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Chitavi SO, Patrianakos J, Williams SC, Schmaltz SP, Ahmedani BK, Roaten K, Boudreaux ED, Brown GK. Evaluating the Prevalence of Four Recommended Practices for Suicide Prevention Following Hospital Discharge. Jt Comm J Qual Patient Saf 2024; 50:393-403. [PMID: 38538500 DOI: 10.1016/j.jcjq.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND The Joint Commission's National Patient Safety Goal (NPSG) for suicide prevention (NPSG.15.01.01) requires that accredited hospitals maintain policies/procedures for follow-up care at discharge for patients identified as at risk for suicide. The proportion of hospitals meeting these requirements through use of recommended discharge practices is unknown. METHODS This cross-sectional observational study explored the prevalence of suicide prevention activities among Joint Commission-accredited hospitals. A questionnaire was sent to 1,148 accredited hospitals. The authors calculated the percentage of hospitals reporting implementation of four recommended discharge practices for suicide prevention. RESULTS Of 1,148 hospitals, 346 (30.1%) responded. The majority (n = 212 [61.3%]) of hospitals had implemented formal safety planning, but few of those (n = 41 [19.3%]) included all key components of safety planning. Approximately a third of hospitals provided a warm handoff to outpatient care (n = 128 [37.0%)] or made follow-up contact with patients (n = 105 [30.3%]), and approximately a quarter (n = 97 [28.0%]) developed a plan for lethal means safety. Very few (n = 14 [4.0%]) hospitals met full criteria for implementing recommended suicide prevention activities at time of discharge. CONCLUSION The study revealed a significant gap in implementation of recommended practices related to prevention of suicide postdischarge. Additional research is needed to identify factors contributing to this implementation gap.
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O'Brien KHM, Quinlan K, Humm L, Cole A, Hanita M, Pires WJ, Jacobs A, Grumet JG. Effectiveness of a virtual patient simulation training on improving provider engagement in suicide safer care. Community Ment Health J 2024:10.1007/s10597-024-01289-0. [PMID: 38806886 DOI: 10.1007/s10597-024-01289-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/25/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Health care providers have a critical opportunity to mitigate the public health problem of suicide. Virtual patient simulations (VPS) allow providers to learn and practice evidence-based suicide prevention practices in a realistic and risk-free environment. The purpose of this study was to test whether receiving VPS training increases the likelihood that providers will engage in effective suicide safer care practices. METHODS Behavioral health and non-behavioral health providers (N = 19) at a Federally Qualified Health Center who work with patients at risk for suicide received the VPS training on risk assessment, safety planning, and motivation to engage in treatment. Providers' electronic health records were compared 6 months pre- and post-VPS training on their engagement in suicide safer care practices of screening, assessment, safety planning, and adding suicide ideation to the problem list. RESULTS Most behavioral health providers were already engaging in evidence-based suicide prevention care prior to the VPS training. Findings demonstrated the VPS training may impact the likelihood that non-behavioral health providers engage in suicide safer care practices. CONCLUSION VPS training in evidence-based suicide prevention practices can optimize and elevate all health care providers' skills in suicide care regardless of role and responsibility, demonstrating the potential to directly impact patient outcomes.
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Affiliation(s)
- Kimberly H McManama O'Brien
- Behavioral Research & Training Institute, Rutgers University, Piscataway, NJ, USA.
- Department of Health Promotion, Practice, and Innovation, Education Development Center, Waltham, MA, USA.
| | - Kristen Quinlan
- Department of Health Promotion, Practice, and Innovation, Education Development Center, Waltham, MA, USA
| | | | - Andrea Cole
- School of Pharmacy and Health Sciences, Fairleigh Dickinson University, Florham Park, NJ, USA
| | - Makoto Hanita
- Department of Health Promotion, Practice, and Innovation, Education Development Center, Waltham, MA, USA
| | - Warren Jay Pires
- Harlem Residency in Family Medicine, Institute for Family Health, New York, NY, USA
| | - Ariel Jacobs
- Harlem Residency in Family Medicine, Institute for Family Health, New York, NY, USA
| | - Julie Goldstein Grumet
- Department of Health Promotion, Practice, and Innovation, Education Development Center, Waltham, MA, USA
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Francis CJ, Johnson A, Wilson RL. Supported decision-making interventions in mental healthcare: A systematic review of current evidence and implementation barriers. Health Expect 2024; 27:e14001. [PMID: 38433012 PMCID: PMC10909645 DOI: 10.1111/hex.14001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND There is a growing momentum around the world to foster greater opportunities for the involvement of mental health service users in their care and treatment planning. In-principle support for this aim is widespread across mental healthcare professionals. Yet, progress in mental health services towards this objective has lagged in practice. OBJECTIVES We conducted a systematic review of quantitative, qualitative and mixed-method research on interventions to improve opportunities for the involvement of mental healthcare service users in treatment planning, to understand the current research evidence and the barriers to implementation. METHODS Seven databases were searched and 5137 articles were screened. Articles were included if they reported on an intervention for adult service users, were published between 2008 and October 2023 and were in English. Evidence in the 140 included articles was synthesised according to the JBI guidance on Mixed Methods Systematic Reviews. RESULTS Research in this field remains exploratory in nature, with a wide range of interventions investigated to date but little experimental replication. Overarching barriers to shared and supported decision-making in mental health treatment planning were (1) Organisational (resource limitations, culture barriers, risk management priorities and structure); (2) Process (lack of knowledge, time constraints, health-related concerns, problems completing and using plans); and (3) Relationship barriers (fear and distrust for both service users and clinicians). CONCLUSIONS On the basis of the barriers identified, recommendations are made to enable the implementation of new policies and programs, the designing of new tools and for clinicians seeking to practice shared and supported decision-making in the healthcare they offer. PATIENT OR PUBLIC CONTRIBUTION This systematic review has been guided at all stages by a researcher with experience of mental health service use, who does not wish to be identified at this point in time. The findings may inform organisations, researchers and practitioners on implementing supported decision-making, for the greater involvement of people with mental ill health in their healthcare.
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Affiliation(s)
| | - Amanda Johnson
- Head of School, Dean of Nursing and MidwiferyUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Rhonda L. Wilson
- University of NewcastleNewcastleNew South WalesAustralia
- Massey UniversityPalmerston NorthNew Zealand
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Rainbow C, Tatnell R, Blashki G, Fuller-Tyszkiewicz M, Melvin GA. Digital safety plan effectiveness and use: Findings from a three-month longitudinal study. Psychiatry Res 2024; 333:115748. [PMID: 38277811 DOI: 10.1016/j.psychres.2024.115748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 01/28/2024]
Abstract
Few studies have examined the effectiveness of self-guided smartphone apps for suicide safety planning, despite their increasing use. Participants (n = 610) were self-selected users of the Beyond Now suicide prevention safety planning app with a history of suicidal thoughts and behaviours. Surveys were completed (baseline, one and three months), safety plan content and app usage data was shared. Repeated-measures ANOVAs examined changes in suicidal ideation and suicide-related coping over three months. Multiple regression models were used to predict suicidal ideation and suicide-related coping at one- and three-month follow-ups with plan-related variables: perceived usefulness, personalised content, app use time and co-authoring of the plan with a third party. Significant reductions in suicidal ideation and increases in suicide-related coping were found over three months. Higher suicide-related coping at three months predicted lower suicidal ideation. Higher perceived usefulness and personalised content at three months were associated with higher suicide-related coping, but not suicidal ideation. App use time and co-authoring were not significantly related to suicidal ideation or suicide-related coping. Practitioners should empower clients to create safety plans with personalised (not generic) strategies that a client perceives to be useful. Such plans may strengthen beliefs about coping with suicidal ideation, which in turn reduces suicidal ideation over time.
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Affiliation(s)
- Christopher Rainbow
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia.
| | - Ruth Tatnell
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - Grant Blashki
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Level 5, 333 Exhibition Street, VIC 3000, Australia; Beyond Blue, Melbourne, GPO Box 1883, Melbourne VIC 3001, Australia
| | - Matthew Fuller-Tyszkiewicz
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - Glenn A Melvin
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
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Rainbow C, Tatnell R, Blashki G, Melvin GA. Perceived Usefulness of Self-Guided Versus Collaborative Suicide Safety Plans in Online Help-Seekers. CRISIS 2024. [PMID: 38319612 DOI: 10.1027/0227-5910/a000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Background: Suicide safety plans were originally devised to be paper-based and clinician-guided, but digital self-guided plans are now common. Aim: This study explored whether plan format (paper vs. digital), assistance (self-authored vs. collaboration), and suicide attempt history were associated with differences in suicidal ideation, suicide-related coping, and perceived usefulness. Method: An online sample of safety plan users (N = 131) completed a survey assessing suicidal ideation, suicide-related coping, and perceived usefulness of their plan. t tests compared outcomes by plan format, collaboration, and suicide attempt history. Pearson correlations explored associations between reasons for plan use, suicidal ideation, and suicide-related coping. Results: Suicidal ideation was significantly higher, and perceived usefulness significantly lower in participants with a past suicide attempt (vs. none) and in those who had collaborated to make their safety plan (vs. self-authored). Collaborators were largely health professionals. No significant differences were found between plan formats. Suicide-related coping was associated with higher perceived usefulness overall. Limitations: Our study design was cross-sectional, utilizing a largely young, female, English-speaking, online help-seeking sample. Conclusions: For clients with prior suicide attempts and higher levels of suicidal ideation, meaningful collaboration may be needed to find safety plan coping strategies that are perceived as useful.
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Affiliation(s)
- Christopher Rainbow
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Ruth Tatnell
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Grant Blashki
- Nossal Institute for Global Health, University of Melbourne, VIC, Australia
- Beyond Blue, Melbourne, VIC, Australia
| | - Glenn A Melvin
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, Melbourne, VIC, Australia
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Minian N, Gayapersad A, Coroiu A, Dragonetti R, Zawertailo L, Zaheer J, O’Neill B, Lange S, Thomson N, Crawford A, Kennedy SH, Selby P. Prototyping the implementation of a suicide prevention protocol in primary care settings using PDSA cycles: a mixed method study. Front Psychiatry 2024; 15:1286078. [PMID: 38333892 PMCID: PMC10850298 DOI: 10.3389/fpsyt.2024.1286078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/04/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction In Canada, approximately 4,500 individuals die by suicide annually. Approximately 45% of suicide decedents had contact with their primary care provider within the month prior to their death. Current versus never smokers have an 81% increased risk of death by suicide. Those who smoke have additional risks for suicide such as depression, chronic pain, alcohol, and other substance use. They are more likely to experience adverse social determinants of health. Taken together, this suggests that smoking cessation programs in primary care could be facilitators of suicide prevention, but this has not been studied. Study objectives The objectives of the study are to understand barriers/facilitators to implementing a suicide prevention protocol within a smoking cessation program (STOP program), which is deployed by an academic mental health and addiction treatment hospital in primary care clinics and to develop and test implementation strategies to facilitate the uptake of suicide screening and assessment in primary care clinics across Ontario. Methods The study employed a three-phase sequential mixed-method design. Phase 1: Conducted interviews guided by the Consolidated Framework for Implementation Research exploring barriers to implementing a suicide prevention protocol. Phase 2: Performed consensus discussions to map barriers to implementation strategies using the Expert Recommendations for Implementing Change tool and rank barriers by relevance. Phase 3: Evaluated the feasibility and acceptability of implementation strategies using Plan Do Study Act cycles. Results Eleven healthcare providers and four research assistants identified lack of training and the need of better educational materials as implementation barriers. Participants endorsed and tested the top three ranked implementation strategies, namely, a webinar, adding a preamble before depression survey questions, and an infographic. After participating in the webinar and reviewing the educational materials, all participants endorsed the three strategies as acceptable/very acceptable and feasible/very feasible. Conclusion Although there are barriers to implementing a suicide prevention protocol within primary care, it is possible to overcome them with strategies deemed both acceptable and feasible. These results offer promising practice solutions to implement a suicide prevention protocol in smoking cessation programs delivered in primary care settings. Future efforts should track implementation of these strategies and measure outcomes, including provider confidence, self-efficacy, and knowledge, and patient outcomes.
