS: The team has extensive expertise in ED-based suicide screening and assessment (Larkin, Boudreaux), user-centered technology development (Tulu, Djamasbi), tele-behavioral health (Boudreaux, Tulu), electronic health record integration (Tulu), and health economics (Clements). Longitudinal stakeholder engagement will ensure TASCS is grounded in realities of the ED, with patient, clinician, and payer perspectives. INNOVATION: The TASCS will be the first health information technology designed to enable flexible delivery of the ED-SAFE intervention components with strong fidelity and with responsiveness to the conditions and barriers present in most EDs. This will include an integrated approach to delivering components usually completed during the ED visit, such as personalized safety planning, as well as those completed after the visit, such as coaching to foster mental health treatment engagement. This R34 addresses both patient and implementation outcomes. APPROACH:
Aim 1 will use persona development, an innovative human computer interaction approach, to ensure the TASCS is intimately informed by end users.
Aim 2 will optimize the TASCS in a small field test in the ED.
Aim 3, modeled after a Hybrid Type 2 effectiveness-implementation design, will gather data on usability, acceptability, and implementation of the TASCS ED App using a randomized experiment (n=45) of three modalities: (1) On site (n=15), (2) Telehealth (n=15), and (3) Self-administered (n=15). For 3 months post- discharge, all participants will receive coaching calls, facilitated by the Post-ED Clinician App, and will have access to the Post-ED Patient and Family App. The intervention is intended to decrease suicidal ideation and behavior by improving perceived social support, increasing behavioral activation, and improving suicide-related impulse control. ENVIRONMENT: UMass and WPI have demonstrated their capability to support this study through the ED-SAFE trial and other highly successful technology development and testing studies funded through NIH and NSF. IMPACT: Building a comprehensive suite of integrated enabling technologies to address ED-SAFE translation barriers will not only improve ED-SAFE intervention adoption, it will provide a road map for how to do the same for other suicide interventions, both existing and those yet to be developed, maximizing impact on the field.

Public Health Relevance

Effective prevention of suicide among adult emergency department (ED) patients hinges on an indispensable component: the ability to translate evidence-based interventions into routine clinical practice on a broad scale and with fidelity to the intervention components so they can have a maximum public health effect. However, there are critical barriers that prevent such translation, including a lack of trained clinicians, competing priorities in busy EDs, and incompatibility between requirements of evidence-based interventions (such as completing telephone coaching with patients after the ED visit) and the workflow and infrastructure typically present in most EDs. The proposed new intervention will address these barriers by building a suite of technologies that will make it easier to implement the Emergency Department Safety Assessment and Follow-up Evaluation (ED- SAFE), an evidence-based suicide intervention targeting perceived social support, behavioral activation and impulse control, revolutionizing the field's ability to scale and implement this intervention and acting as a model for efforts to implement other existing and emerging suicide interventions.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Planning Grant (R34)
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Special Emphasis Panel (ZMH1)
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O'Connor, Stephen
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University of Massachusetts Medical School Worcester
United States
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