Integrated Intervention for Caregivers--Open Trial
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|ClinicalTrials.gov Identifier: NCT03487575|
Recruitment Status : Not yet recruiting
First Posted : April 4, 2018
Last Update Posted : January 14, 2019
|Condition or disease||Intervention/treatment||Phase|
|Distress; Maternal Self-Efficacy Parenting Suicide||Behavioral: Open trial||Not Applicable|
Adolescents who have been hospitalized after attempting suicide are at high risk for engaging in additional suicidal behavior. Following hospitalization, parents or guardians are typically tasked with helping to prevent further suicidal episodes by monitoring youth, ensuring safety in the home, helping youth receive needed care, and parenting in a way that balances expectations for appropriate behavior with recognition of the vulnerable status of the adolescents. Despite parental efforts, adolescents often have additional crises, which sometimes culminate in emergency department visits and repeat hospitalizations. Findings from the principal investigators' recent longitudinal study of mothers after adolescent hospitalization for suicide attempts (Impact of Adolescent Hospitalization on Parents) suggested that the period of time following discharge from the hospital can be a very important time for providing services and supports to youth and families. Parents in that study described emotional distress (e.g., depression, anxiety) and reduced parenting self-efficacy, and indicated a need for more information about suicidal youth and the treatment needs of these youth, parenting and monitoring of suicidal youth, and support in navigating the treatment system.
Given these needs, the purpose of this study is to develop, refine, and preliminarily test an integrated electronic (mHealth) and care support service intervention for caregivers of adolescents who have made a recent suicide attempt. It is expected that such an intervention will provide needed information and supports to parents, increase parenting self-efficacy, increase parents' ability to follow safety plans in the home, reduce parents' emotional distress, and help parents access needed services in the community. As a consequence of these proximal outcomes, it is expected that the intervention will help facilitate treatment engagement and follow through for youth and caregiver, and reduce use of emergency mental health services and hospitalizations.
In the context of an open trial, the primary aim is to assess the feasibility of this intervention, and to use experiences from implementing the intervention and feedback from caregivers and care support managers to refine the intervention.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||18 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Primary Purpose:||Supportive Care|
|Official Title:||Integrated Electronic and Care Manager Support Intervention For Caregivers of Adolescents With Suicide Attempts--Open Trial|
|Estimated Study Start Date :||February 2019|
|Estimated Primary Completion Date :||January 2020|
|Estimated Study Completion Date :||January 2020|
|Experimental: Open trial||
Behavioral: Open trial
Integrated mHealth and support care managers
- Change in parental distress as assessed with SCL-90-R [ Time Frame: Baseline (hospitalization), and at 3- and 6- months following discharge ]To assess severity of depression, anxiety, and hostility, parents will be administered the Symptom Checklist - 90 (SCL-90-R). The SCL-90-R yields scores along several dimensions: Somatization, Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic Anxiety, Paranoid Ideation, and Psychoticism. The scale range for each dimension is a T-score of 0-100, with higher scores representing greater problem severity.
- Change in parental self-efficacy as assessed with PSOC [ Time Frame: Baseline (hospitalization), and at 3- and 6- months following discharge ]Facets of parental self-efficacy will be assessed with the Parenting Sense of Competence Scale (PSOC), which measures sense of self-efficacy and satisfaction with parenting. It has a scale range of 17-102, with higher scores indicating a greater parenting sense of competency. It has been used with parents of children and adolescents.
- Change in parental self-efficacy as assessed with "Me as a Parent" Parent Self-Regulation scale [ Time Frame: Baseline (hospitalization), and at 3- and 6- months following discharge ]Facets of parental self-efficacy will be assessed with the "Me as a Parent" Parenting Self-Regulation scale, which assesses constructs such as sense of effectiveness, sense of control as a parent, ability to manage situations with children (a central concept for the current study), and parental self-management (planful parenting activities). The scale range is 16 - 80, with higher scores representing a greater parental sense of self-regulation. It has been used with parents of children and adolescents.
