scholarly journals Recruitment of adolescents with suicidal ideation in the emergency department: lessons from a randomized controlled pilot trial of a youth suicide prevention intervention

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Matthew Tracey ◽  
Yaron Finkelstein ◽  
Reva Schachter ◽  
Kristin Cleverley ◽  
Suneeta Monga ◽  
...  
Keyword(s):  
Mental Health ◽  
Suicide Prevention ◽  
Time Of Day ◽  
Recruitment Strategy ◽  
Recruitment Strategies ◽  
Youth Suicide ◽  
Prevention Intervention ◽  
Randomized Controlled ◽  
Link Type ◽  
Recruitment Period

Abstract Background Emergency Departments (EDs) are a first point-of-contact for many youth with mental health and suicidality concerns and can serve as an effective recruitment source for randomized controlled trials (RCTs) of mental health interventions. However, recruitment in acute care settings is impeded by several challenges. This pilot RCT of a youth suicide prevention intervention recruited adolescents aged 12 to 17 years presenting to a pediatric hospital ED with suicide related behaviors. Methods Recruitment barriers were identified during the initial study recruitment period and included: the time of day of ED presentations, challenges inherent to study presentation, engagement and participation during an acute presentation, challenges approaching and enrolling acutely suicidal patients and families, ED environmental factors, and youth and parental concerns regarding the study. We calculated the average recruitment productivity for published trials of adolescent suicide prevention strategies which included the ED as a recruitment site in order to compare our recruitment productivity. Results In response to identified barriers, an enhanced ED-centered recruitment strategy was developed to address low recruitment rate, specifically (i) engaging a wider network of ED and outpatient psychiatry staff (ii) dissemination of study pamphlets across multiple areas of the ED and relevant outpatient clinics. Following implementation of the enhanced recruitment strategy, the pre-post recruitment productivity, a ratio of patients screened to patients randomized, was computed. A total of 120 patients were approached for participation, 89 (74.2%) were screened and 45 (37.5%) were consented for the study from March 2018 to April 2019. The screening to randomization ratio for the study period prior to the introduction of the enhanced recruitment strategies was 3:1, which decreased to 1.8:1 following the implementation of enhanced recruitment strategies. The ratio for the total recruitment period was 2.1:1. This was lower than the average ratio of 3.2:1 for published trials. Conclusions EDs are feasible sites for participant recruitment in RCTs examining new interventions for acute mental health problems, including suicidality. Engaging multi-disciplinary ED staff to support recruitment for such studies, proactively addressing anticipated concerns, and creating a robust recruitment pathway that includes approach at outpatient appointments can optimize recruitment. Trial registration ClinicalTrials.gov: NCT03488602, retrospectively registered April 4, 2018.

scholarly journals Effective Recruitment Strategies for Community-Dwelling Persons Living With Dementia and Their Caregivers

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 547-547
Author(s):  
LaShauna Connell ◽  
Augustine Boateng ◽  
Darina Petrovsky ◽  
Justine Sefcik ◽  
Nancy Hodgson ◽  
...  
Keyword(s):  
Community Outreach ◽  
Community Dwelling ◽  
Recruitment Strategy ◽  
Controlled Trials ◽  
Recruitment Strategies ◽  
Randomized Controlled ◽  
Health Fairs ◽  
Diverse Community ◽  
One Year ◽  
Almost All

Abstract Recruitment of diverse community-dwelling persons living with dementia (PLWD) and their caregivers (dyads) into randomized controlled trials (RCT) is challenging, time consuming and expensive. This presentation will describe community outreach efforts used over a one-year period to recruit dyads of PLWD and their caregivers in Healthy Patterns RCT. Community outreach yielded 296 inquiries, such that people expressed interest in joining the study. Of the 296 inquiries, almost all (95.6%) identified as African American, and 91(30.7%) consented to join the study. Presentations at senior centers yielded the highest number of inquiries (n=148), followed by staff presence at various community events such as health fairs and senior galas (n=145) and referrals (n=3). We found that community outreach was an effective recruitment strategy to generate inquiries among diverse PLWD and their caregivers to enroll in Healthy Patterns. We will discuss these strategies and provide suggestions for recruiting diverse dyads into clinical trials.

scholarly journals Effective recruitment strategies for home-living vulnerable older adults with depression into a psychotherapy RCT

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 859-859
Author(s):  
Eva-Marie Kessler ◽  
Fee Hoppmann ◽  
Julie L O’Sullivan ◽  
Paul Gellert ◽  
Christina Tegeler
Keyword(s):  
Older Adults ◽  
Hospital Setting ◽  
Cognitive Status ◽  
Recruitment Strategy ◽  
Recruitment Strategies ◽  
Medical Practitioners ◽  
Randomized Controlled ◽  
Time Investment ◽  
Home Living ◽  
First Contact

