Recommendations for Using Clinical Video Telehealth with Patients at High Risk for Suicide

McGinn, Meghan M.; Roussev, Milena S; Shearer, Erika M.; McCann, Russell A.; Rojas, Sasha M.; Felker, Bradford

doi:10.1016/j.psc.2019.08.009

Cited by 29 publications

(23 citation statements)

References 15 publications

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“…Despite this, the limited face-toface contact and protracted availability afforded by the internet means that internet-based interventions are impacted by a range of ethical and practical challenges. The ethical and practical challenges associated with online mental health service delivery to individuals at high risk of suicide have been well studied [27,28], and management of suicide risk has been embedded into standard ethical codes and guidelines for health practitioners and services [29,30]. Static, self-directed interventions designed to prevent suicide are increasingly being developed and evaluated [31], but the relative lack of therapist involvement likely gives rise to particular ethical and practical issues.…”

Section: Introductionmentioning

confidence: 99%

Ethical issues and practical barriers in internet-based suicide prevention research: a review and investigator survey

et al. 2020

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Background: People who are at elevated risk of suicide stand to benefit from internet-based interventions; however, research in this area is likely impacted by a range of ethical and practical challenges. The aim of this study was to examine the ethical issues and practical barriers associated with clinical studies of internet-based interventions for suicide prevention. Method: This was a mixed-methods study involving two phases. First, a systematic search was conducted to identify studies evaluating internet-based interventions for people at risk of suicide, and information pertaining to safety protocols and exclusion criteria was extracted. Second, investigators on the included studies were invited to complete an online survey comprising open-ended and forced-choice responses. Quantitative and qualitative methods were used to analyse the data. Results: The literature search identified 18 eligible studies, of which three excluded participants based on severity of suicide risk. Half of the 15 suicide researchers who participated in the survey had experienced problems obtaining ethics approval, and none had encountered adverse events attributed to their intervention. Survey respondents noted the difficulty of managing risk in online environments and the limitations associated with implementing safety protocols, although some also reported increased confidence resulting from the ethical review process. Respondents recommended researchers pursue a collaborative relationship with their research ethics committees. Conclusion: There is a balance to be achieved between the need to minimise the risk of adverse events whilst also ensuring interventions are being validated on populations who may be most likely to use and benefit from them (i.e., those who prefer anonymity). Further research is required to obtain the views of research ethics committees and research participants on these issues. Dialogue between researchers and ethics committees is necessary to address the need to ensure safety while also advancing the timely development of effective interventions in this critical area.

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Section: Introductionmentioning

confidence: 99%

Ethical issues and practical barriers in internet-based suicide prevention research: a review and investigator survey

et al. 2020

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“…One notable concern that providers describe is the feasibility of hospitalization via CVT. Although hospitalization was not needed while BCBT-SP was delivered in the current case example, CVT recommendations to address acute suicide risk that requires psychiatric hospitalization have been outlined ( McGinn et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Brief Cognitive-Behavioral Therapy for Suicide Prevention (BCBT-SP) via Video Telehealth: A Case Example During the COVID-19 Outbreak

Rojas

Gold

Bryan

et al. 2022

Cognitive and Behavioral Practice

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Although veterans living in remote/rural areas are at elevated risk for suicide, there is very little research specific to treating suicidal veterans who present with barriers to in-person care. The current study aims to examine the delivery of brief cognitive-behavioral therapy for suicide prevention (BCBT-SP) via Clinical Video Telehealth (CVT) to the home of a veteran discharged from the psychiatric inpatient unit after a recent suicide attempt. Preliminary data on acceptability, feasibility, and changes in symptoms were gathered. The veteran received treatment during the 2020 COVID-19 outbreak and additional adaptations were made accordingly. The veteran did not engage in any suicidal behavior during the course of treatment, and suicidal ideation, depression, and anxiety decreased as treatment progressed. The results provide initial support for the feasibility of BCBT-SP via CVT to the home.

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“…Our experience using PIVOT-R reiterated the necessity of VTH emergency procedures that reflect each specific site's resources (29) to conduct a wellness check when concerned about the well-being of a patient. However, caution is advised when sending police to a rural patient's home unannounced due to a higher presence of firearms and skepticism about law enforcement.…”

Section: Unique Factors For Vth In Rural Communitiesmentioning

confidence: 95%

Personalized implementation of video telehealth for rural veterans (PIVOT-R)

Day¹,

Day²,

Keller³

et al. 2021

mHealth

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Background: A national shortage of mental health (MH) professionals leaves more than 90% of rural individuals without adequate access to services each year, troubling because 33% of Veterans Health Administration (VHA) enrollees live in rural areas and rural Veterans have a greater risk of suicide than urban Veterans. Additional barriers such as travel distance and cost, stigma and extreme weather or geography add to challenges of rural Veterans seeking treatment. Although the VHA has addressed this disparity by providing telemental health services, provision of services via traditional hub-and-spoke and/or establishment of regional centers has not fully addressed barriers or resource limitations. Video telehealth to home (VTH) has assisted in better addressing geographic, attitudinal and systematic barriers to in-person care; however, its uptake and implementation have been problematic. This article describes the Personalized Implementation of Video Telehealth for Rural Veterans (PIVOT-R) approach, developed in response to the unique needs of rural veterans. Methods:We developed PIVOT, a flexible implementation strategy that is adaptive to site-specific contexts and different digital innovations and relies on a collaborative relationship between external facilitators, internal facilitators and clinical champions. We used formative evaluation (FE) to gather ongoing information about our quality improvement (QI) implementation approach of VTH. Our FE of PIVOT at rural sites provided insight into adaptations to improve rural implementation. This led to development of PIVOT-R, which explicitly focuses on rural implementation. PIVOT-R, developed from provider and patient feedback plus lessons learned during implementation, focuses on rurality as an important diversity factor and addresses relationship building, engaging the site, assessing context and infrastructure and balancing national expectations with site-level goals. During fiscal year 2018 we partnered with a VHA healthcare system in a Western mountain state to pilot the PIVOT-R approach, again using FE which included quantitative and qualitative data collection to evaluate its impact.Results: PIVOT-R effectively increased uptake of VTH for MH care at the healthcare system evaluated. In fiscal year 2019 the percentage of Veterans receiving MH care via VTH at the site was 10 times greater than in fiscal year 2018, matching the mean VHA nationwide percentage and increasing by 43.24% by the end of 2019. Veteran feedback supported a positive experience by users.Conclusions: Inclusion of a comprehensive assessment of the rural system, including infrastructure and resources, greatly improves understanding of a system's specific needs and enables a tailored approach

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Recommendations for Using Clinical Video Telehealth with Patients at High Risk for Suicide

Cited by 29 publications

References 15 publications

Ethical issues and practical barriers in internet-based suicide prevention research: a review and investigator survey

Ethical issues and practical barriers in internet-based suicide prevention research: a review and investigator survey

Brief Cognitive-Behavioral Therapy for Suicide Prevention (BCBT-SP) via Video Telehealth: A Case Example During the COVID-19 Outbreak

Personalized implementation of video telehealth for rural veterans (PIVOT-R)

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