Department of Pediatrics, Dartmouth Health Children's, Lebanon, New Hampshire; The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
Department of Pediatrics, Dartmouth Health Children's, Lebanon, New Hampshire.
J Adolesc Health. 2023 Jun;72(6):923-932. doi: 10.1016/j.jadohealth.2023.01.015. Epub 2023 Mar 3.
Youth with suicidality requiring psychiatric hospitalization may first experience boarding at acute care hospitals. Given infrequent provision of therapy during this period, we developed a modular digital intervention (I-CARE; Improving Care, Accelerating Recovery and Education) to facilitate delivery of evidence-based psychosocial skills by non-mental health clinicians. This pilot study describes changes in emotional distress, severity of illness, and readiness for engagement following I-CARE participation, and evaluates the feasibility, acceptability, and appropriateness of I-CARE.
A mixed-methods approach was used to evaluate I-CARE, offered to youth 12-17 years from 11/21 to 06/22. Changes in emotional distress, severity of illness, and engagement readiness were evaluated using paired t-tests. Semistructured interviews with youth, caregivers, and clinicians were conducted concurrently with collection of validated implementation outcome measures. Quantitative measure results were linked to interview transcripts, which were analyzed thematically.
Twenty-four adolescents participated in I-CARE; median length of stay was 8 days (IQR:5-12 days). Emotional distress decreased significantly by 6.3 points (63-point scale) following participation (p = .02). The increase in engagement readiness and decrease in youth-reported illness severity were not statistically significant. Among 40 youth, caregivers, and clinicians who participated in the mixed-methods evaluation, 39 (97.5%) rated I-CARE as feasible, 36 (90.0%) as acceptable, and 31 (77.5%) as appropriate. Adolescents' prior knowledge of psychosocial skills and clinicians' competing demands were reported barriers.
I-CARE was feasible to implement and youth reported reduced levels of distress following participation. I-CARE has the potential to teach evidence-based psychosocial skills during boarding, which may provide a head-start on recovery before psychiatric hospitalization.
有自杀倾向需要精神科住院治疗的年轻人可能首先在急症医院接受住院治疗。由于在此期间很少提供治疗，我们开发了一种模块化数字干预措施（I-CARE；改善护理、加速康复和教育），以方便非心理健康临床医生提供循证心理社会技能。这项试点研究描述了 I-CARE 参与后情绪困扰、疾病严重程度和参与准备度的变化，并评估了 I-CARE 的可行性、可接受性和适当性。
采用混合方法评估 I-CARE，于 2021 年 11 月 21 日至 2022 年 6 月 22 日期间向 12-17 岁的年轻人提供。使用配对 t 检验评估情绪困扰、疾病严重程度和参与准备度的变化。同时收集验证后的实施结果测量数据，对青少年、照顾者和临床医生进行半结构化访谈。定量测量结果与访谈记录相关联，对访谈记录进行主题分析。
共有 24 名青少年参与了 I-CARE；中位住院时间为 8 天（IQR：5-12 天）。参与后情绪困扰显著下降 6.3 分（63 分制）（p=0.02）。参与准备度的提高和青少年报告的疾病严重程度的降低没有统计学意义。在参加混合方法评估的 40 名青少年、照顾者和临床医生中，39 名（97.5%）认为 I-CARE 是可行的，36 名（90.0%）是可以接受的，31 名（77.5%）是适当的。青少年对心理社会技能的先前了解和临床医生的竞争需求被报告为障碍。
I-CARE 实施可行，参与后青少年报告的压力水平降低。I-CARE 有可能在住院期间教授循证心理社会技能，这可能为精神科住院前的康复提供一个良好的开端。
