Zero Suicide Implementation and Evaluation in Outpatient Mental Health Clinics

项目摘要 拟议的项目是我们目前资助的赠款，#R 01 MH 112139“零自杀实施的更新 门诊心理健康诊所的评估”，这是一个实施零自杀模式的大型项目 在纽约州的165个门诊行为健康诊所中进行的基于证据的自杀预防实践。 尽管在我们目前的项目中成功地实施了自杀筛查和安全计划， 在90天的门诊自杀护理方案中， 成功大约36%的参与方案的客户在摄入后没有返回，不到30%的人没有返回。 客户接受了6次以上的培训，只有2%的人完成了建议的每周12次培训。因此，注意 实施有效的参与和保留战略对于最大限度地提高 基于证据的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目标， 包括有自杀相关生活经历的个人。这项建议建立在基础设施和 合作网络在我们目前的项目中发展，并将针对治疗的实施结果 参与和留住高自杀风险的客户。该项目继续与纽约州办公室合作 国家现有的行政数据库基础设施，包括 受照料者自杀未遂和死亡情况的强制报告以及客户和机构一级的数据， 治疗出勤、住院和急诊科就诊。使用阶梯楔，III型混合动力 在12个参与我们当前项目的机构中，我们将比较 标准实施与一个新的实施战略，结合生活经验的声音， 提高有自杀风险客户的保留率。同伴自杀预防专家实施（PSPSI） 在这种情况下，有自杀经历的人将是发展和 提供临床培训和学习协作，并将与初级临床医生合作， 以证据为基础的战略，以提高客户保留：结构化的电话外展（SPO）和共同决策- 制作（SDM）。我们的工作将遵循EPIS（探索、准备、实施和维持） 框架.目标1将比较标准实施与PSPSI在第一次访问后的回报率， 90天高风险方案期间的出勤率，以及客户结局（自杀企图，住院治疗， 急诊科就诊）。目标2将比较系统、提供商和客户层面的影响因素， 使用混合定性-定量方法在标准和PSPSI条件之间成功实施 接近。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，从而减少自杀造成的生命损失。

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.