Development, evaluation, and refinement of the Suicide Prevention Toolkit for Rural Primary Care Practices.

Abstract

Suicide is a significant issue in the United States and worldwide, and its prevention is a public health imperative. The Suicide Prevention Toolkit for Rural Primary Care was developed to address gaps in education and tools to assist primary care providers and other clinic staff in identifying and managing patients at risk for suicide. Given the high suicide rates in rural areas, coupled with the evidence that many people who die by suicide visit their primary care provider in the month prior to their death, primary care health settings offer an important prevention and intervention opportunity for patients at varying levels of risk for suicide. This article details (a) the evolution of a project that began with identifying a need for tools and training in suicide prevention and brief intervention by rural primary care providers, (b) the development of the Suicide Prevention Toolkit for Rural Primary Care, (c) the effectiveness of a training based the toolkit to improve suicide prevention knowledge and skills of primary care providers and other employees in health care settings, and (d) recommendations for future research and dissemination strategies of suicide prevention and intervention in primary care and other health settings.

Training medical providers in evidence-based approaches to suicide prevention

“…In 2012, pre- and post-training surveys were collected to evaluate perceived curriculum effectiveness. These data have been reported elsewhere 4 and indicate that recipients of the Toolkit training curriculum experienced an improved sense of preparedness, knowledge of suicide facts and best practices, and perceived competence related to assessing and responding appropriately to patients with risk factors or warning signs for suicide. Recall that PCPs who perceive themselves as competent in suicide prevention are more willing to assess and treat suicidal patients, according to recent research.…”

“…The content of the Toolkit has been described in detail in a previous publication. 4 As stated above, the Toolkit training curriculum was developed to provide instruction to individuals at any level of training, from medical residents to seasoned providers; however, the specific applicability to post-graduate medical training, especially in family medicine, is clear. The goals and objectives of the curriculum are closely aligned with the graduate medical education training requirements outlined by the Accreditation Council for Graduate Medical Education (ACGME), as well as the American Academy of Family Physicians (AAFP).…”

“…2,3 Primary care providers (PCPs) are uniquely positioned to provide care for individuals at risk for suicide. 4 Research indicates that up to 90% of patients who die by suicide have had contact with their PCP in the year prior to their death, and up to 76% had contact with their PCP in the month prior. 5 Despite being at the frontline of suicide prevention, however, recent surveys indicate that primary care physicians receive inadequate training in suicide prevention and intervention within the United States and internationally.…”

Suicide interventions in primary care: A selective review of the evidence.

“…In addition, the training results in positive changes in health care staff's attitudes and confidence in assessing for and managing suicide risk in primary care (Gask, Dixon, Morriss, Practitioner education is also a major component of the SPRC Toolkit. Evidence shows recipients of the SPRC Toolkit training experience an improved sense of preparedness, knowledge of risk factors and warning signs for suicide, and perceived competence regarding assessment and management of at-risk patients (McFaul et al, 2014). The Pennsylvania YSP-PC program also emphasizes the importance of practitioner education.…”

The experiences of north-central rural Appalachian clients who utilize mental health services.

“…Another strategy that has been gaining momentum to address the provider shortage in rural areas is the use of technology (see Crisanti, Pasko, Pyeatt, Silverblatt, & Anastasoff, 2015;Gonzalez & Brossart, 2015;Lorenz, Levey, & Case, 2013;McFaul, Mohatt, & Dehay, 2014;Reed et al, 2014). Provider professional development through online courses, professional collaboration, and supervision would serve to enhance cultural competence in north-central Appalachia.…”