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Affiliation(s)
- Nadia Minian
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Allison Gayapersad
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Adina Coroiu
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rosa Dragonetti
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Laurie Zawertailo
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Juveria Zaheer
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Braden O’Neill
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Shannon Lange
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nicole Thomson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Allison Crawford
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sidney H. Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Arthur Sommer Rotenberg Program in Suicide Studies, Unity Health Toronto, Toronto, ON, Canada
| | - Peter Selby
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Harris BR. Helplines for Mental Health Support: Perspectives of New York State College Students and Implications for Promotion and Implementation of 988. Community Ment Health J 2024; 60:191-199. [PMID: 37351714 DOI: 10.1007/s10597-023-01157-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
Mental health and suicide are serious concerns in the U.S. Though many adults report struggling with their mental health, a significant proportion do not receive care for various reasons including stigma, limited availability, long wait times, inability to pay, and a lack of culturally appropriate options. Helplines can be used to fill gaps in care and, though currently underutilized, are a significant focus of the federal government in the implementation of 988. To better understand the factors that facilitate and impede the utilization of helplines, we conducted 14 focus groups with 95 college students attending a public university and two private colleges in upstate New York between April 2019 and October 2020. Participants included undergraduates, graduate students, LGBTQIA + students, student-athletes, and international students. Participants shared several reasons for using helplines including convenience, comfort, immediate support, and privacy and anonymity. On the other hand, participants expressed hesitation as they expected ingenuine interactions with operators and a lack of continuity, they feared police involvement, and they felt that helplines are not for them, as they are marketed for those in a mental health or suicide crisis and their issues are not that severe. LGBTQIA + participants provided additional reasons as to why they use and do not use LGBTQIA+-specific helplines. Together, our findings suggest the need for improved education, marketing, and training around helplines and may be used to inform the implementation and promotion of 988 in its early stages.
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Affiliation(s)
- Brett R Harris
- Public Health Research Department, NORC at the University of Chicago, 4350 East-West Highway, 8th Floor, 20814, Bethesda, MD, USA.
- Department of Health Policy, Management and Behavior, University at Albany School of Public Health, One University Place, 12144, Rensselaer, NY, USA.
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Whitmyre ED, Esposito-Smythers C, Goldberg DG, Scalzo G, Defayette AB, López R. Impact of a Virtual Suicide Safety Planning Training on Clinician Knowledge, Self-Efficacy, and Use of Safety Plans in Community Mental Health Clinics. Arch Suicide Res 2024; 28:428-437. [PMID: 36899466 DOI: 10.1080/13811118.2023.2183163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
OBJECTIVE Safety planning is a critical evidence-based intervention used to prevent suicide among individuals who report suicidal ideation or behavior. There is a dearth of research on optimal ways to disseminate and implement safety plans in community settings. The present study examined one implementation strategy, a 1-hour virtual pre-implementation training, designed to teach clinicians to effectively use an electronic safety plan template (ESPT), integrated with suicide risk assessment tools, in the context of a measurement feedback system. We examined the effect of this training on clinician knowledge and self-efficacy in use of safety planning as well as ESPT completion rates. METHOD Thirty-six clinicians across two community-based clinical psychology training clinics completed the virtual pre-implementation training as well as pre- and post-training knowledge and self-efficacy assessments. Twenty-six clinicians completed a 6-month follow-up term. RESULTS Clinicians reported significant improvements in self-efficacy and knowledge from pre- to post-training. They retained significant improvements in self-efficacy and a trend toward greater knowledge at the 6-month follow-up. Of the clinicians who worked with suicidal youth, 81% attempted to use an ESPT and 63% successfully completed all sections of the ESPT. Reasons for partial completion included technological difficulties and time constraints. CONCLUSION A brief virtual pre-implementation training can improve clinician knowledge and self-efficacy in use of an ESPT with youth at risk for suicide. This strategy also holds the potential to improve the adoption of this novel evidence-based intervention in community-based settings.
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Woodward EN, Lunsford A, Brown R, Downing D, Ball I, Gan-Kemp JM, Smith A, Atkinson O, Graham T. Pre-implementation adaptation of suicide safety planning intervention using peer support in rural areas. FRONTIERS IN HEALTH SERVICES 2023; 3:1225171. [PMID: 38188615 PMCID: PMC10766826 DOI: 10.3389/frhs.2023.1225171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
Introduction Currently, seventeen veterans die by suicide daily in the United States (U.S.). There are disparities in suicide behavior and access to preventative treatment. One disparity is the suicide rate in rural areas, including the state of Arkansas-suicide deaths among rural veterans increased 48% in the last 2 decades, double that of urban veterans. One major challenge for veterans in rural areas is the lack of healthcare providers to provide Safety Planning Intervention, which is an effective intervention to reduce suicide attempts in the general adult population and among veterans. One solution is more broadly implementing Safety Planning Intervention, by using peers to deliver the intervention in rural communities. Before implementation, the intervention needs to be adapted for peer-to-peer delivery, and barriers and facilitators identified. Methods Since January 2021, using community-based participatory research, we collaboratively developed and executed a 1 year study to adapt Safety Planning Intervention for peer-to-peer delivery in rural communities and identified implementation barriers and facilitators prior to spread. From July 2022 to February 2023, we conducted group interviews with 12 participants: rural veterans with prior suicidal thoughts or attempts in one U.S. state, their support persons, and healthcare professionals with expertise in veteran suicide prevention, Safety Planning Intervention, and/or peer delivery. We collected qualitative data through interviews during nine, 2 h meetings, and quantitative data from one anonymous survey and real-time anonymous voting-all on the topic of core and adaptable components of Safety Planning Intervention and implementation barriers and facilitators for peer delivery in rural communities. Questions about adaptation were designed according to processes in the ENGAGED for CHANGE community-engaged intervention framework and questions about facilitators and barriers were designed according to the Health Equity Implementation Framework. Participants categorized which Safety Planning Intervention components were core or adaptable, and how freely they could be adapted, using the metaphor of a traffic light in red (do not change), yellow (change with caution), and green (change freely) categories. Results Participants made few actual adaptations (categorized according to the FRAME modification system), but strongly recommended robust training for peers. Participants identified 27 implementation facilitators and 47 barriers, organized using the Health Equity Implementation Framework. Two example facilitators were (1) peer-to-peer safety planning intervention was highly acceptable to rural veterans; and (2) some state counties already had veteran crisis programs that could embed this intervention for spread. Two example barriers were (1) some community organizations that might spread the intervention have been motivated initially, wanting to help right away, yet not able to sustain interventions; and (2) uncertainty about how to reach veterans at moderate suicide risk, as many crisis programs identified them when suicide risk was higher. Discussion Our results provide one of the more comprehensive pre-implementation assessments to date for Safety Planning Intervention in any setting, especially for peer delivery (also referred to as task shifting) outside healthcare or clinical settings. One important next step will be mapping these barriers and facilitators to implementation strategies for peer-to-peer delivery. One finding surprised our research team-despite worse societal context in rural communities leading to disproportionate suicide deaths-participants identified several positive facilitators specifically about rural communities that can be leveraged during implementation.
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Affiliation(s)
- Eva N. Woodward
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- VA Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, United States
| | - Amanda Lunsford
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Rae Brown
- Arkansas Freedom Fund, Little Rock, AR, United States
| | | | - Irenia Ball
- VA Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, United States
| | - Jennifer M. Gan-Kemp
- Department of Medical Humanities and Bioethics, Center for Health Literacy, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Anthony Smith
- Arkansas Freedom Fund, Little Rock, AR, United States
| | | | - Thomas Graham
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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Parrish EM, Quynh A, Scott V, Chalker SA, Chang C, Kamarsu S, Twamley EW, Depp CA. Suicide Safety Plan Self-knowledge in Serious Mental Illness: Psychiatric Symptom Correlates and Effects of Brief Intervention. Community Ment Health J 2023; 59:1639-1646. [PMID: 37340170 DOI: 10.1007/s10597-023-01155-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Abstract
Psychiatric symptoms experienced by people with serious mental illness (SMI; schizophrenia, bipolar and other psychotic disorders) may impact suicide safety planning. This study examined safety plan self-knowledge, or an individual's own knowledge and awareness of their safety plan, in a sample of people with SMI. Participants (N = 53) with SMI at elevated risk of suicide completed a 4-session intervention that included safety plans, with one intervention group that included mobile augmentation. Self-knowledge was assessed from previous safety plans at 4-, 12- and 24-weeks. Fewer warning signs generated was correlated with greater psychiatric symptoms (r = - .306, p = .026) and suicidal ideation (r = - .298, p = .030). Fewer coping strategies generated was correlated with greater suicidal ideation (r = .- 323, p = .018). Preliminarily, there was greater self-knowledge of warning signs over time among participants in the mobile intervention. These preliminary findings highlight the relationship of safety plan self-knowledge to symptoms and suggest that mobile augmentation of safety planning may be beneficial. Trial Registration: NCT03198364.
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Affiliation(s)
- Emma M Parrish
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, San Diego, CA, USA
| | - Avery Quynh
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Vanessa Scott
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Samantha A Chalker
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Cindy Chang
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Snigdha Kamarsu
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elizabeth W Twamley
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
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Hilliard M, Parkhurst JT. Suicide Risk Assessment and Safety Planning in Pediatric Primary Care. Pediatr Ann 2023; 52:e422-e425. [PMID: 37935394 DOI: 10.3928/19382359-20230906-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Suicidal thoughts and behavior are an increasing concern for youth. Pediatricians can prevent youth suicide through a stepwise process of screening, risk assessment, and safety planning incorporated into their practice. This article describes practical steps for pediatric clinicians to effectively detect and assess risks associated with suicidal thoughts and behaviors in youth while concurrently providing effective intervention. [Pediatr Ann. 2023;52(11):e422-e425.].
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Beaudreau SA, Lutz J, Wetherell JL, Nezu AM, Nezu CM, O'Hara R, Gould CE, Roelk B, Jo B, Hernandez B, Samarina V, Otero MC, Gallagher A, Hirsch J, Funderburk J, Pigeon WR. Beyond maintaining safety: Examining the benefit of emotion-centered problem solving therapy added to safety planning for reducing late life suicide risk. Contemp Clin Trials 2023; 128:107147. [PMID: 36921689 PMCID: PMC10164054 DOI: 10.1016/j.cct.2023.107147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
Few clinical trials have examined brief non-pharmacological treatments for reducing suicide risk in older Veterans, a high-risk group. Problem Solving Therapy (PST) is a promising psychosocial intervention for reducing late life suicide risk by increasing adaptive coping to problems through effective problem solving and related coping skills. The current randomized clinical trial will compare the efficacy of six telephone-delivered sessions of Safety Planning (enhanced usual care; EUC) only or an updated version of PST (emotion-centered PST [EC-PST]) + EUC to determine the added clinical benefit of EC-PST for reducing severity of suicidal ideation and for increasing reasons for living, a critical protective factor. Participants randomized to EC-PST + EUC or EUC only will be 150 Veterans (75 each) with active suicidal ideation who are aged 60 or older; have a current DSM-5 anxiety, depressive, and/or trauma-related disorder; and without significant cognitive impairment. Primary outcomes (Geriatric Suicide Ideation Scale and Reasons for Living-Older Adults scale) will be assessed at 11 timepoints: baseline, after each of 6 treatment sessions, posttreatment, and at follow-up at 1, 3, and 6 months posttreatment, and analyzed using mixed effects modeling. Additionally, moderators and mediators of primary outcomes will be examined-functional disability, executive dysfunction, and problem-solving ability. Qualitative feedback from participants will identify potential Veteran-centric changes to the EC-PST protocol and to EUC. Ultimately, the goal of this study is to inform the evidence-based clinical practice guidelines for treatments to reduce suicide risk in older Veterans and specifically to inform clinical decision-making regarding the merit of adding EC-PST to EUC.
