Signature Project

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The Signature Project of the Penn Innovation in Suicide Prevention Implementation Research (INSPIRE) Center is a large-scale research study designed to examine the effectiveness and implementation of an evidence-based intervention to lower suicide risk in health care settings. The Project will leverage the methodological and administrative support of the INSPIRE Center with its focus on optimizing implementation of practice-based suicide prevention interventions for minority and disadvantaged populations. Individuals at high risk for suicide often present to acute care settings, such as emergency departments (EDs), and then typically are hospitalized or referred for outpatient mental health treatment. Yet, despite being at increased risk of suicidal behavior and suicide following an ED visit, many patients do not attend outpatient treatment. Brief evidenced-based interventions such as the Safety Planning Intervention and follow-up services (SPI+) are available to mitigate this risk and engage patients in outpatient treatment. However, such practices often can be challenging for busy ED clinicians to provide for suicidal patients. Our interdisciplinary team of suicide, implementation, health services, qualitative and quantitative researchers as well as diverse stakeholder groups of ED clinicians, health systems leaders, mental health clinicians, and patients will collaborate to improve the delivery of ED-based suicide prevention efforts. We propose a novel delivery model in which ED staff will connect patients at risk for suicide to mental health clinicians who are located external to the ED. These off-site licensed and credentialed clinicians will provide SPI+ via telehealth for ED patients prior to discharge and provide follow-up services after ED discharge as part of an innovative Suicide Prevention Consultation Center (SPCC). The Project has three Specific Aims. Aim 1 will use a stepped-wedge cluster-randomized design to evaluate the effectiveness of SPI+ delivered by SPCC clinicians via telehealth compared to SPI+ delivered by SPI+-trained ED clinicians on rates of suicidal behavior and engagement in care following ED discharge. Aim 2 will evaluate the implementation of SPI+ delivered by SPCC clinicians compared to SPI+ delivered by ED clinicians on key implementation outcomes including adoption, fidelity, acceptability, and feasibility and will also explore the mediation of clinician intentions, norms, and self-efficacy on the fidelity of SPI+. Aim 3 will evaluate the costs to ED and SPCC practices and examine potential cost offsets to the health system to provide evidence of SPCC scalability and sustainability. If successful and cost effective, use of a SPCC, external to EDs, could become a scalable model for providing suicide prevention evidenced-based practices to those at risk for suicide presenting for emergency care with the potential to save lives.