Abstract Objectives Vulnerable older adults, such as physically impaired or care-dependent individuals, are vastly underrepresented in psychotherapy research. Improving their inclusion in randomized controlled trials is necessary to determine the effectiveness of psychotherapy in this population. This study is the first to systematically evaluate strategies to recruit home-living vulnerable older adults with clinically significant depression into a large randomized controlled psychotherapy trial. Potential participants were approached directly (self-referral) or via cooperation with gatekeepers (gatekeeper-referral). Methods The initiator of the first contact with the study team and successful recruitment strategies were recorded. Referral strategies were compared with respect to number of inquiries and inclusion rates; study personnel’s time investment; and participant characteristics (sociodemographics, functional and cognitive status, depression and anxiety scores). Results Most of the N=197 participants were included via gatekeeper-referral (80.5%, 95%CI=[74.9%,86.1%], but time investment for gatekeeper-referrals was five times higher than for self-referral by media reports. Clinical psychologists and medical practitioners referred the largest proportion of participants (32.3% each) and referral by medical practitioners led to highest inclusion rates (55.6%; χ²(3)=8.964, p<.05). Most participants were referred from a hospital setting (50.3%), whereas referral numbers by medical practices were low (15.9%). Participants who initiated the first contact themselves had higher inclusion rates and were less functionally and cognitively impaired. Conclusions Including home-living vulnerable older adults into psychotherapy trials requires simultaneous implementation of diverse recruitment strategies. Medical practitioners and psychologists, especially in hospitals, are the most effective recruitment strategy, but self-referral via media is most cost-efficient in terms of time investment.

scholarly journals Developing a tailored implementation action plan for a suicide prevention clinical intervention in an Australian mental health service: A qualitative study using the EPIS framework

2022 ◽  
Vol 3 ◽  
pp. 263348952110657
Author(s):  
Isabel Zbukvic ◽  
Demee Rheinberger ◽  
Hannah Rosebrock ◽  
Jaclyn Lim ◽  
Lauren McGillivray ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Suicide Prevention ◽  
Action Plan ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Local Health ◽  
Prevention Intervention ◽  
Tailored Implementation

Background: Tailoring implementation strategies to local contexts is a promising approach to supporting implementation and sustainment of evidence-based practices in health settings. While there is increasing research on tailored implementation of mental health interventions, implementation research on suicide prevention interventions is limited. This study aimed to evaluate implementation and subsequently develop a tailored action plan to support sustainment of an evidence-based suicide prevention intervention; Collaborative Assessment and Management of Suicidality (CAMS) in an Australian public mental health service. Methods: Approximately 150 mental health staff working within a regional and remote Local Health District in Australia were trained in CAMS. Semi-structured interviews and focus groups with frontline staff and clinical leaders were conducted to examine barriers and facilitators to using CAMS. Data were analysed using a reflexive thematic analysis approach and mapped to the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and followed by stakeholder engagement to design a tailored implementation action plan based on a ‘tailored blueprint’ methodology. Results: A total of 22 barriers to implementing CAMS were identified. Based on the perceived impact on implementation fidelity and the feasibility of addressing identified barriers, six barriers were prioritised for addressing through an implementation action plan. These barriers were mapped to evidence-based implementation strategies and, in collaboration with local health district staff, goals and actionable steps for each strategy were generated. This information was combined into a tailored implementation plan to support the sustainable use of CAMS as part of routine care within this mental health service. Conclusions: This study provides an example of a collaborative approach to tailoring strategies for implementation on a large scale. Novel insights were obtained into the challenges of evaluating the implementation process and barriers to implementing an evidence-based suicide prevention treatment approach within a geographically large and varied mental health service in Australia. Plain language abstract: This study outlines the process of using a collaborative stakeholder engagement approach to develop tailored implementation plans. Using the Exploration Preparation Implementation Sustainment Framework, findings identify the barriers to and strategies for implementing a clinical suicide prevention intervention in an Australian community mental health setting. This is the first known study to use an implementation science framework to investigate the implementation of the clinical suicide prevention intervention (Collaborative Assessment and Management of Suicidality) within a community mental health setting. This work highlights the challenges of conducting implementation research in a dynamic public health service.

scholarly journals Usage and Acceptability of the iBobbly App: Pilot Trial for Suicide Prevention in Aboriginal and Torres Strait Islander Youth

10.2196/14296 ◽  
2020 ◽  
Vol 7 (12) ◽  
pp. e14296
Author(s):  
Joseph Tighe ◽  
Fiona Shand ◽  
Kathy McKay ◽  
Taylor-Jai Mcalister ◽  
Andrew Mackinnon ◽  
...  
Keyword(s):  
Mental Health ◽  
Randomized Controlled Trial ◽  
Regression Analysis ◽  
Suicide Prevention ◽  
Technology Use ◽  
Torres Strait Islander ◽  
Controlled Trial ◽  
Psychological Wellbeing ◽  
Randomized Controlled ◽  
Torres Strait