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Affiliation(s)
- Sherry A Beaudreau
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, USA.
| | - Julie Lutz
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
| | - Julie Loebach Wetherell
- Mental Health Service, Veterans Affairs San Diego Health Care System, 3350 La Jolla Village Drive, San Diego, CA 92161-0002, USA; Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Arthur M Nezu
- Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104, USA
| | - Christine Maguth Nezu
- Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104, USA
| | - Ruth O'Hara
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, USA
| | - Christine E Gould
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, USA; Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
| | - Brandi Roelk
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave, Syracuse, NY 13210, USA
| | - Booil Jo
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, USA
| | - Beatriz Hernandez
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, USA
| | - Viktoriya Samarina
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
| | - Marcela C Otero
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, USA
| | - Alana Gallagher
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA; Psychology Department, Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA 94304, USA
| | - James Hirsch
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
| | - Jennifer Funderburk
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave, Syracuse, NY 13210, USA; Department of Psychiatry, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Wilfred R Pigeon
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave, Syracuse, NY 13210, USA; Department of Psychiatry, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, USA; VA Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, 400 Fort Hill Ave, Canandaigua, NY 14624, USA
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Pisani AR, Boudreaux ED. Systems Approach to Suicide Prevention: Strengthening Culture, Practice, and Education. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:152-159. [PMID: 37201147 PMCID: PMC10172554 DOI: 10.1176/appi.focus.20220081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Contemporary approaches to suicide prevention extend beyond an individual's interactions with care providers to seek opportunities for improvement in the wider care system. A systems-based analysis can yield opportunities to improve prevention and recovery across the care continuum. This article uses an example of an individual seeking care in an emergency department to show how a traditional clinical case formulation can be framed in terms of the outer and inner contexts of the EPIS (Exploration, Preparation, Implementation, Sustainment) framework to illuminate the impact of systemic factors on outcomes and to identify opportunities for improvement. Three mutually reinforcing domains (a culture of safety and prevention; best practices, policies, and pathways; and workforce education and development) of a systems approach to suicide prevention are outlined, along with their defining characteristics. A culture of safety and prevention requires engaged, informed leaders who prioritize prevention; lived experience integrated into leadership teams; and adverse events review in a Restorative Just Culture focused on healing and improvement. Best practices, policies, and pathways that promote safety, recovery, and health require codesign of processes and services and evolve through continuous measurement and improvement. To support a culture of safety and prevention, and caring, competent application of policy, organizations benefit from a longitudinal approach to workforce education. This includes a common framework and language; models clinical and lived experience collaboration; and supports continuous learning, as well as onboarding of new staff, rather than following a "one-and-done" approach, so that suicide prevention training remains top of mind across the workforce.
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Affiliation(s)
- Anthony R Pisani
- Departments of Psychiatry and Pediatrics, University of Rochester Medical Center, Rochester, New York (Pisani); Departments of Emergency Medicine, Psychiatry, and Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux)
| | - Edwin D Boudreaux
- Departments of Psychiatry and Pediatrics, University of Rochester Medical Center, Rochester, New York (Pisani); Departments of Emergency Medicine, Psychiatry, and Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux)
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Davis M, Siegel J, Becker-Haimes EM, Jager-Hyman S, Beidas RS, Young JF, Wislocki K, Futterer A, Mautone JA, Buttenheim AM, Mandell DS, Marx D. Identifying Common and Unique Barriers and Facilitators to Implementing Evidence-Based Practices for Suicide Prevention across Primary Care and Specialty Mental Health Settings. Arch Suicide Res 2023; 27:192-214. [PMID: 34651544 PMCID: PMC9930207 DOI: 10.1080/13811118.2021.1982094] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE We identified common and unique barriers and facilitators of evidence-based suicide prevention practices across primary care practices with integrated behavioral health services and specialty mental health settings to identify generalizable strategies for enhancing future implementation efforts. METHOD Twenty-six clinicians and practice leaders from behavioral health (n = 2 programs) and primary care (n = 4 clinics) settings participated. Participation included a semi-structured qualitative interview on barriers and facilitators to implementing evidence-based suicide prevention practices. Within that interview, clinicians participated in a chart-stimulated recall exercise to gather additional information about decision making regarding suicide screening. Interview guides and qualitative coding were informed by leading frameworks in implementation science and behavioral science, and an integrated approach to interpreting qualitative results was used. RESULTS There were a number of similar themes associated with implementation of suicide prevention practices across settings and clinician types, such as the benefits of inter-professional collaboration and uncertainties about managing suicidality once risk was disclosed. Clinicians also highlighted barriers unique to their settings. For primary care settings, time constraints and competing demands were consistently described as barriers. For specialty mental health settings, difficulties coordinating care with schools and other providers in the community made implementation of suicide prevention practices challenging. CONCLUSION Findings can inform the development and testing of implementation strategies that are generalizable across primary care and specialty mental health settings, as well as those tailored for unique site needs, to enhance use of evidence-based suicide prevention practices in settings where individuals at risk for suicide are especially likely to present.HIGHLIGHTSWe examined barriers and facilitators to suicide prevention across health settings.Common and unique barriers and facilitators across health-care settings emerged.Findings can enhance suicide prevention implementation across health-care settings.
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Affiliation(s)
- Molly Davis
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA
| | - Jennifer Siegel
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Emily M. Becker-Haimes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Hall Mercer Community Mental Health, University of Pennsylvania Health System
| | - Shari Jager-Hyman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Rinad S. Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA
| | - Jami F. Young
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, and PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Katherine Wislocki
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Anne Futterer
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jennifer A. Mautone
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, and PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Alison M. Buttenheim
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - David S. Mandell
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Darby Marx
- Weill Cornell Medical College of Cornell University, New York, NY
| | - Courtney Benjamin Wolk
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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Chalker SA, Parrish EM, Martinez Ceren CS, Depp CA, Goodman M, Doran N. Predictive Importance of Social Contacts on U.S. Veteran Suicide Safety Plans. Psychiatr Serv 2023; 74:244-249. [PMID: 36039556 DOI: 10.1176/appi.ps.202100699] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Safety planning is a suicide prevention intervention that relies partly on an individual's social relationships as distractions during or help in a suicidal crisis. The primary objectives of this study were to estimate rates of missingness on social aspects of safety plans to determine whether rates differ by demographic characteristics and diagnoses and to examine whether missing social contacts on safety plans may affect clinical outcomes. METHODS Data were drawn from the U.S. Department of Veterans Affairs San Diego Healthcare System's electronic medical record (N=1,602 individuals) from 2018 to 2021. Safety plans were coded according to the absence of listed distraction or help contacts, and clinical records of suicide attempts, suicide deaths, and use of crisis services were recorded for 1 year after completion of the safety plan. RESULTS In total, 30% of plans lacked a contact for distraction or help. Male veterans were less likely to have a distraction contact listed, and veterans identifying as Hispanic or Latino were more likely to have a help contact listed. The lack of a help contact (odds ratio [OR]=2.11) and having neither distraction nor help contacts (OR=2.45) were associated with a markedly higher risk for next-year suicide attempt or death. The lack of a help contact was associated with increased odds of a next-year psychiatric inpatient hospitalization (OR=1.90) and an emergency department visit (OR=1.88). CONCLUSIONS A lack of social contacts on safety plans may be a potential indicator for increased suicide risk among veterans.
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Affiliation(s)
- Samantha A Chalker
- Department of Psychiatry, University of California, San Diego (Chalker, Parrish, Martinez Ceren, Depp, Doran); U.S. Department of Veterans Affairs (VA) San Diego Healthcare System, San Diego (Chalker, Depp, Doran); James J. Peters VA Medical Center, Bronx, New York City, and Icahn School of Medicine at Mount Sinai, New York City (Goodman)
| | - Emma M Parrish
- Department of Psychiatry, University of California, San Diego (Chalker, Parrish, Martinez Ceren, Depp, Doran); U.S. Department of Veterans Affairs (VA) San Diego Healthcare System, San Diego (Chalker, Depp, Doran); James J. Peters VA Medical Center, Bronx, New York City, and Icahn School of Medicine at Mount Sinai, New York City (Goodman)
| | - Camila S Martinez Ceren
- Department of Psychiatry, University of California, San Diego (Chalker, Parrish, Martinez Ceren, Depp, Doran); U.S. Department of Veterans Affairs (VA) San Diego Healthcare System, San Diego (Chalker, Depp, Doran); James J. Peters VA Medical Center, Bronx, New York City, and Icahn School of Medicine at Mount Sinai, New York City (Goodman)
| | - Colin A Depp
- Department of Psychiatry, University of California, San Diego (Chalker, Parrish, Martinez Ceren, Depp, Doran); U.S. Department of Veterans Affairs (VA) San Diego Healthcare System, San Diego (Chalker, Depp, Doran); James J. Peters VA Medical Center, Bronx, New York City, and Icahn School of Medicine at Mount Sinai, New York City (Goodman)
| | - Marianne Goodman
- Department of Psychiatry, University of California, San Diego (Chalker, Parrish, Martinez Ceren, Depp, Doran); U.S. Department of Veterans Affairs (VA) San Diego Healthcare System, San Diego (Chalker, Depp, Doran); James J. Peters VA Medical Center, Bronx, New York City, and Icahn School of Medicine at Mount Sinai, New York City (Goodman)
| | - Neal Doran
- Department of Psychiatry, University of California, San Diego (Chalker, Parrish, Martinez Ceren, Depp, Doran); U.S. Department of Veterans Affairs (VA) San Diego Healthcare System, San Diego (Chalker, Depp, Doran); James J. Peters VA Medical Center, Bronx, New York City, and Icahn School of Medicine at Mount Sinai, New York City (Goodman)
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Chalker SA, Parrish EM, Martinez Ceren CS, Depp CA, Ilgen MA, Goodman M, Twamley EW, Doran N. Crisis service utilization following completion of a suicide safety plan for Veterans with and without affective and nonaffective psychosis. J Psychiatr Res 2022; 154:219-223. [PMID: 35961177 DOI: 10.1016/j.jpsychires.2022.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/30/2022] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Psychosis is associated with increased suicide risk. Safety planning is a suicide prevention practice that is associated with decreased suicidal behavior and psychiatric hospitalizations. A common feature of safety planning is listing of crisis line numbers. The primary purpose of this study was to compare Veterans with and without psychosis who completed a safety plan in terms of their next year crisis service use, including Veterans Crisis Line (VCL) calls, and suicidal behavior. METHODS Data were drawn from the VA San Diego's electronic medical record system for (N = 1602) safety plans from 2018 to 2021. Clinical records of crisis services and suicide attempt/death were recorded for one year after the safety plan. RESULTS Following completion of a safety plan, Veterans with psychosis were more likely to have a next year psychiatric hospitalization (OR = 4.1), emergency department visit (OR = 2.3), and psychiatric emergency clinic visit (OR = 2.2) than those without psychosis. In contrast, there were no group differences in likelihood of calling the VCL. CONCLUSIONS Veterans with psychosis who recently completed a safety plan do not show elevated rates of VCL use that are commensurate with increases in crisis service use. Interventions for this high-risk group may focus on understanding the motivation and ability to call the VCL as ways to enhance safety planning.
