David A. Jobes - US grants

? DESCRIPTION (provided by applicant): Every 13 minutes, someone in the United States (U.S.) chooses to end his or her life, resulting in over 40,000 suicides in the US each year. The economic cost of suicide in the U.S. was $34.6 billion annually in 2005; when adjusted for present day inflation, the economic toll rises to $42.2 billion. The combined cost of medical and work loss is estimated at $34.6 billion annually. In 2011, 487,700 people were treated in EDs for self-inflicted injuries. Beginning in 1999 with the Surgeon General's Call to Action to Prevent Suicide, millions have been devoted annually - both publicly (approximately $40 million from NIH) and privately (approximately $20 million from American Foundation for Suicide Prevention) - to prevent suicide. Yet, despite this significant and sustained effort, there is no evidence of a decrease in suicides or suicide attempts in the U.S. Our overarching goal is to create a tool that could reduce suicide rates, increase delivery of efficacious suicide interventions, and decrease overall costs associated with suicidal behaviors. With this in mind, we intend to: (1) develop and scientifically validate a relational agent for suicidal patients that delivers Collaborative Assessment and Management of Suicidality (CAMS), an efficacious and cost-effective intervention developed by David Jobes, PhD; and (2) to create an integrated software system (CAMS Relational Agent System; CAMS-RAS) that assists medical personnel by synthesizing the CAMS intervention findings into an easy-to-interpret report and providing empirically-derived clinical decision support; integrates into the health care system's electronic health record (EHR); enhances the patient's coping capability by including psychoeducational skills training modules for use during and after hospitalization; and automates the delivery of caring contacts, an efficacious and brief suicide prevention intervention provided after discharge. Our initial target will be EDs, as they are often the initial point of contact and where personnel must make the decision whether to hospitalize or discharge the suicidal patient. We will also conduct testing in other medical and outpatient mental health settings to ensure public health impact and commercial success. Phase I project aims include: (1) creating an advisory board to guide the development of CAMS-RAS; (2) iteratively design and develop relational agent (Dr. Dave) modeled after the gestures, expressions, and mannerisms of CAMS treatment developer, David Jobes, PhD; and (3) conduct feasibility tests to determine whether CAMS-RAS is acceptable, easy to use, and liked by target end-users: acutely suicidal patients admitted to hospital EDs, psychiatric inpatient units, and medical floors for treatment of injuries sustained during a suicid attempt; hospital medical personnel, administrators, and other stakeholders including peer advocates; and outpatient suicidal patients, clinicians and administrators.

PROJECT SUMMARY/ABSTRACT Suicide remains a serious public health problem in the U.S. as rates have risen nearly each year since 2005, from 11.0 per 100,000 to 14.8 per 100,000 in 2018, totaling 48,344 in 2018; 1.4 million U.S. adults made a suicide attempt, and another 12 million thought seriously about killing themselves that same year. Alcohol use disorder (AUD) exponentially increases suicide risk and can also interfere with suicide prevention intervention efforts. Suicide prevention initiatives over the past decade have targeted healthcare systems (HCS) in general and primary care clinics (PCC) in particular because so many who die by suicide access their primary care provider (PCP) in the months and year prior to their death. Though universal suicide screening is now routinely conducted in PCC, many HCS and PCC struggle to provide suicide prevention evidence-based practices (EBP) on par with other behavioral health EBP commonly treated in PCC. Digital technologies can efficiently and reliably help deliver suicide prevention EBP in PCC and increase the confidence and competence of PCP in treating suicide, including AUD that may interfere with these efforts. Jaspr Health (?Jaspr?; R44MH108222) is a suicide prevention platform originally designed for use by acutely suicidal patients in emergency departments (ED) to deliver suicide prevention EBP. Grounded in Jobes? Collaborative Assessment and Management of Suicidality (CAMS), Jaspr guides patients in completing a comprehensive suicide risk assessment and lethal means counseling, builds a crisis stabilization plan, and teaches behavioral skills to reduce imminent distress; videos of people with live experience (PLE) offer wisdom and hope for getting through suicide crises. Information is summarized for the care team to aid in discharge disposition planning. A companion app provides support post-discharge. Results from a randomized controlled trial (RCT; N=31) comparing Jaspr to Care-as-Usual strongly support its feasibility, acceptability, and effectiveness in increasing delivery of EBP, reducing agitation and distress, improving capacity to cope with suicidal thoughts, and improving ED satisfaction. This 34-month fast track seeks to increase the public health impact of Jaspr Health by extending its utility to deliver evidence-based brief interventions that directly target and treat a person?s reasons for wanting to die (their ?drivers? for suicide) while simultaneously addressing alcohol misuse. The proposal is defined by three project stages which include: (1) a proof-of-concept formative evaluation stage where we will iteratively design, test, and build a prototype (Phase I; Months 1-10); (2) a product design-and-build formative evaluation stage, where we will design, build and test all remaining features and apps (Phase II; Months 11- 22); and (3) a summative evaluation stage involving a pilot test (N=20) and a RCT (N=120) comparing Jaspr to a suicide prevention app and other online wellness resources (Phase II; Months 23-34).