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Zero Suicide Implementation and Evaluation in Outpatient Mental Health Clinics

门诊心理健康诊所零自杀实施与评估

基本信息

批准号：
10572128
负责人：
LISA B. DIXON
金额：
$ 52.15万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-15 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10572128
关键词：
Adopted Adoption Affect Agreement Ambulatory Care Attention Attitude Behavior Caring Client Clinic Clinical Clinical effectiveness Collaborations Data Development Dose Drops Educational Intervention Effectiveness Emergency department visit Enrollment Evaluation Evidence based treatment Exploration Preparation Implementation and Sustainment Feeling suicidal Frequencies Funding Goals Grant Health Health Benefit Healthcare Healthcare Systems Hospitalization Individual Infrastructure Inpatients Intake Leadership Learning Length Life Measures Mediator of activation protein Mental Health Methods Modality New York Outcome Outpatients Pathway interactions Planning Theory Play Population Protocols documentation Provider Reporting Risk Safety Self Efficacy Specialist Structure Suicide Suicide attempt Suicide prevention System Telephone Testing Training Treatment outcome Visit Voice Work administrative database behavioral health design dissemination research effectiveness implementation design effectiveness implementation study evidence base experience high risk implementation barriers implementation outcomes implementation process implementation research implementation strategy improved mortality novel organizational climate outreach peer preference preventive intervention provider factors reducing suicide response retention rate satisfaction screening shared decision making success suicidal suicidal behavior suicidal individual suicidal morbidity suicidal risk suicide model sustainability framework tool uptake

项目摘要

PROJECT SUMMARY The proposed project is a renewal of our currently funded grant, # R01 MH112139 “Zero Suicide Implementation and Evaluation in Outpatient Mental Health Clinics,” a large-scale project implementing the Zero Suicide model of evidence-based suicide prevention practices in 165 outpatient behavioral health clinics in New York State. Despite successful implementation of suicide screening and safety planning in our current project, treatment engagement and retention of suicidal clients in a 90-day outpatient suicide care protocol was much less successful. Approximately 36% of clients enrolled in the protocol did not return after intake, fewer than 30% of clients received >6 sessions, and only 2% completed the recommended 12 weekly sessions. Thus, attention to implementation of effective engagement and retention strategies is crucial to maximize effectiveness of evidence-based suicide prevention. We plan to accomplish this by testing a novel implementation strategy that incorporates individuals with suicide-related lived experience. This proposal builds on the infrastructure and collaborative network developed in our current project and will target the implementation outcome of treatment engagement and retention of clients at high suicide risk. This project continues collaboration with the NYS Office of Mental Health and benefits from the State's existing administrative database infrastructure, including mandated reporting of suicide attempts and deaths for individuals in care and client- and agency-level data on treatment attendance, hospitalizations, and emergency department visits. Using a stepped-wedge, type III hybrid effectiveness-implementation design in 12 agencies that participated in our current project, we will compare standard implementation with a novel implementation strategy incorporating the voice of lived experience to improve retention of at-risk suicidal clients. In the Peer Suicide Prevention Specialist Implementation (PSPSI) condition, individuals with lived experience of suicidality will be active collaborators in the development and delivery of clinical trainings and learning collaboratives and will work with primary clinicians to implement two evidence-based strategies for improved client retention: structured phone outreach (SPO) and shared decision- making (SDM). Our work will be guided by the EPIS (Exploration, Preparation, Implementation, and Sustainment) framework. Aim 1 will compare standard implementation with PSPSI on rates of return after the first visit, session attendance during a 90-day high risk protocol, and client outcomes (suicide attempts, inpatient hospitalizations, and emergency department visits). Aim 2 will compare systems-, provider-, and client-level factors affecting successful implementation between standard and PSPSI conditions using mixed qualitative-quantitative approaches. Results will inform broader national implementation to enhance client retention in outpatient care by including peers in suicide prevention interventions and thereby reduce loss of life to suicide.

项目总结拟议的项目是我们目前资助的#R01 MH112139“零自杀实施”的续期门诊精神卫生诊所的评估--一个实施零自杀模式的大型项目对纽约州165家门诊行为健康诊所的循证自杀预防实践进行了评估。尽管我们目前的项目成功地实施了自杀筛查和安全规划，但治疗在为期90天的门诊自杀护理方案中，自杀客户的参与度和保留率要低得多成功。在注册了该方案的客户中，约36%的客户在接受治疗后没有返回，不到30%的客户客户接受了6次治疗，只有2%的人完成了推荐的每周12次治疗。因此，要注意实施有效的接洽和保留战略对于最大限度地提高循证自杀预防。我们计划通过测试一种新的实现策略来实现这一点结合了与自杀相关的生活经历的个人。这项提议建立在基础设施和在我们目前的项目中开发了协作网络，并将针对治疗的实施结果吸引和留住自杀风险较高的客户。该项目继续与纽约办事处合作国家现有的行政数据库基础设施对精神健康和福利的影响，包括强制报告接受护理的个人的自杀未遂和死亡情况以及关于以下方面的客户和机构级数据就诊、住院和急诊科就诊。使用阶梯形楔形III型混合动力车有效性-参与我们当前项目的12个机构的实施设计，我们将比较标准实施和新的实施策略，融合了现场体验的声音提高有自杀倾向的高危客户的保留率。在同伴自杀预防专家实施(PSPSI)中在这种情况下，有自杀经历的人将成为发展和提供临床培训和学习协作，并将与初级临床医生合作实施两项提高客户保留率的循证策略：结构化电话外展(SPO)和共享决策- 制作(SDM)。我们的工作将以EPIS(探索、准备、实施和持续)为指导框架。目标1将在第一次访问、会议后将标准实施与PSPSI的回报率进行比较在90天的高危方案期间的就诊情况，以及客户的结果(自杀未遂、住院治疗、和急诊科就诊)。AIM 2将比较系统级、提供商级和客户端级影响因素用定性和定量相结合的方法成功地实现了标准条件和PSPSI条件之间的转换接近了。结果将为更广泛的国家实施提供信息，以提高门诊护理的客户保留率通过将同伴纳入自杀预防干预措施，从而减少因自杀而造成的生命损失。