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Affiliation(s)
- Samantha A Chalker
- VA San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA.
| | - Emma M Parrish
- University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
| | | | - Colin A Depp
- VA San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Mark A Ilgen
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan, Department of Psychiatry, Ann Arbor, MI, USA
| | | | - Elizabeth W Twamley
- VA San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Neal Doran
- VA San Diego Healthcare System, San Diego, CA, USA; University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
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Wilson MP, Waliski A, Thompson RG. Feasibility of Peer-Delivered Suicide Safety Planning in the Emergency Department: Results From a Pilot Trial. Psychiatr Serv 2022; 73:1087-1093. [PMID: 35502515 DOI: 10.1176/appi.ps.202100561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The emergency department (ED) is an important site for suicide prevention efforts, and safety planning has been identified as a best practice for suicide prevention among ED patients at increased suicide risk. However, few ED clinicians are prepared to assess suicide risk or guide patients in the creation of safety plans. This study was a pilot randomized controlled trial of the feasibility, acceptability, and preliminary effects of safety planning by individuals with lived experience of suicide attempt or of severe suicidal ideation but without medical training (i.e., peers) in the ED. METHODS Patients at risk for suicide in a general ED were randomly assigned to receive peer-delivered or mental health provider–delivered safety planning. Intervention feasibility measures included ED length of stay, safety plan completeness, and safety plan quality. Acceptability measures included patient satisfaction. Preliminary effects were assessed as number of ED returns within the 3 months after the ED visit. RESULTS Data from 31 participants were available for analysis. Compared with participants with provider-delivered safety planning, participants with peer-delivered safety planning had similar ED lengths of stay, higher safety plan completeness, and higher safety plan quality. Acceptability of the safety planning process was similar for the two groups. Compared with participants receiving provider-delivered safety planning, participants receiving peer-delivered planning had significantly fewer ED visits during the subsequent 3 months than during the 3 months preceding the ED visit. CONCLUSIONS Peer-delivered safety planning is feasible and acceptable and may result in fewer return ED visits. These findings provide preliminary support for peer-delivered safety planning in the ED.
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Affiliation(s)
- Michael P Wilson
- Division of Research and Evidence-Based Medicine and Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab, Department of Emergency Medicine (Wilson), and Center for Health Services Research, Department of Psychiatry (Waliski, Thompson), University of Arkansas for Medical Sciences (UAMS), Little Rock; Department of Health Services Research and Development, Central Arkansas Veteran's Healthcare system, Little Rock (Waliski)
| | - Angie Waliski
- Division of Research and Evidence-Based Medicine and Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab, Department of Emergency Medicine (Wilson), and Center for Health Services Research, Department of Psychiatry (Waliski, Thompson), University of Arkansas for Medical Sciences (UAMS), Little Rock; Department of Health Services Research and Development, Central Arkansas Veteran's Healthcare system, Little Rock (Waliski)
| | - Ronald G Thompson
- Division of Research and Evidence-Based Medicine and Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab, Department of Emergency Medicine (Wilson), and Center for Health Services Research, Department of Psychiatry (Waliski, Thompson), University of Arkansas for Medical Sciences (UAMS), Little Rock; Department of Health Services Research and Development, Central Arkansas Veteran's Healthcare system, Little Rock (Waliski)
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Ferguson M, Rhodes K, Loughhead M, McIntyre H, Procter N. The Effectiveness of the Safety Planning Intervention for Adults Experiencing Suicide-Related Distress: A Systematic Review. Arch Suicide Res 2022; 26:1022-1045. [PMID: 33913799 DOI: 10.1080/13811118.2021.1915217] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The safety planning intervention (SPI) is gaining momentum in suicide prevention practice and research. This systematic review sought to determine the effectiveness of the SPI for adults experiencing suicide-related distress. Systematic searches of international, peer-reviewed literature were conducted in six databases (Cochrane Trials, Embase, Emcare, Medline, PsycINFO and Web of Science), including terms for safety planning, suicide, and suicide-related outcomes. A total of 565 results were included for screening. Result screening (title/abstract and full-text), data extraction and critical appraisal were conducted in duplicate. Twenty-six studies met the inclusion criteria. Studies were primarily quantitative (n = 20), largely with general adult or veteran samples; a small number of studies explored the perspectives of staff and significant others. Half of the studies included the SPI as a standalone intervention, while the other half examined the SPI in combination with other interventions. Most interventions were delivered in-person, with a hard-copy safety plan created, while a smaller number explored internet-based interventions. Primary measures included: suicidality (ideation, behavior, deaths; 10 studies), suicide-related outcomes (depression, hopelessness; 5 studies) and treatment outcomes (hospitalizations, treatment engagement; 7 studies). The evidence supports improvements in each of these domains, with complementary findings from the remaining quantitative and qualitative studies suggesting that the SPI is a feasible and acceptable intervention. While positive, these findings are limited by the heterogeneity of interventions and study designs, making the specific impact of the SPI difficult to both determine and generalize. Conversely, this also points to the flexibility of the SPI.HighlightsThe Safety Planning Intervention (SPI) is a valuable indicated intervention for general adult and veteran populations experiencing suicide-related distress, primarily in face-to-face, clinical settings.Quantitative findings indicate associations between the SPI and improvements in suicidal ideation and behavior, decreases in depression and hopelessness, along with reductions in hospitalizations and improvements in treatment attendance.Qualitative studies suggest the SPI is acceptable and feasible, with areas for development.SPIs have been shown to be adaptable to the clinical area in its modality (digital or paper-based), delivery (face-to-face or online), facilitation (clinician or self-administered) and multiplicity (as stand-alone or combined intervention).
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Abstract
Suicide rates continue to rise, and clinicians and mental health staff play a critical role in keeping suicidal clients safe. Safety planning, including means safety, may help to decrease suicide risk. Unfortunately, availability and evaluation of safety planning training for these providers are scarce. The goal of the present study was to evaluate a safety planning training, LINC to LIFE Safety Planning (L2L SP). L2L SP is a 150-minute, face-to-face training program that teaches providers to engage clients in collaborative safety planning and means safety efforts, facilitate diverse client coping strategies, problem-solve, and involve close others, among other skills. These objectives are achieved through interactive content delivery, role-play, and corrective feedback. L2L SP was administered to 95 participants. Key determinants of behavioral change (e.g., knowledge, attitudes, perceived behavioral control [PBC]) were measured at pre, post, and six-month follow-up. Additionally, participants' behaviors and emotions in working with suicidal clients were measured at pretest and six-month follow-up. Paired sample t-tests, repeated measures MANOVA, and univariate ANOVAs with post-hoc testing using Bonferroni correction were conducted. Results supported significant improvements in knowledge, PBC, and intentions at post-test, and attitudes, PBC, and effective emotional responses at follow-up. Exploratory analyses suggested significant improvements in behaviors among clinicians and mental health staff who saw clients reporting suicidal ideation. The present study provides promising results regarding brief safety planning training. Declines in knowledge and PBC following the training highlight the potential need for booster sessions or more intensive initial training in these areas.HighlightsThe present study evaluated a comprehensive, interactive safety planning training.Knowledge, PBC, and intentions were significantly improved at post-test.Attitudes, PBC, and emotions were significantly improved at follow-up.
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Allison MK, Waliski A, Haynes TF, Marshall SA. Formative evaluation of Zero Suicide in the emergency department: Identifying strategies to overcome implementation barriers. EVALUATION AND PROGRAM PLANNING 2022; 92:102050. [PMID: 35217479 DOI: 10.1016/j.evalprogplan.2022.102050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/03/2021] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Zero Suicide has been widely promoted as a comprehensive suicide prevention approach in healthcare systems, yet less is known about the barriers to implementing this approach in the emergency department. OBJECTIVES This developmental evaluation aimed to assess emergency department providers' perceived knowledge and self-efficacy regarding suicide prevention practices, as well as apply the Consolidated Framework for Implementation Research to explore potential facilitators and barriers to implementing Zero Suicide and identify strategies to overcome barriers. METHODS A sequential mixed methods approach was used, including a survey assessing emergency department providers' perceived knowledge and attitudes and semi-structured interviews exploring potential determinants of implementation. RESULTS Survey respondents (n = 43) perceived that they have the knowledge and self-efficacy to implement clinical elements of Zero Suicide; however, interview participants (n = 18) revealed that some clinical elements are not implemented consistently and perceive implementation barriers across multiple levels, including limited training on suicide risk assessment and limited resources needed to engage and re-engage at-risk patients in their suicide care management plan and provide follow-up supportive contacts during patients' transitions in care. CONCLUSION To overcome identified barriers in this setting, targeted implementation strategies are needed, including integration in electronic health record systems, leadership advocacy, and ongoing staff training.
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Affiliation(s)
- M Kathryn Allison
- Department of Health Behavior & Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301W Markham Street, Little Rock, AR 72205, United States.
| | - Angie Waliski
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR 72114, United States; Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301W Markham Street, Little Rock, AR 72205, United States
| | - Tiffany F Haynes
- Department of Health Behavior & Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301W Markham Street, Little Rock, AR 72205, United States
| | - S Alexandra Marshall
- Department of Health Behavior & Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301W Markham Street, Little Rock, AR 72205, United States
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Carbajal J, Ponder WN. Does Attachment Mediate PTSD and Suicidality in a Sample of Global War on Terrorism (GWOT) Combat Veterans? JOURNAL OF VETERANS STUDIES 2022. [DOI: 10.21061/jvs.v8i1.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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22
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du Pont A, Stanley IH, Pruitt LD, Reger MA. Local implementation evaluation of a suicide prevention predictive model at a large VA health care system. Suicide Life Threat Behav 2022; 52:214-221. [PMID: 34757649 DOI: 10.1111/sltb.12810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Veterans Health Administration (VHA) implemented REACH VET, which analyzes health records to identify veterans at statistically elevated risk for suicide and other adverse outcomes compared to other veterans in VHA. This project evaluated REACH VET program implementation at a large VA health care system by examining program fidelity and treatment engagement, receipt of suicide prevention interventions, and suicide-related behaviors in the 6 months following identification. METHODS Over a 12-month period, 218 unique cases were identified by REACH VET within a local VA system. Data were extracted from the VA's electronic medical records. RESULTS Protocol adherence for required clinical and administrative steps was 94% and above. After identification, 88% received outpatient mental health treatment, 21% had a psychiatric hospitalization, and 83% engaged in Safety Planning around the time of identification or in the following six months. Twenty-six percent of cases were identified by another existing method for identifying high-risk veterans. Five percent had a medically documented suicide attempt, and none were known to die by suicide in the following 6 months. CONCLUSIONS Local evaluation suggested high protocol fidelity and high engagement in mental health and suicide prevention services following identification among veterans who remained at elevated risk in the 6 months that followed.