- Change in parenting practices as assessed with Alabama Parenting Practices Questionnaire [ Time Frame: Baseline (hospitalization), and at 3- and 6- months following discharge ]The Alabama Parenting Practices Questionnaire will be used to assess parenting behaviors. For purposes of our study, we will focus on the parental involvement subscale (10 items), the positive parenting subscale (6 items), the monitoring and supervision subscale (10 items), and the inconsistent discipline scale (6 items). The scale ranges are 10-50 for the 10-item subscales, and 6-30 for the 6-item subscales. Higher scores denote better outcomes for the parental involvement and positive parenting subscales, whereas higher scores denote worse outcomes for the monitoring/supervision and inconsistent discipline subscales.
- Change in parent reports of adolescent suicidal behavior as assessed with C-SSRS [ Time Frame: Baseline (hospitalization), and at 3- and 6- months following discharge ]Parental reports of adolescent suicidal ideation and behaviors following hospitalization will be assessed with selected queries from the Columbia - Suicide Severity Rating Scale (C-SSRS). This measure does not have an overall scoring range, but it does include a suicidal ideation intensity rating with a range 0-25. In general, a greater number of endorsed items and/or a higher suicidal ideation intensity rating denote greater suicidal risk.
- Change in child emotional and behavioral problems as assessed with CBCL [ Time Frame: Baseline (hospitalization), and at 3- and 6- months following discharge ]To provide some contextual information at each assessment, parents at baseline hospitalization only will complete the Achenbach Child Behavior Checklist (CBCL). The CBCL is a widely used parent-report scale. The measure includes 20 subscales, each having a T-score range of 50-100, with higher scores denoting greater psychological and behavioral problems.
- Change in parent perceptions of support and safety monitoring as assessed with a series of likert rating questions [ Time Frame: Through study completion, up to 6 months following discharge ]Using a series of likert rating questions, we also will assess the degree to which parents feel they were provided with information regarding their child's condition and the management of their child in the home, and the degree to which they feel supported by the intervention and by mental health professionals. We will use likert scales at formal assessment points to assess perceived success and confidence in monitoring youth and following safety plans in the first month after hospitalization, and during any other times of high risk. In addition to formal assessments, the CSM will use ratings during their regular check-ins to gauge the degree to which parents' needs are being met.
- Adolescent service use assessed with CASA and treatment records [ Time Frame: Baseline (hospitalization), and at 3- and 6- months following discharge ]The semi-structured interview-based Child and Adolescent Services Assessment-Parent Interview-Version 5.0 (CASA) will be used to assess emergency department visits and repeat hospitalizations; duration and frequency of adolescent involvement with specialty mental health services (therapists, psychiatrists, etc.) following hospitalization; and attitudes about service use for adolescents. In addition, with consent/assent of parents and adolescents, we will obtain adolescents' treatment records to verify contacts with mental health providers. This measure does not have an overall scale range.
- Cost information assessed with measure of time spent [ Time Frame: Up to 6 months following discharge ]Time spent by the care support manager in patient contacts, preparation, and documentation will be tracked to estimate potential costs. These data will be preliminary due to the early phase of intervention development, but will set the stage for scalability efforts and later well-powered cost-effectiveness studies.
- Assessment of the patient satisfaction and acceptability of the intervention assessed with Client Satisfaction Questionnaire [ Time Frame: Through study completion, up to 6 months following discharge ]To assess patient satisfaction and acceptability of the intervention, we will administer the Client Satisfaction Questionnaire. This measure has a range of 8-32, with higher scores indicating greater satisfaction. Following Mohr et al. (2011), additional indices of the acceptability and usability of the intervention will include the degree to which parents use the mHealth application over time.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03487575
|Contact: Stephanie S Daniel, Ph.D.||email@example.com|
|Contact: Andy M Mayfield, MMFTfirstname.lastname@example.org|
|United States, North Carolina|
|Wake Forest School of Medicine||Not yet recruiting|
|Winston-Salem, North Carolina, United States, 27157|
|Contact: Stephanie S Daniel, Ph.D. 336-716-1839 email@example.com|
|Contact: Andy Mayfield, MMFT 336-716-6815 firstname.lastname@example.org|
|Principal Investigator: Stephanie S Daniel, Ph.D.|
|Principal Investigator:||Stephanie S Daniel, Ph.D.||Wake Forest University Health Sciences|