Zero Suicide Implementation and Evaluation in Outpatient Mental Health Clinics

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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.