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Affiliation(s)
- Alta du Pont
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Ian H Stanley
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Larry D Pruitt
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Mark A Reger
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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Darnell D, Areán PA, Dorsey S, Atkins DC, Tanana MJ, Hirsch T, Mooney SD, Boudreaux ED, Comtois KA. Harnessing Innovative Technologies to Train Nurses in Suicide Safety Planning With Hospitalized Patients: Protocol for Formative and Pilot Feasibility Research. JMIR Res Protoc 2021; 10:e33695. [PMID: 34914618 PMCID: PMC8717131 DOI: 10.2196/33695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022] Open
Abstract
Background Suicide is the 10th leading cause of death in the United States, with >47,000 deaths in 2019. Most people who died by suicide had contact with the health care system in the year before their death. Health care provider training is a top research priority identified by the National Action Alliance for Suicide Prevention; however, evidence-based approaches that target skill-building are resource intensive and difficult to implement. Advances in artificial intelligence technology hold promise for improving the scalability and sustainability of training methods, as it is now possible for computers to assess the intervention delivery skills of trainees and provide feedback to guide skill improvements. Much remains to be known about how best to integrate these novel technologies into continuing education for health care providers. Objective In Project WISE (Workplace Integrated Support and Education), we aim to develop e-learning training in suicide safety planning, enhanced with novel skill-building technologies that can be integrated into the routine workflow of nurses serving patients hospitalized for medical or surgical reasons or traumatic injury. The research aims include identifying strategies for the implementation and workflow integration of both the training and safety planning with patients, adapting 2 existing technologies to enhance general counseling skills for use in suicide safety planning (a conversational agent and an artificial intelligence–based feedback system), observing training acceptability and nurse engagement with the training components, and assessing the feasibility of recruitment, retention, and collection of longitudinal self-report and electronic health record data for patients identified as at risk of suicide. Methods Our developmental research includes qualitative and observational methods to explore the implementation context and technology usability, formative evaluation of the training paradigm, and pilot research to assess the feasibility of conducting a future cluster randomized pragmatic trial. The trial will examine whether patients hospitalized for medical or surgical reasons or traumatic injury who are at risk of suicide have better suicide-related postdischarge outcomes when admitted to a unit with nurses trained using the skill-building technology than those admitted to a unit with untrained nurses. The research takes place at a level 1 trauma center, which is also a safety-net hospital and academic medical center. Results Project WISE was funded in July 2019. As of September 2021, we have completed focus groups and usability testing with 27 acute care and 3 acute and intensive care nurses. We began data collection for research aims 3 and 4 in November 2021. All research has been approved by the University of Washington institutional review board. Conclusions Project WISE aims to further the national agenda to improve suicide prevention in health care settings by training nurses in suicide prevention with medically hospitalized patients using novel e-learning technologies. International Registered Report Identifier (IRRID) DERR1-10.2196/33695
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Affiliation(s)
- Doyanne Darnell
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Patricia A Areán
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - David C Atkins
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Michael J Tanana
- Social Research Institute, University of Utah, Salt Lake City, UT, United States
| | - Tad Hirsch
- College of Arts, Media, and Design, Northeastern University, Boston, MA, United States
| | - Sean D Mooney
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States
| | - Edwin D Boudreaux
- University of Massachusetts Medical School, Worcester, MA, United States
| | - Katherine Anne Comtois
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States
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Richards JE, Kuo E, Stewart C, Bobb JF, Mettert KD, Rowhani-Rahbar A, Betz ME, Parrish R, Whiteside U, Boggs JM, Simon GE. Self-reported Access to Firearms Among Patients Receiving Care for Mental Health and Substance Use. JAMA HEALTH FORUM 2021; 2:e211973. [PMID: 35977197 PMCID: PMC8796974 DOI: 10.1001/jamahealthforum.2021.1973] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/14/2021] [Indexed: 12/03/2022] Open
Abstract
Question Did patients respond to a standard question about firearm access on a mental health questionnaire, and, if so, how did they respond? Findings In this cross-sectional study of 128 802 patients receiving care for mental health and substance use, 83% of primary care patients answered a standard question about firearm access and 21% reported access. In mental health clinics, 92% of patients answered the question and 15% reported access. Meaning In this study, most patients reported firearm access on standard questionnaires; this screening practice may improve efforts to identify and engage patients at risk of suicide in discussions about securing firearms. Importance Firearms are the most common method of suicide, one of the “diseases of despair” driving increased mortality in the US over the past decade. However, routine standardized questions about firearm access are uncommon, particularly among adult populations, who are more often asked at the discretion of health care clinicians. Because standard questions are rare, patterns of patient-reported access are unknown. Objective To evaluate whether and how patients self-report firearm access information on a routine mental health monitoring questionnaire and additionally to examine sociodemographic and clinical associations of reported access. Design, Setting, and Participants Cross-sectional study of patients receiving care for mental health and/or substance use in primary care or outpatient mental health specialty clinics of Kaiser Permanente Washington, an integrated health insurance provider and care delivery system. Main Outcomes and Measures Electronic health records were used to identify patients who completed a standardized self-reported mental health monitoring questionnaire after a single question about firearm access was added from January 1, 2016, through December 31, 2019. Primary analyses evaluated response (answered vs not answered) and reported access (yes vs no) among those who answered, separately for patients seen in primary care and mental health. These analyses also evaluated associations between patient characteristics and reported firearm access. Data analysis took place from February 2020 through May 2021. Results Among patients (n = 128 802) who completed a mental health monitoring questionnaire during the study period, 74.4% (n = 95 875) saw a primary care clinician and 39.3% (n = 50 631) saw a mental health specialty clinician. The primary care and mental health samples were predominantly female (63.1% and 64.9%, respectively) and White (75.7% and 77.0%), with a mean age of 42.8 and 51.1 years. In primary care, 83.4% of patients answered the question about firearm access, and 20.9% of patients who responded to the firearm question reported having access. In mental health, 91.8% of patients answered the question, and 15.3% reported having access. Conclusions and Relevance In this cross-sectional study of adult patients receiving care for mental health and substance use, most patients answered a question about firearm access on a standardized mental health questionnaire. These findings provide a critical foundation to help advance understanding of the utility of standardized firearm access assessment and to inform development of practice guidelines and recommendations. Responses to standard firearm access questions used in combination with dialogue and decision-making resources about firearm access and storage may improve suicide prevention practices and outcomes.
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Affiliation(s)
- Julie E. Richards
- Health Research Institute, Kaiser Permanente Washington, Seattle
- Department of Health Services, University of Washington, Seattle
| | - Elena Kuo
- Health Research Institute, Kaiser Permanente Washington, Seattle
| | | | - Jennifer F. Bobb
- Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Kayne D. Mettert
- Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington School of Public Health, Seattle
- Harborview Injury Prevention and Research Center, Seattle, Washington
| | - Marian E. Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
| | - Rebecca Parrish
- Department of Mental Health & Wellness, Kaiser Permanente Washington, Seattle
| | - Ursula Whiteside
- NowMattersNow.org, Seattle, Washington
- Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | | | - Gregory E. Simon
- Health Research Institute, Kaiser Permanente Washington, Seattle
- Department of Mental Health & Wellness, Kaiser Permanente Washington, Seattle
- Psychiatry and Behavioral Sciences, University of Washington, Seattle
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Richards JE, Hohl SD, Segal CD, Grossman DC, Lee AK, Whiteside U, Luce C, Ludman EJ, Simon G, Penfold RB, Williams EC. "What Will Happen If I Say Yes?" Perspectives on a Standardized Firearm Access Question Among Adults With Depressive Symptoms. Psychiatr Serv 2021; 72:898-904. [PMID: 33940947 PMCID: PMC8328914 DOI: 10.1176/appi.ps.202000187] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Addressing firearm access is recommended when patients are identified as being at risk of suicide. However, the practice of assessing firearm access is controversial, and no national guidelines exist to inform practice. This study qualitatively explored patient perspectives on a routine question about firearm access to optimize the patient centeredness of this practice in the context of suicide risk. METHODS Electronic health record data were used to identify primary care patients reporting depressive symptoms, including suicidal thoughts, within 2 weeks of sampling. Participants completed a semistructured telephone interview (recorded and transcribed), which focused broadly on the experience of being screened for suicidality and included specific questions to elicit beliefs and opinions about being asked a standard firearm access question. Directive (deductive) and conventional (inductive) content analysis was used to analyze responses to the portion of the interview focused on firearm assessment and disclosure. RESULTS Thirty-seven patients in Washington State ages 20-95 completed the qualitative interview by phone. Organizing themes included apprehensions about disclosing access to firearms related to privacy, autonomy, and firearm ownership rights; perceptions regarding relevance of the firearm question, informed by experiences with suicidality and common beliefs and misconceptions about the inevitability of suicide; and suggestions for connecting questions about firearms and other lethal means to suicide risk. CONCLUSIONS Clarifying the purpose and use of routine firearm access assessment, contextualizing firearm questions within injury prevention broadly, and addressing misconceptions about suicide prevention may help encourage disclosure of firearm access and increase the patient centeredness of this practice.
