Zero Suicide Implementation and Evaluation in Outpatient Mental Health Clinics

项目总结 尽管发展了基于证据的治疗和评估工具，但自杀人数 过去10年，美国的死亡人数大幅上升。门诊患者自杀率与行为健康的关系 护理是普通人口的100倍，25%的人死于自杀，50%的人自杀未遂 在前一年接受门诊行为健康设置的护理。不幸的是，基于证据的做法 还没有进入常规的门诊护理。因此，门诊部是 预防自杀的努力和改进自杀预防的做法有望减少自杀。这个 ZS模式是一个多组成部分(包括评估、干预和持续护理)，系统范围内 这种方法的基础是，医疗保健系统内的自杀是可以预防的。鉴于ZS 为了在全国推广这一方法，重要的是确定哪些因素影响其有效性，以及哪些因素影响其有效性 实施的强度达到了最大限度的吸收。在这个项目中，我们建议进行大规模的 ZS模式在门诊患者行为健康中的应用与评价我们将实施ZS 纽约州(NYS)145家诊所的战略，为80,000名行为健康客户提供服务。这个项目 与纽约精神卫生办公室的持续质量改进部门共同努力，并受益于 来自国家发展良好的现有行政数据库基础设施，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治疗的客户、诊所和机构级别的数据 出诊、住院和急诊科就诊。 使用混合有效性-实施类型1设计，我们将在145中测试ZS的有效性 有州立执照(但不是州立)的门诊诊所。我们将随机分配给以下两个机构中的一个 条件：“基本执行”(BI)或“强化执行”(EI；加强培训/协商、使用 网站冠军、参与式学习协作)。在目标1中，我们将比较EI和EI的有效性 BI在减少自杀行为(企图和死亡)、精神科住院和急诊室就诊方面的情况。 我们将进行队列和历史比较分析，以确定ZS条件与 在目标2中，我们将使用定性和定量相结合的方法来比较EI和BI ZS模式的实施和可持续性的条件。我们将使用先行处理框架 评估机构和服务提供商级影响实施的诱因、支持和强化因素 实施过程中ZS组成部分的成功率和质量(过程/影响评价)， 维护和随访期。这项研究将是ZS最大的实施和评估 这是一种前所未有的方法，将为更广泛的传播提供至关重要的见解。结果将通知 如何最好地采用经验性的、自杀安全的护理，从而减少悲惨和可预防的生命损失。

PROJECT SUMMARY Despite development of evidenced-based treatments and assessment tools, the number of suicide deaths in the US has risen dramatically in the past decade. The suicide rate of outpatients in behavioral health care is 100x higher than the general population, and >25% who die by suicide and >50% of those who attempt receive care in outpatient behavioral health settings in the prior year. Unfortunately, evidenced-based practices have not found their way into routine outpatient care. As such, outpatient clinics are a critical location for suicide prevention efforts, and improving suicide prevention practices holds promise for reducing suicide. The ZS model is a multi-component (including assessment, intervention, and continuity of care), system-wide approach based on the assumption that suicide within the health care system is preventable. Given that the ZS approach is being promoted nationally, it is important to ascertain what factors affect its effectiveness and what intensity of implementation achieves maximal uptake. In this project, we propose to conduct a large scale implementation and evaluation of the ZS model in outpatient behavioral health. We will implement ZS strategies in 145 clinics in New York State (NYS) serving >80,000 behavioral health clients. This project combines efforts with the NYS Office of Mental Health’s Continuous Quality Improvement unit, and benefits from the State's well-developed, existing administrative database infrastructure, including mandated reporting of suicide attempts and deaths for individuals in care and client-, clinic-, and agency-level data on treatment attendance, hospitalizations, and Emergency Department visits. Using a hybrid effectiveness-implementation type 1 design, we will test the effectiveness of ZS in 145 outpatient state licensed (but not state operated) clinics. We will randomly-assign agencies to one of two conditions: “Basic Implementation” (BI) or “Enhanced Implementation” (EI; enhanced training/consultation, use of site champions, participatory learning collaboratives). In Aim 1, we will compare the effectiveness of EI and BI conditions in reducing suicidal behaviors (attempts and deaths), psychiatric hospitalizations, and ED visits. We will conduct cohort and historical comparison analyses to determine the effectiveness of ZS conditions vs “treatment-as-usual." In Aim 2, we will use mixed qualitative-quantitative approaches to compare the EI and BI conditions on implementation and sustainability of the ZS model. We will use the Precede-Proceed framework to evaluate agency- and provider-level predisposing, enabling, and reinforcing factors affecting implementation success, as well as rates and quality of ZS components (process/impact evaluation) during implementation, maintenance, and follow-up periods. This study will be the largest implementation and evaluation of the ZS approach ever conducted, and will provide crucial insight regarding broader dissemination. Results will inform how to best adopt empirically-supported, suicide-safe care, thereby reducing tragic and preventable loss of life.