Background The proliferation of mental health apps purporting to target and improve psychological wellbeing is ever-growing and also concerning: Few apps have been rigorously evaluated, and, indeed, the safety of the vast majority of them has not been determined. Over 10,000 self-help apps exist but most are not used much after being downloaded. Gathering and analyzing usage data and the acceptability of apps are critical to inform consumers, researchers, and app developers. Objective This paper presents pilot usage and acceptability data from the iBobbly suicide prevention app, an app distributed through a randomized controlled trial. Methods Aboriginal and Torres Strait Islander participants from the Kimberley region of Western Australia completed a survey measuring their technology use in general (n=13), and data on their experiences with and views of the iBobbly app were also collected in semistructured interviews (n=13) and thematically analyzed. Finally, engagement with the app, such as the number of sessions completed and time spent on various acceptance-based therapeutic activities, was analyzed (n=18). Both groups were participants in the iBobbly app pilot randomized controlled trial (n=61) completed in 2015. Results Regression analysis indicated that app use improved psychological outcomes, although only minimally, and effects were not significant. However, results of the thematic analysis indicated that the iBobbly app was deemed effective, acceptable, and culturally appropriate by those interviewed. Conclusions There is a scarcity of randomized controlled trials and eHealth interventions in Indigenous communities, while extremely high rates of psychological distress and suicide persist. In this environment, studies that can add evidence from mixed-methods approaches are important. While the regression analysis in this study did not indicate a significant effect of app use on psychological wellbeing, this was predictable considering the small sample size (n=18) and typically brief app use. The results on engagement with the iBobbly app were however positive. This study showed that Indigenous youth are early and frequent users of technology in general, and they regarded the iBobbly app to be culturally safe and of therapeutic value. Qualitative analyses demonstrated that iBobbly app use was associated with self-reported improvements in psychological wellbeing, mental health literacy, and reductions in shame. Importantly, participants reported that they would recommend other similar apps if available to their peers.

Suicide Prevention in Schools: The Art, the Issues, and the Pitfalls

Crisis ◽  
1999 ◽  
Vol 20 (3) ◽  
pp. 132-142 ◽  
Author(s):  
Antoon A Leenaars ◽  
Susanne Wenckstern
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Suicide Prevention ◽  
Mental Health Problem ◽  
Health Problem ◽  
Public Health Problem ◽  
Tertiary Prevention ◽  
Prevention Intervention ◽  
Prevention In Schools

Suicide is a major mental health problem and public health problem worldwide. Schools and their communities must respond in a comprehensive fashion. Caplan's model of primary, secondary, and tertiary prevention—or prevention, intervention, and postvention—is proposed as a comprehensive response to suicide in youths. Current myths and facts about these fabrications are discussed for each mode of response. Research, clinical suggestions, and a call for further discussion are presented.

scholarly journals The effectiveness of a low-intensity problem-solving intervention for common adolescent mental health problems in New Delhi, India: protocol for a school-based, individually randomized controlled trial with an embedded stepped-wedge, cluster randomized controlled recruitment trial

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Rachana Parikh ◽  
Daniel Michelson ◽  
Kanika Malik ◽  
Sachin Shinde ◽  
Helen A. Weiss ◽  
...  
Keyword(s):  
Mental Health ◽  
Problem Solving ◽  
Mental Health Problems ◽  
Controlled Trial ◽  
Adolescent Mental Health ◽  
Health Problems ◽  
Mental Health Symptoms ◽  
Health Symptoms ◽  
Randomized Controlled ◽  
Link Type

Abstract Background Conduct, anxiety, and depressive disorders account for over 75% of the adolescent mental health burden globally. The current protocol will test a low-intensity problem-solving intervention for school-going adolescents with common mental health problems in India. The protocol also tests the effects of a classroom-based sensitization intervention on the demand for counselling services in an embedded recruitment trial. Methods/design We will conduct a two-arm, individually randomized controlled trial in six Government-run secondary schools in New Delhi. The targeted sample is 240 adolescents in grades 9–12 with persistent, elevated mental health symptoms and associated distress/impairment. Participants will receive either a brief problem-solving intervention delivered over 3 weeks by lay counsellors (intervention) or enhanced usual care comprised of problem-solving booklets (control). Self-reported adolescent mental health symptoms and idiographic problems will be assessed at 6 weeks (co-primary outcomes) and again at 12 weeks post-randomization. In addition, adolescent-reported distress/impairment, perceived stress, mental wellbeing, and clinical remission, as well as parent-reported adolescent mental health symptoms and impact scores, will be assessed at 6 and 12 weeks post-randomization. We will also complete a parallel process evaluation, including estimations of the costs of delivering the interventions. An embedded recruitment trial will apply a stepped-wedge, cluster (class)-randomized controlled design in 70 classes across the six schools. This will evaluate the added effect of a classroom-based sensitization intervention over and above school-level sensitization activities on the primary outcome of referral rate into the host trial. Other outcomes will be the proportion of referrals eligible to participate in the host trial, proportion of self-generated referrals, and severity and pattern of symptoms among referred adolescents in each condition. Power calculations were undertaken separately for each trial. A detailed statistical analysis plan will be developed separately for each trial prior to unblinding. Discussion Both trials were initiated on 20 August 2018. A single research protocol for both trials offers a resource-efficient methodology for testing the effectiveness of linked procedures to enhance uptake and outcomes of a school-based psychological intervention for common adolescent mental health problems. Trial registration Both trials are registered prospectively with the National Institute of Health registry (www.clinicaltrials.gov), registration numbers NCT03633916 and NCT03630471, registered on 16th August, 2018 and 14th August, 2018 respectively).

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