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Affiliation(s)
- Julie E Richards
- Kaiser Permanente Washington Health Research Institute, Seattle (Richards, Grossman, Lee, Luce, Ludman, Simon, Penfold); Department of Health Services (Richards, Hohl, Segal, Penfold, Williams) and Department of Psychiatry and Behavioral Sciences (Whiteside, Simon), University of Washington, Seattle; NowMattersNow.org, Seattle (Whiteside); Center of Innovation for Veteran-Centered Value-Driven Care, Health Services Research and Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Williams); Department of Preventive Care, Kaiser Permanente Washington (Grossman)
| | - Sarah D Hohl
- Kaiser Permanente Washington Health Research Institute, Seattle (Richards, Grossman, Lee, Luce, Ludman, Simon, Penfold); Department of Health Services (Richards, Hohl, Segal, Penfold, Williams) and Department of Psychiatry and Behavioral Sciences (Whiteside, Simon), University of Washington, Seattle; NowMattersNow.org, Seattle (Whiteside); Center of Innovation for Veteran-Centered Value-Driven Care, Health Services Research and Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Williams); Department of Preventive Care, Kaiser Permanente Washington (Grossman)
| | - Courtney D Segal
- Kaiser Permanente Washington Health Research Institute, Seattle (Richards, Grossman, Lee, Luce, Ludman, Simon, Penfold); Department of Health Services (Richards, Hohl, Segal, Penfold, Williams) and Department of Psychiatry and Behavioral Sciences (Whiteside, Simon), University of Washington, Seattle; NowMattersNow.org, Seattle (Whiteside); Center of Innovation for Veteran-Centered Value-Driven Care, Health Services Research and Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Williams); Department of Preventive Care, Kaiser Permanente Washington (Grossman)
| | - David C Grossman
- Kaiser Permanente Washington Health Research Institute, Seattle (Richards, Grossman, Lee, Luce, Ludman, Simon, Penfold); Department of Health Services (Richards, Hohl, Segal, Penfold, Williams) and Department of Psychiatry and Behavioral Sciences (Whiteside, Simon), University of Washington, Seattle; NowMattersNow.org, Seattle (Whiteside); Center of Innovation for Veteran-Centered Value-Driven Care, Health Services Research and Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Williams); Department of Preventive Care, Kaiser Permanente Washington (Grossman)
| | - Amy K Lee
- Kaiser Permanente Washington Health Research Institute, Seattle (Richards, Grossman, Lee, Luce, Ludman, Simon, Penfold); Department of Health Services (Richards, Hohl, Segal, Penfold, Williams) and Department of Psychiatry and Behavioral Sciences (Whiteside, Simon), University of Washington, Seattle; NowMattersNow.org, Seattle (Whiteside); Center of Innovation for Veteran-Centered Value-Driven Care, Health Services Research and Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Williams); Department of Preventive Care, Kaiser Permanente Washington (Grossman)
| | - Ursula Whiteside
- Kaiser Permanente Washington Health Research Institute, Seattle (Richards, Grossman, Lee, Luce, Ludman, Simon, Penfold); Department of Health Services (Richards, Hohl, Segal, Penfold, Williams) and Department of Psychiatry and Behavioral Sciences (Whiteside, Simon), University of Washington, Seattle; NowMattersNow.org, Seattle (Whiteside); Center of Innovation for Veteran-Centered Value-Driven Care, Health Services Research and Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Williams); Department of Preventive Care, Kaiser Permanente Washington (Grossman)
| | - Casey Luce
- Kaiser Permanente Washington Health Research Institute, Seattle (Richards, Grossman, Lee, Luce, Ludman, Simon, Penfold); Department of Health Services (Richards, Hohl, Segal, Penfold, Williams) and Department of Psychiatry and Behavioral Sciences (Whiteside, Simon), University of Washington, Seattle; NowMattersNow.org, Seattle (Whiteside); Center of Innovation for Veteran-Centered Value-Driven Care, Health Services Research and Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Williams); Department of Preventive Care, Kaiser Permanente Washington (Grossman)
| | - Evette J Ludman
- Kaiser Permanente Washington Health Research Institute, Seattle (Richards, Grossman, Lee, Luce, Ludman, Simon, Penfold); Department of Health Services (Richards, Hohl, Segal, Penfold, Williams) and Department of Psychiatry and Behavioral Sciences (Whiteside, Simon), University of Washington, Seattle; NowMattersNow.org, Seattle (Whiteside); Center of Innovation for Veteran-Centered Value-Driven Care, Health Services Research and Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Williams); Department of Preventive Care, Kaiser Permanente Washington (Grossman)
| | - Greg Simon
- Kaiser Permanente Washington Health Research Institute, Seattle (Richards, Grossman, Lee, Luce, Ludman, Simon, Penfold); Department of Health Services (Richards, Hohl, Segal, Penfold, Williams) and Department of Psychiatry and Behavioral Sciences (Whiteside, Simon), University of Washington, Seattle; NowMattersNow.org, Seattle (Whiteside); Center of Innovation for Veteran-Centered Value-Driven Care, Health Services Research and Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Williams); Department of Preventive Care, Kaiser Permanente Washington (Grossman)
| | - Robert B Penfold
- Kaiser Permanente Washington Health Research Institute, Seattle (Richards, Grossman, Lee, Luce, Ludman, Simon, Penfold); Department of Health Services (Richards, Hohl, Segal, Penfold, Williams) and Department of Psychiatry and Behavioral Sciences (Whiteside, Simon), University of Washington, Seattle; NowMattersNow.org, Seattle (Whiteside); Center of Innovation for Veteran-Centered Value-Driven Care, Health Services Research and Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Williams); Department of Preventive Care, Kaiser Permanente Washington (Grossman)
| | - Emily C Williams
- Kaiser Permanente Washington Health Research Institute, Seattle (Richards, Grossman, Lee, Luce, Ludman, Simon, Penfold); Department of Health Services (Richards, Hohl, Segal, Penfold, Williams) and Department of Psychiatry and Behavioral Sciences (Whiteside, Simon), University of Washington, Seattle; NowMattersNow.org, Seattle (Whiteside); Center of Innovation for Veteran-Centered Value-Driven Care, Health Services Research and Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle (Williams); Department of Preventive Care, Kaiser Permanente Washington (Grossman)
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Ferguson M, Posselt M, McIntyre H, Loughhead M, Kenny MA, Mau V, Procter N. Staff Perspectives of Safety Planning as a Suicide Prevention Intervention for People of Refugee and Asylum-Seeker Background. CRISIS 2021; 43:331-338. [PMID: 33944610 PMCID: PMC9353668 DOI: 10.1027/0227-5910/a000781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Safety planning involves the co-development of a personalized list of coping strategies to prevent a suicide crisis. Aims: We explored the perspectives of workers regarding safety planning as a suicide prevention strategy for people of refugee background and those seeking asylum in Australia. Method: Participants attended suicide prevention training, specific to refugees and asylum seekers, at which safety planning was a key component. Semistructured, posttraining interviews (n = 12) were analyzed thematically. Results: Four key themes were identified: safety planning as a co-created, personalized activity for the client; therapeutic benefits of developing a safety plan; barriers to engaging in safety planning; strategies to enhance safety planning engagement. Limitations: First-hand refugee and asylum-seeker experiences were not included. Conclusion: As a relatively low-cost, flexible intervention, safety planning may be valuable and effective for these groups.
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Affiliation(s)
- Monika Ferguson
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Miriam Posselt
- Survivors of Torture and Trauma Assistance and Rehabilitation Service, Adelaide, SA, Australia
| | - Heather McIntyre
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Mark Loughhead
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | | | - Vicki Mau
- Australian Red Cross, Melbourne, VIC, Australia
| | - Nicholas Procter
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
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Abstract
Psychiatry has a contentious history of coercion in the care of patients with mental illness, and legal frameworks often govern use of coercive interventions, such as involuntary hospitalization, physical restraints, and medication over objection. Research also suggests that informal coercion, including subtle inducements, leverage, or threats, is prevalent and influential in psychiatric settings. Digital technologies bring promise for expanding access to psychiatric care and improving delivery of these services; however, use and misuse of digital technologies, such as electronic medical record flags, surveillance cameras, videoconferencing, and risk assessment tools, could lead to unexpected coercion of patients with mental illness. Using several composite case examples, the author proposes that the integration of digital technologies into psychiatric care can influence patients' experiences of coercion and provides recommendations for studying and addressing these effects.
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Affiliation(s)
- Nathaniel P Morris
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco
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Harris BR, Tracy M, Comber KG, Pechenik S, Carruthers JW. Suicide safer care in behavioral health settings: A comparative analysis of perceptions, training completion, and practice between mental health and substance use disorder treatment providers. J Subst Abuse Treat 2021; 126:108330. [PMID: 34116821 DOI: 10.1016/j.jsat.2021.108330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/02/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite prevention and treatment efforts, opioid overdose deaths continue to rise in the United States and totaled 46,802 in 2018. This public health crisis is closely linked with suicide, with those who misuse opioids at six times the risk of death by suicide. Suicide prevention in substance use disorder (SUD) treatment may be a critical step in saving lives and promoting recovery among those at risk for opioid overdose. METHODS We distributed an electronic survey to clinicians in mental health and SUD treatment in nine health systems across New York State from November 2018 to January 2019. The goal of the survey was to assess attitudes, perceptions, practice, and training needs among SUD treatment providers and how they differ from those of mental health providers. RESULTS A total of 633 clinicians responded to the survey (62.4% response rate). Seventy-one percent of SUD providers reported working with a client who attempted suicide. Even so, less than half of SUD providers reported routinely screening new (48.9%) or existing patients (25.6%) for suicidal thoughts/behaviors; overall, 28.4% of SUD providers reported low levels of action to address suicide risk, compared to 9.0% of mental health providers (p < 0.001). Perceived self-efficacy and effectiveness at reducing a patient's risk of suicide and training completion were strongly associated with routine delivery of suicide safer care in adjusted logistic regression models. CONCLUSIONS The results of this study identify key areas for targeted training and technical assistance to increase the provision of quality suicide safer care in SUD treatment.
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Affiliation(s)
- Brett R Harris
- University at Albany School of Public Health, One University Place, Rensselaer, NY 12144, USA.
| | - Melissa Tracy
- University at Albany School of Public Health, One University Place, Rensselaer, NY 12144, USA.
| | - Katharine G Comber
- New York State Office of Mental Health, 44 Holland Avenue, Albany, NY 12229, USA.
| | - Sigrid Pechenik
- New York State Office of Mental Health, 44 Holland Avenue, Albany, NY 12229, USA.
| | - Jay W Carruthers
- New York State Office of Mental Health, 44 Holland Avenue, Albany, NY 12229, USA.
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Bettis AH, Donise KR, MacPherson HA, Bagatelas P, Wolff JC. Safety Planning Intervention for Adolescents: Provider Attitudes and Response to Training in the Emergency Services Setting. Psychiatr Serv 2020; 71:1136-1142. [PMID: 32838677 PMCID: PMC8722644 DOI: 10.1176/appi.ps.201900563] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to describe the implementation of the empirically supported Safety Planning Intervention (SPI) for adolescent suicidality in emergency services (ES) settings. METHODS Using an implementation science framework, the authors collaboratively evaluated the needs of ES providers; developed a plan; and trained ES psychiatrists, social workers, and mental health specialists for SPI implementation. The health care and social workers put the safety plan into practice in ES settings and, after involving stakeholders in addressing challenges during implementation, fully integrated the program into ES practice. This study examined providers' attitudes toward the structured SPI before and after training in this evidence-based intervention. RESULTS Providers reported a desire to learn evidence-based interventions for safety planning before the training. The effect of time from pre- to posttraining on provider attitudes and knowledge about the SPI was statistically significant (F=4.19, df=2 and 22, p=0.030), indicating that providers' attitudes toward using the structured SPI in their work improved after completing the training. CONCLUSIONS These findings are relevant for health care settings that seek to comply with new standards for hospital accreditation and improve overall patient care for suicidal youths. The results suggest that stakeholder collaboration and brief training in SPI may be effective for incorporating structured safety planning practices into pediatric ES settings.
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Affiliation(s)
- Alexandra H Bettis
- Rhode Island Hospital, Providence (Bettis, Donise, Wolff); Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island (all authors); Bradley Hospital, Riverside, Rhode Island (MacPherson, Bagatelas)
| | - Kathleen R Donise
- Rhode Island Hospital, Providence (Bettis, Donise, Wolff); Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island (all authors); Bradley Hospital, Riverside, Rhode Island (MacPherson, Bagatelas)
| | - Heather A MacPherson
- Rhode Island Hospital, Providence (Bettis, Donise, Wolff); Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island (all authors); Bradley Hospital, Riverside, Rhode Island (MacPherson, Bagatelas)
| | - Pauline Bagatelas
- Rhode Island Hospital, Providence (Bettis, Donise, Wolff); Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island (all authors); Bradley Hospital, Riverside, Rhode Island (MacPherson, Bagatelas)
| | - Jennifer C Wolff
- Rhode Island Hospital, Providence (Bettis, Donise, Wolff); Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island (all authors); Bradley Hospital, Riverside, Rhode Island (MacPherson, Bagatelas)
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Davis M, Wolk CB, Jager-Hyman S, Beidas RS, Young JF, Mautone JA, Buttenheim AM, Mandell DS, Volpp KG, Wislocki K, Futterer A, Marx D, Dieckmeyer EL, Becker-Haimes EM. Implementing nudges for suicide prevention in real-world environments: project INSPIRE study protocol. Pilot Feasibility Stud 2020; 6:143. [PMID: 32995040 PMCID: PMC7519386 DOI: 10.1186/s40814-020-00686-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background Suicide is a global health issue. There are a number of evidence-based practices for suicide screening, assessment, and intervention that are not routinely deployed in usual care settings. The goal of this study is to develop and test implementation strategies to facilitate evidence-based suicide screening, assessment, and intervention in two settings where individuals at risk for suicide are especially likely to present: primary care and specialty mental health care. We will leverage methods from behavioral economics, which involves understanding the many factors that influence human decision making, to inform strategy development. Methods We will identify key mechanisms that limit implementation of evidence-based suicide screening, assessment, and intervention practices in primary care and specialty mental health through contextual inquiry involving behavioral health and primary care clinicians. Second, we will use contextual inquiry results to systematically design a menu of behavioral economics-informed implementation strategies that cut across settings, in collaboration with an advisory board composed of key stakeholders (i.e., behavioral economists, clinicians, implementation scientists, and suicide prevention experts). Finally, we will conduct rapid-cycle trials to test and refine the menu of implementation strategies. Primary outcomes include clinician-reported feasibility and acceptability of the implementation strategies. Discussion Findings will elucidate ways to address common and unique barriers to evidence-based suicide screening, assessment, and intervention practices in primary care and specialty mental health care. Results will yield refined, pragmatically tested strategies that can inform larger confirmatory trials to combat the growing public health crisis of suicide.
