Zero Suicide Implementation and Evaluation in Outpatient Mental Health Clinics

项目摘要 尽管发展了循证治疗和评估工具， 在过去的十年里，美国的死亡人数急剧上升。行为健康门诊病人自杀率调查 护理费用比一般人群高出100倍，自杀死亡率>25%，自杀未遂死亡率>50% 上一年在门诊行为健康机构接受护理。不幸的是，基于证据的实践 还没有进入常规门诊治疗因此，门诊诊所是一个关键的位置， 自杀预防工作和改善自杀预防实践有望减少自杀。的 ZS模式是一个多组成部分（包括评估，干预和护理的连续性），全系统 这种方法基于这样一种假设，即医疗保健系统内的自杀是可以预防的。鉴于ZS 在国家一级推广这一方法时，必须确定哪些因素影响其有效性， 实施强度达到最大吸收。在这个项目中，我们建议进行大规模的 ZS模式在门诊行为健康中的实施与评价。我们将实施ZS 在纽约州（NYS）的145家诊所中实施了一项行为健康策略，为超过80，000名行为健康客户提供服务。这个项目 与纽约州心理健康办公室的持续质量改进部门合作， 从国家的发达，现有的行政数据库基础设施，包括授权报告 护理人员的自杀企图和死亡人数以及客户、诊所和机构层面的治疗数据 就诊、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 门诊州许可（但不是国家经营）诊所。我们将随机分配两个机构 条件：“基本实施”（BI）或“加强实施”（EI;加强培训/咨询，使用 现场冠军，参与式学习合作者）。在目标1中，我们将比较EI和 减少自杀行为（企图和死亡）、精神病住院和艾德访视的BI条件。 我们将进行队列和历史比较分析，以确定ZS条件与 “一切照旧”“在目标2中，我们将使用混合定性-定量方法来比较EI和BI ZS模式的实施和可持续性的条件。我们将使用“先进行”框架 评估机构和供应商层面影响实施的诱发、促成和强化因素 成功，以及在实施过程中ZS组件的比率和质量（过程/影响评估）， 维持期和随访期。这项研究将是ZS最大的实施和评估 这是迄今为止采用的最佳做法，将为更广泛的传播提供重要的见解。结果将通知 如何最好地采取医疗支持，自杀安全护理，从而减少悲剧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.