An Exposure-Based Implementation Strategy to Decrease Clinician Anxiety Around Suicide Prevention
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ClinicalTrials.gov Identifier: NCT05172609 |
Recruitment Status :
Recruiting
First Posted : December 29, 2021
Last Update Posted : May 10, 2023
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Condition or disease | Intervention/treatment | Phase |
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Implementation Science | Behavioral: Exposure Based Implementation Strategy (EBIS) Behavioral: Implementation as Usual (IAU) | Not Applicable |
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 55 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Health Services Research |
Official Title: | An Exposure-Based Implementation Strategy to Decrease Clinician Anxiety About Delivering Suicide Prevention Evidence-Based Practices |
Actual Study Start Date : | March 29, 2023 |
Estimated Primary Completion Date : | February 28, 2025 |
Estimated Study Completion Date : | August 31, 2025 |
Arm | Intervention/treatment |
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Experimental: Exposure Based Implementation Strategy (EBIS)
EBIS is informed by the latest science in exposure theory, borrowing heavily from brief exposure-based treatments that can be delivered in a single session. We anticipate that EBIS will occur in four phases that map on to standard exposure therapy practice for patients with anxiety disorders: psychoeducation, assessment, practice, and relapse prevention; however, the final version will depend on the outcomes of the preparatory phases of this study. Clinicians assigned to the EBIS arm will also receive all elements of IAU.
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Behavioral: Exposure Based Implementation Strategy (EBIS)
EBIS will include psychoeducation, assessment/hierarchy building. guided practice, and guidance for application to clinical practice. |
Active Comparator: Implementation as Usual (IAU)
Gold-standard IAU for SSAIs typically comprises pre-implementation preparation, didactic training, knowledge tests, experiential role plays, ongoing expert consultation, and providing certification status to clinicians who attain established benchmarks. Pre-implementation preparation will include provision of materials. Didactic training will occur in two parts: (1) suicide screening and assessment, and (2) Safety Planning Intervention (SPI) use. Part one will consist of materials we previously developed based on community clinician feedback. Part two will follow established SPI guidelines, including didactic training about SPI rationale and evidence base and experiential practice. IAU also will include supports for electronic health record integration (e.g., previously developed templates). After training, clinicians will receive 8 weeks of expert consultation to discuss implementation barriers and receive more role play practice.
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Behavioral: Implementation as Usual (IAU)
IAU will consist of standard didactic training and ongoing consultation activities for enrolled clinicians |
- Clinician perception of EBIS acceptability for clinical practice [ Time Frame: end of trial period (12 weeks) ]Acceptability of EBIS will be measured via qualitative interviews with participants as well as the Acceptability of Intervention Measure (AIM), a 4-item, psychometrically-validated measure that indexes the extent to which stakeholders believe an implementation strategy is acceptable. Items on the AIM are rated on a 5-point Likert scale (Range = 4-20) and higher scores indicate greater acceptability.
- Clinician perception of EBIS feasibility and utility for clinical practice [ Time Frame: end of trial period (12 weeks) ]Feasibility of EBIS will with the Feasibility of Intervention Measure (FIM), a 4-item measure that indexes the extent to which an implementation strategy is perceived as feasible. Items on the FIM are rated on a 5-point Likert scale (Range = 4-20) and higher scores indicate greater acceptability.
- EBIS feasibility as assessed by clinician retention statistics [ Time Frame: through study completion, an average of 12 weeks ]Feasibility statistics for study retention (e.g., the proportion of recruited clinicians that agrees to be randomized to EBIS, he proportion of randomized clinicians that completes EBIS)
- Clinician Anxiety [ Time Frame: baseline, immediately post-intervention, two week follow up, and 12 week follow up ]Clinician anxiety will be assessed via 10-point Subjective Units of Distress (SUDS), a 10-point Likert rating of subjective distress where 1 = Not at all Distressed and 10 = Very Distressed.
- Clinician Self-Efficacy Questionnaire [ Time Frame: baseline, immediately post-intervention, two week follow up, and 12 week follow up ]Self-efficacy will be measured via responses to two statements on a 7-point scale measuring clinicians' self-efficacy to use SSAIs, using established question stems from behavioral science (e.g., "If I really wanted to, I could screen every patient I see for suicide risk"). Self-efficacy will be assessed separately for clinician self-efficacy for suicide screening and for use of the Safety Planning Intervention. Higher scores indicate greater self-efficacy. Scores will be averaged for analysis (Range = 1 - 7).
- Screening use [ Time Frame: baseline, immediately post-intervention, two week follow up, and 12 week follow up ]Use of clinician routine suicide screening in all patient encounters will be indexed via chart-stimulated recall (CSR). CSR is an established technique for examining clinician decision-making and clinical processes beyond what can be determined from chart review or self-report alone. A research team member will review the clinician's deidentified caseload with them for the past clinic week. For each patient seen that week, the researcher will ask brief questions related to the clinicians' suicide-related practices around screening for suicide risk.
- Safety Planning Intervention Use [ Time Frame: baseline, immediately post-intervention, two week follow up, and 12 week follow up ]Clinician use of the Safety Planning Intervention when indicated (i.e., patient screens positive for suicide risk) will be indexed via chart-stimulated recall. CSR is an established technique for examining clinician decision-making and clinical processes beyond what can be determined from chart review or self-report alone. A research team member will review the clinician's caseload with them for the past clinic week. For each patient seen that week for which the clinician reports screening for suicide risk, the researcher will ask brief questions (no more than 5 minutes) related to the clinicians' follow up intervention to assess clinician use of the Safety Planning Intervention.
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Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | Yes |
Inclusion Criteria:
- Practicing mental health clinicians who provide direct mental health services to a treatment-seeking population
- Proficient in the English language
- Have access to a computer with internet connectivity
Exclusion Criteria:
- Participants will be excluded if they do not see any mental health patients that are at risk for suicide (e.g., they screen out high-risk patients for their individual practice).
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05172609
Contact: Emily M Becker-Haimes, PhD | 215-573-5614 | emily.haimes@pennmedicine.upenn.edu | |
Contact: Megan Brady, B.A. | mhquire@pennmedicine.upenn.edu |
United States, Pennsylvania | |
University of Pennsylvania Department of Psychiatry | Recruiting |
Philadelphia, Pennsylvania, United States, 19104 | |
Contact: Emily M Becker-Haimes, PhD 215-573-5614 emily.haimes@pennmedicine.upenn.edu | |
Contact: Megan Brady, BA mhquire@pennmedicine.upenn.edu |
Responsible Party: | University of Pennsylvania |
ClinicalTrials.gov Identifier: | NCT05172609 |
Other Study ID Numbers: |
356336 |
First Posted: | December 29, 2021 Key Record Dates |
Last Update Posted: | May 10, 2023 |
Last Verified: | May 2023 |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
Suicide Suicide Prevention Self-Injurious Behavior Behavioral Symptoms |