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Affiliation(s)
- Molly Davis
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA USA
| | - Courtney Benjamin Wolk
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA USA
| | - Shari Jager-Hyman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Jami F Young
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA.,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA USA
| | - Jennifer A Mautone
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA.,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA USA
| | - Alison M Buttenheim
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA.,Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA.,Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA USA
| | - David S Mandell
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA USA
| | - Kevin G Volpp
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA.,Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA.,Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, PA USA.,Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA USA
| | - Katherine Wislocki
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Anne Futterer
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Darby Marx
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - E L Dieckmeyer
- Jefferson College of Life Sciences, Thomas Jefferson University, University of Pennsylvania, Philadelphia, PA USA
| | - Emily M Becker-Haimes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
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Moscardini EH, Hill RM, Dodd CG, Do C, Kaplow JB, Tucker RP. Suicide Safety Planning: Clinician Training, Comfort, and Safety Plan Utilization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186444. [PMID: 32899637 PMCID: PMC7559434 DOI: 10.3390/ijerph17186444] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/19/2020] [Accepted: 09/02/2020] [Indexed: 11/16/2022]
Abstract
Extant literature has demonstrated that suicide safety planning is an efficacious intervention for reducing patient risk for suicide-related behaviors. However, little is known about factors that may impact the effectiveness of the intervention, such as provider training and comfort, use of specific safety plan elements, circumstances under which providers choose to use safety planning, and personal factors which influence a provider’s decision to use safety planning. Participants were (N = 119) safety plan providers who responded to an anonymous web-based survey. Results indicated that most providers had received training in safety planning and were comfortable with the intervention. Providers reported that skills such as identifying warning signs and means safety strategies were routinely used. Providers who reported exposure to suicide were more likely to complete safety plans with patients regardless of risk factors. In addition, almost 70% of providers indicated a need for further training. These data provide important considerations for safety plan implementation and training.
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Affiliation(s)
- Emma H. Moscardini
- Department of Psychology, Louisiana State University, 216 Audubon Hall, Baton Rouge, LA 70803, USA;
- Correspondence:
| | - Ryan M. Hill
- Baylor College of Medicine and Texas Children’s Hospital, 1102 Bates Ave., Suite C.0235.05, Houston, TX 77030, USA; (R.M.H.); (C.G.D.); (C.D.); (J.B.K.)
| | - Cody G. Dodd
- Baylor College of Medicine and Texas Children’s Hospital, 1102 Bates Ave., Suite C.0235.05, Houston, TX 77030, USA; (R.M.H.); (C.G.D.); (C.D.); (J.B.K.)
| | - Calvin Do
- Baylor College of Medicine and Texas Children’s Hospital, 1102 Bates Ave., Suite C.0235.05, Houston, TX 77030, USA; (R.M.H.); (C.G.D.); (C.D.); (J.B.K.)
| | - Julie B. Kaplow
- Baylor College of Medicine and Texas Children’s Hospital, 1102 Bates Ave., Suite C.0235.05, Houston, TX 77030, USA; (R.M.H.); (C.G.D.); (C.D.); (J.B.K.)
| | - Raymond P. Tucker
- Department of Psychology, Louisiana State University, 216 Audubon Hall, Baton Rouge, LA 70803, USA;
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Zhou E, DeCou CR, Stuber J, Rowhani-Rahbar A, Kume K, Rivara FP. Usual Care for Emergency Department Patients Who Present with Suicide Risk: A Survey of Hospital Procedures in Washington State. Arch Suicide Res 2020; 24:342-354. [PMID: 31248352 PMCID: PMC6980417 DOI: 10.1080/13811118.2019.1635932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hospital emergency departments (EDs) are important settings for the implementation of effective suicide-specific care. Usual care for suicidal patients who present to EDs remains understudied. This study surveyed EDs in Washington State to assess the adoption of written procedures for recommended standards of care for treating suicidality. Most (N = 79, 84.9%) of the 93 EDs in Washington State participated. Most (n = 58, 73.4%) hospitals had a written protocol for suicide risk assessment, but half (n = 42, 53.2%) did not include documentation of access to lethal means. There was evidence of an association between patient volume and the adoption of suicide-specific protocols and procedures. Our findings suggest the need to enhance the adoption and implementation of recommended standard care in this setting.
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The perspectives of adults with suicidal ideation and behaviour regarding their interactions with nurses in mental health and emergency services: A systematic review. Int J Nurs Stud 2020; 110:103692. [PMID: 32682109 DOI: 10.1016/j.ijnurstu.2020.103692] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/04/2020] [Accepted: 06/14/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND In contemporary healthcare, both community and inpatient mental health and emergency services are important help-seeking avenues for persons with suicidal ideation and behaviour. Regarding nursing practice in these services, there is a strong focus on assessing and managing suicide risk. Within this clinical context, the perspectives of persons with suicidal ideation and behaviour are often overlooked. OBJECTIVE To synthesise the literature examining the perceptions and experiences of persons with suicidal ideation and behaviour regarding their interactions with nurses. DESIGN Review of qualitative and quantitative studies within a data-based convergent synthesis design. DATA SOURCES A systematic search of electronic databases (until January 2020) in PubMed, Web of Science, Embase, and PsycARTICLES. Additional articles were identified through hand searching reference lists. REVIEW METHODS The methodological quality was assessed using the Critical Appraisal Skills Programme for qualitative studies and the QualSyst tool for quantitative studies. Thematic analysis was used to identify the key themes and subthemes. RESULTS In total, 26 studies were selected for analysis. Most studies were qualitative and focused on inpatient mental health services. The studies reflected a spectrum of positive and negative perceptions and experiences of persons with suicidal ideation and behaviour regarding their interactions with nurses. Three key themes were identified: being cared for and acknowledged as a unique individual, giving voice to myself in an atmosphere of connectedness, and encountering a nurturing space to address my suicidality. CONCLUSIONS This systematic review provides insights that can be used to encourage nurses to contribute to suicide prevention and treatment as part of an approach in which they care for, connect, and collaborate with persons experiencing suicidal ideation and behaviour as unique individuals.
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Goodman M, Brown GK, Galfalvy HC, Spears AP, Sullivan SR, Kapil-Pair KN, Jager-Hyman S, Dixon L, Thase ME, Stanley B. Group ("Project Life Force") versus individual suicide safety planning: A randomized clinical trial. Contemp Clin Trials Commun 2020; 17:100520. [PMID: 32043013 PMCID: PMC7000793 DOI: 10.1016/j.conctc.2020.100520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 12/20/2019] [Accepted: 01/04/2020] [Indexed: 11/28/2022] Open
Abstract
One in five suicide deaths is a Veteran and in spite of enhanced suicide prevention services in the Veterans Health Administration (VHA), twenty Veterans die by suicide each day. One component of the VHA's coordinated effort to treat high-risk suicidal Veterans, and diminish suicide risk, is the use of the safety plan. The current study aims to examine a novel intervention integrating skills training and social support with safety planning for Veterans at high-risk for suicide, "Project Life Force" (PLF). A randomized clinical trial (RCT) will be conducted examining if Veterans who are at high-risk for suicide will benefit from the novel group intervention, PLF, compared to Veterans who receive treatment as usual (TAU). We plan to randomize 265 Veterans over the course of the study. The primary outcome variable is the incidence of suicidal behavior, during follow-up, established using a rigorous, multi-method assessment. Secondary outcomes include depression, hopelessness, suicide coping and treatment utilization. Exploratory analyses include safety plan quality and belongingness for those in both arms as well as group cohesion for those in the PLF intervention. Strengths and limitations of this protocol are discussed.
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Affiliation(s)
- Marianne Goodman
- James J Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Gregory K. Brown
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA
| | - Hanga C. Galfalvy
- Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY USA
| | | | | | - Kalpana Nidhi Kapil-Pair
- James J Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Shari Jager-Hyman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Lisa Dixon
- Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Michael E. Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA
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35
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Conti EC, Jahn DR, Simons KV, Edinboro LPC, Jacobs ML, Vinson L, Stahl ST, Van Orden KA. Safety Planning to Manage Suicide Risk with Older Adults: Case Examples and Recommendations. Clin Gerontol 2020; 43:104-109. [PMID: 31096885 PMCID: PMC6858938 DOI: 10.1080/07317115.2019.1611685] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Adults age 65 and older have high rates of suicide, despite recent efforts to reduce the suicide rate in this population. One suicide prevention strategy with burgeoning empirical support is safety planning; however, there is a lack of information and resources on safety planning for older adults to support uptake of this evidence-based practice in clinical settings where older adults are commonly seen. Safety plans can address risk factors for suicide in older adults, including social isolation, physical illness, functional limitations, and use of highly lethal means. Safety plans also promote relevant protective factors, including increasing use of coping strategies, social support, and help-seeking. Clinicians may encounter challenges and barriers to safety planning with older adults. This paper describes a collaborative, creative approach to safety planning that is relevant and useful for this vulnerable population. Using two case examples, we illustrate how to engage older adults in safety planning, including ways to minimize barriers associated with the aging process.
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Affiliation(s)
- Elizabeth C Conti
- Michael E. DeBakey VA Medical Center, , Houston, TX, USA.,Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | | | - Kelsey V Simons
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York, USA.,Department of Psychiatry, University of Rochester School of Medicine, Rochester, New York, USA
| | - Lenis P Chen Edinboro
- School of Health and Applied Human Sciences, University of North Carolina, Wilmington, North Carolina, USA
| | - M Lindsey Jacobs
- Geriatric Mental Health Clinic, VA Boston Healthcare System, Brockton Division, Brockton, Massachusetts, USA.,Department of Psychiatry Harvard Medical School, Boston, Massachusetts, USA
| | - Latrice Vinson
- Office of Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, District of Columbia, USA.,VISN 5 Mental Illness Research, Education, and Clinical Center, Baltimore VA Medical Center, Baltimore, Maryland, USA
| | - Sarah T Stahl
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kimberly A Van Orden
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, New York, USA
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Chesin M, Interian A, Kline A, St Hill L, King A, Miller R, Latorre M, Stanley B. Past-year opioid misuse and suicide attempt are positively associated in high suicide risk veterans who endorse past- year substance use. Addict Behav 2019; 99:106064. [PMID: 31425930 DOI: 10.1016/j.addbeh.2019.106064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/25/2019] [Accepted: 07/27/2019] [Indexed: 11/19/2022]
Abstract
The main purpose of this study was to test the relationship between past-year suicide attempt (SA) and past-year opioid misuse among Veterans at high risk of suicide who reported using at least one illicit substance or alcohol in the past year. Baseline data from 130 high suicide-risk Veterans (n = 39 past-year opioid misusers; n = 91 past-year users of other substances) who enrolled in a randomized controlled trial testing adjunctive Mindfulness-Based Cognitive Therapy to Prevent Suicidal Behavior were used. Information was collected on a semi-structured interview that included the Columbia-Suicide Severity Rating Scale to collect suicide attempt history. Past-year opioid misusers, compared to those who used at least one other illicit substance or alcohol in the past year, were more likely to have made a past-year SA. Past-year opioid misuse remained associated with past-year SA in multivariate analysis that included other known risk factors for SA. Our findings show a robust link between near-term SA and opioid misuse in Veterans.
