Using a Tablet-Based App to Deliver Evidence-Based Practices for Suicidal Patients in the Emergency Department: Pilot Randomized Controlled Trial

BACKGROUND: Emergency departments (EDs) have the potential to provide evidence-based practices for suicide prevention to patients who are acutely suicidal. However, few EDs have adequate time and personnel resources to deliver recommended evidence-based assessment and interventions. To raise the clinical standard of care for patients who are suicidal and seeking psychiatric crisis services in the ED, we developed Jaspr Health, a tablet-based app for direct use by such patients, which enables the delivery of 4 evidence-based practices. OBJECTIVE: This study aims to evaluate the feasibility, acceptability, and effectiveness of Jaspr Health among suicidal adults in EDs. METHODS: Patients who were acutely suicidal and seeking psychiatric crisis services participated in an unblinded pilot randomized controlled trial while in the ED. Participants were randomly assigned to Jaspr Health (n=14) or care as usual (control; n=17) groups. Participants were assessed at baseline, and a 2-hour posttest using self-report measures and a semistructured interview were conducted. RESULTS: Conditions differed significantly at baseline with regard to age but not other demographic variables or baseline measures. On average, participants had been in the ED for 17 hours before enrolling in the study. Over their lifetime, 84% (26/31) of the sample had made a suicide attempt (mean 3.4, SD 6.4) and 61% (19/31) had engaged in nonsuicidal self-injurious behaviors, with an average rate of 8.8 times in the past 3 months. All established feasibility and acceptability criteria were met: no adverse events occurred, participants\u27 app use was high, Jaspr Health app user satisfaction ratings were high, and all participants using Jaspr Health recommended its use for other suicidal ED patients. Comparisons between study conditions provide preliminary support for the effectiveness of the app: participants using Jaspr Health reported a statistically significant increase in receiving 4 evidence-based suicide prevention interventions and overall satisfaction ratings with their ED experience. In addition, significant decreases in distress and agitation, along with significant increases in learning to cope more effectively with current and future suicidal thoughts, were observed among participants using Jaspr Health compared with those receiving care as usual. CONCLUSIONS: Even with limited statistical power, the results showed that Jaspr Health is feasible, acceptable, and clinically effective for use by ED patients who are acutely suicidal and seeking ED-based psychiatric crisis services. TRIAL REGISTRATION: ClinicalTrials.gov NCT03584386; https://clinicaltrials.gov/ct2/show/NCT03584386

Enhancing Online Training in an Evidence-Based Treatment for Adolescent Panic Disorder: A Randomized Controlled Trial

This randomized controlled trial compared 3 modes of training clinicians in a youth-focused evidence-based treatment for panic disorder, using an additive design. Community practitioners (N = 140) were randomly assigned to one of three conditions: a standard text-alone training condition (TXT); an interactive, online training program plus the TXT (TXT + OLT); or the TXT + OLT enhanced by a learning community adjunct leveraging Twitter (TXT + OLT + LC). Mastery of Anxiety and Panic for Adolescents (MAP-A), an efficacious cognitive-behavioral therapy for adolescents with panic disorder, was taught in all three training conditions. Analyses revealed that participants were more satisfied with the TXT + OLT and TXT + OLT + LC training, compared to the TXT condition. Although all conditions demonstrated equivalent increases in knowledge of MAP-A, participants in the TXT + OLT + LC demonstrated greater proficiency using MAP-A skills in a simulated clinical scenario, compared to those in both the TXT + OLT and TXT conditions. However, this effect was no longer statistically significant at a 90-day follow-up. Results indicate initial promise for enhancing online training dissemination efforts with a novel learning community and Twitter adjunct in training clinicians in a youth-focused, efficacious cognitive-behavioral therapy. Directions for future research and dissemination efforts are discussed

Hospitalizations for Students With an Alcohol-Related Sanction: Gender and Pregaming as Risk Factors

OBJECTIVE: The purpose of this study is to investigate whether pregaming (i.e., drinking prior to a social event) is a risk factor for hospitalization. PARTICIPANTS: Participants (N=516) were undergraduate students with an alcohol-related sanction. METHOD: Participants completed a survey about alcohol use, as well as behaviors and experiences prior to and during the referral event. The dependent variable was whether participants received medical attention at an emergency department during the sanction event. RESULTS: Results indicated that older students, females who pregame, students with higher alcohol use screening scores, lighter drinkers, and higher numbers of drinks before the referral event all increased the odds of receiving medical attention. Pregaming alone was not significantly related to receiving medical attention in the multivariate analysis. CONCLUSIONS: Female students who pregame appear to be at risk for requiring hospitalization after drinking when controlling for the number of drinks consumed