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Affiliation(s)
- Megan Chesin
- Department of Psychology, William Paterson University, Wayne, NJ, United States of America.
| | - Alejandro Interian
- Mental Health & Behavioral Sciences, VA New Jersey Healthcare System, Lyons, NJ, United States of America; Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers-The State University of New Jersey, Piscataway, NJ, United States of America
| | - Anna Kline
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers-The State University of New Jersey, Piscataway, NJ, United States of America
| | - Lauren St Hill
- Mental Health & Behavioral Sciences, VA New Jersey Healthcare System, Lyons, NJ, United States of America
| | - Arlene King
- Mental Health & Behavioral Sciences, VA New Jersey Healthcare System, Lyons, NJ, United States of America
| | - Rachael Miller
- Mental Health & Behavioral Sciences, VA New Jersey Healthcare System, Lyons, NJ, United States of America
| | - Miriam Latorre
- Mental Health & Behavioral Sciences, VA New Jersey Healthcare System, Lyons, NJ, United States of America
| | - Barbara Stanley
- Department of Psychiatry, Columbia University College of Physicians & Surgeons and New York State Psychiatric Institute, New York, NY, United States of America
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38
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Cureton JL, Fink M. SHORES: A Practical Mnemonic for Suicide Protective Factors. JOURNAL OF COUNSELING AND DEVELOPMENT 2019. [DOI: 10.1002/jcad.12272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jenny L. Cureton
- Department of Counselor Education and SupervisionKent State University
| | - Matthew Fink
- Department of Counselor Education and SupervisionKent State University
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39
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Bryan CJ. Cognitive behavioral therapy for suicide prevention (CBT-SP): Implications for meeting standard of care expectations with suicidal patients. BEHAVIORAL SCIENCES & THE LAW 2019; 37:247-258. [PMID: 31119794 DOI: 10.1002/bsl.2411] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/04/2018] [Accepted: 01/31/2019] [Indexed: 06/09/2023]
Abstract
Accumulating evidence supports the efficacy of cognitive behavioral therapy for suicide prevention (CBT-SP) as an empirically supported treatment approach for suicidal patients. In light of these findings, several procedures pulled from CBT-SP have been recommended for standard care with suicidal patients. The present article provides an overview of the procedures used in CBT-SP and discusses how these procedures meet, or even exceed, standard of care expectations for outpatient mental healthcare clinicians. Finally, the relevance of clinician fidelity to the CBT-SP model when evaluating standard of care expectations is discussed.
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Affiliation(s)
- Craig J Bryan
- National Center for Veterans Studies, Salt Lake City, UT, USA
- Department of Psychology, The University of Utah, Salt Lake City, UT, USA
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40
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Stanley IH, Simpson S, Wortzel HS, Joiner TE. Documenting suicide risk assessments and proportionate clinical actions to improve patient safety and mitigate legal risk. BEHAVIORAL SCIENCES & THE LAW 2019; 37:304-312. [PMID: 31063254 DOI: 10.1002/bsl.2409] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/23/2019] [Accepted: 03/29/2019] [Indexed: 06/09/2023]
Abstract
Few clinical practices are as important for simultaneously augmenting patient safety and mitigating legal risk as the judicious evaluation and stratification of a patient's risk for suicide, proportionate clinical actions based thereon taken by the healthcare provider, and contemporaneous documentation of the foregoing. In this article, we draw from our combined decades of multidisciplinary experience as a clinical psychologist, forensic psychiatrist, medical malpractice attorney, and clinical psychology trainee to discuss the documentation of suicide risk assessment and management as a conduit to patient safety and legal risk mitigation. We additionally highlight documentation as a core clinical competency across disciplines and note areas of improvement, such as increased training, to bolster documentation practices.
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Affiliation(s)
- Ian H Stanley
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | | | - Hal S Wortzel
- Departments of Psychiatry, Neurology, and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Denver, CO, USA
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Rocky Mountain Regional Medical Center, Denver, CO, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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41
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Buus N, Juel A, Haskelberg H, Frandsen H, Larsen JLS, River J, Andreasson K, Nordentoft M, Davenport T, Erlangsen A. User Involvement in Developing the MYPLAN Mobile Phone Safety Plan App for People in Suicidal Crisis: Case Study. JMIR Ment Health 2019; 6:e11965. [PMID: 30990456 PMCID: PMC6488960 DOI: 10.2196/11965] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 01/15/2019] [Accepted: 01/25/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The effect of safety planning for people in suicidal crisis is not yet determined, but using safety plans to mitigate acute psychological crisis is regarded as best practice. Between 2016 and 2017, Australian and Danish stakeholders were involved in revising and updating the Danish MYPLAN mobile phone safety plan and translating the app into a culturally appropriate version for Australia. OBJECTIVE The objective of this study was to examine the negotiation of stakeholders' suggestions and contributions to the design, function, and content of the MYPLAN app and to characterize significant developments in the emerging user-involving processes. METHODS We utilized a case study design where 4 focus groups and 5 user-involving workshops in Denmark and Australia were subjected to thematic analysis. RESULTS The analyses identified 3 consecutive phases in the extensive development of the app: from phase 1, Suggesting core functions, through phase 2, Refining functions, to phase 3, Negotiating the finish. The user-involving processes continued to prevent closure and challenged researchers and software developers to repeatedly reconsider the app's basic user interface and functionality. It was a limitation that the analysis did not include potentially determinative backstage dimensions of the decision-making process. CONCLUSIONS The extended user involvement prolonged the development process, but it also allowed for an extensive exploration of different user perspectives and needs.
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Affiliation(s)
- Niels Buus
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.,The Centre for Family-Based Mental Health Care, St Vincent's Private Hospital Sydney, Darlinghurst, Australia.,St. Vincent's Hospital Sydney, Darlinghurst, Australia.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anette Juel
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
| | - Hila Haskelberg
- Clinical Research Unit for Anxiety and Depression, St. Vincent's Hospital Sydney, Darlinghurst, Australia
| | - Hanne Frandsen
- Mental Health Services. Capital Region of Denmark, Copenhagen, Denmark
| | | | - Jo River
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Kate Andreasson
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Hillerød, Denmark
| | - Merete Nordentoft
- Mental Health Center Copenhagen, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Tracey Davenport
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Copenhagen, Denmark.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Centre for Mental Health Research, Australian National University, Canberra, Australia
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42
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DeBeer BB, Matthieu MM, Kittel JA, Degutis LC, Clafferty S, Qualls N, Morissette SB. Quality Improvement Evaluation of the Feasibility and Acceptability of Adding a Concerned Significant Other to Safety Planning for Suicide Prevention With Veterans. ACTA ACUST UNITED AC 2019. [DOI: 10.17744/mehc.41.1.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Suicide among veterans remains a serious public health issue, and poor social support is identified as a robust risk factor for suicide. The U.S. Department of Veterans Affairs uses a standard safety planning procedure for suicide prevention. While this intervention can help veterans identify social support sources, it does not directly incorporate a concerned significant other (CSO). Research suggests that veterans prefer a family member or friend to help shoulder the burden of a potential crisis. This qualitative feasibility project examined the role of CSOs in safety planning with veterans. Interviews were conducted with 29 veterans and four CSOs to investigate whether veterans wanted a CSO involved in their safety plan and to investigate associated logistical issues for implementation. Overwhelmingly, veterans (79.13%) reported that having a CSO directly involved in their safety plan would be helpful. Qualitative data are presented highlighting practical concerns for mental health providers developing safety plans with veterans.
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43
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Green JD, Kearns JC, Rosen RC, Keane TM, Marx BP. Evaluating the Effectiveness of Safety Plans for Military Veterans: Do Safety Plans Tailored to Veteran Characteristics Decrease Suicide Risk? Behav Ther 2018; 49:931-938. [PMID: 30316491 DOI: 10.1016/j.beth.2017.11.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 10/21/2017] [Accepted: 11/14/2017] [Indexed: 11/26/2022]
Abstract
In response to high suicide rates among veterans, the Department of Veterans Affairs (VA) has mandated that veterans at risk for suicide be given Safety Plans (SP). Research on the efficacy of SPs, however, is unclear and no prior study has examined the degree to which more personally relevant (i.e., higher quality) SPs may be associated with better outcomes or evaluate which components of SPs may be most effective at reducing suicidal behavior. The goal of the present study was to examine whether more personally relevant (i.e., higher quality) SPs reduce future suicide-related outcomes (psychiatric hospitalization, self-harm, and suicide attempts), and to determine which components of a SP may be most effective at reducing these outcomes. Participants were 68 individuals enrolled in a longitudinal national registry of returning military veterans receiving care from the VA, and who had at least one suicide-related event in the VA Suicide Prevention Applications Network. Data were collected between December 2009 and September 2016 and were analyzed between March 2016 and February 2017. Scores of SP quality were used to predict suicide-related outcomes. SP quality was low. Higher SP quality scores predicted a decreased likelihood of future suicide behavior reports (note entered into veteran's chart after a report of any self-harm behavior, including a suicide attempt). Higher scores on Step 3 (people and places that serve as distractions) predicted a decreased likelihood of future suicide behavior reports. More personally relevant SPs may reduce future suicide-related outcomes among veterans. Low SP quality scores highlight the need for training around SP implementation in the VA.
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Affiliation(s)
- Jonathan D Green
- Veterans Affairs Boston Healthcare System; Boston University School of Medicine.
| | - Jaclyn C Kearns
- Veterans Affairs Boston Healthcare System; University of Rochester
| | | | - Terence M Keane
- Boston University School of Medicine; National Center for PTSD
| | - Brian P Marx
- Boston University School of Medicine; National Center for PTSD
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44
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Zonana J, Simberlund J, Christos P. The Impact of Safety Plans in an Outpatient Clinic. CRISIS 2017; 39:304-309. [PMID: 29216753 DOI: 10.1027/0227-5910/a000495] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Safety plans are recommended as tools to mitigate suicide risk; however, their effectiveness remains unclear. AIM To evaluate the impact of safety plans on patient care at an outpatient mental health clinic. METHOD In this retrospective chart review, patients' treatment engagement, health-care utilization, and risk behaviors were measured. Patients served as their own historical controls, and we compared outcomes in the 6 months before and 6 months after creation of safety plans. RESULTS In all, 48 patient charts were identified. Hospitalizations were significantly reduced and use of crisis calls significantly increased after implementation of safety plans. There were five suicide attempts before safety plan completion and one after, representing a trend toward statistical significance. Outpatient encounters increased by 18%, missed appointments increased by 34%, psychiatric emergency room visits decreased by 47%, and a 69% reduction in inpatient hospital days was observed, all trending toward statistical significance. No differences were seen in episodes of violence or self-injurious behavior. LIMITATIONS The study sample was small and there was a lack of randomization. CONCLUSION Results suggest that safety plans can lead to improvements in utilization of care and patient engagement. Further research is needed to better understand the clinical impact of safety plans on high-risk patients.
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Affiliation(s)
- Jess Zonana
- 1 Weill Cornell Medical College, New York, NY, USA.,2 New York Presbyterian Hospital, New York, NY, USA
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45
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Levandowski BA, Cass CM, Miller SN, Kemp JE, Conner KR. An Intervention With Meaning. CRISIS 2017; 38:376-383. [DOI: 10.1027/0227-5910/a000433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: The Veterans Health Administration (VHA) health-care system utilizes a multilevel suicide prevention intervention that features the use of standardized safety plans with veterans considered to be at high risk for suicide. Aims: Little is known about clinician perceptions on the value of safety planning with veterans at high risk for suicide. Method: Audio-recorded interviews with 29 VHA behavioral health treatment providers in a southeastern city were transcribed and analyzed using qualitative methodology. Results: Clinical providers consider safety planning feasible, acceptable, and valuable to veterans at high risk for suicide owing to the collaborative and interactive nature of the intervention. Providers identified the types of veterans who easily engaged in safety planning and those who may experience more difficulty with the process. Conclusion: Additional research with VHA providers in other locations and with veteran consumers is needed.
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Affiliation(s)
- Brooke A. Levandowski
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY, USA
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - Constance M. Cass
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY, USA
| | | | - Janet E. Kemp
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY, USA
| | - Kenneth R. Conner
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY, USA
- University of Rochester Medical Center, Rochester, NY, USA
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