Use of crisis management interventions among suicidal patients: Results of a randomized controlled trial

Bryan, Craig J.; May, Alexis M.; Rozek, David C.; Williams, Sean R.; Clemans, Tracy A.; Mintz, Jim; Leeson, Bruce; Burch, T. Scott

doi:10.1002/da.22753

Cited by 30 publications

(20 citation statements)

References 26 publications

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“…Advancing our understanding of how patients answer such questions is critical for assessing the utility of this practice for supporting suicide prevention practices in health care settings, such as collaborative discussions about lethal means safety. 17,18 The primary goal of this study was to understand whether and how patients receiving care for MH and substance use responded to a single question about firearm access after it was added to a standardized self-reported MH monitoring questionnaire by a large regional health care system. Specifically, we described the proportion of patients who answered the firearm access question and the proportion who reported access among those who answered, in both PC and outpatient MH specialty settings.…”

Section: Introductionmentioning

confidence: 99%

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Self-reported Access to Firearms Among Patients Receiving Care for Mental Health and Substance Use

et al. 2021

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IMPORTANCE Firearms are the most common method of suicide, one of the "diseases of despair" driving increased mortality in the US over the past decade. However, routine standardized questions about firearm access are uncommon, particularly among adult populations, who are more often asked at the discretion of health care clinicians. Because standard questions are rare, patterns of patient-reported access are unknown. OBJECTIVE To evaluate whether and how patients self-report firearm access information on a routine mental health monitoring questionnaire and additionally to examine sociodemographic and clinical associations of reported access. DESIGN, SETTING, AND PARTICIPANTSCross-sectional study of patients receiving care for mental health and/or substance use in primary care or outpatient mental health specialty clinics of Kaiser Permanente Washington, an integrated health insurance provider and care delivery system. MAIN OUTCOMES AND MEASURESElectronic health records were used to identify patients who completed a standardized self-reported mental health monitoring questionnaire after a single question about firearm access was added from January 1, 2016, through December 31, 2019. Primary analyses evaluated response (answered vs not answered) and reported access (yes vs no) among those who answered, separately for patients seen in primary care and mental health. These analyses also evaluated associations between patient characteristics and reported firearm access. Data analysis took place from February 2020 through May 2021.RESULTS Among patients (n = 128 802) who completed a mental health monitoring questionnaire during the study period, 74.4% (n = 95 875) saw a primary care clinician and 39.3% (n = 50 631) saw a mental health specialty clinician. The primary care and mental health samples were predominantly female (63.1% and 64.9%, respectively) and White (75.7% and 77.0%), with a mean age of 42.8 and 51.1 years. In primary care, 83.4% of patients answered the question about firearm access, and 20.9% of patients who responded to the firearm question reported having access. In mental health, 91.8% of patients answered the question, and 15.3% reported having access. CONCLUSIONS AND RELEVANCEIn this cross-sectional study of adult patients receiving care for mental health and substance use, most patients answered a question about firearm access on a standardized mental health questionnaire. These findings provide a critical foundation to help advance understanding of the utility of standardized firearm access assessment and to inform development of practice guidelines and recommendations. Responses to standard firearm access questions used in combination with dialogue and decision-making resources about firearm access and storage may improve suicide prevention practices and outcomes.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Self-reported Access to Firearms Among Patients Receiving Care for Mental Health and Substance Use

et al. 2021

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“…Some systems were also in the process of planning implementation of suicide risk prediction algorithms (Simon et al, 2018) for purposes of enhancing suicide risk assessment and engagement in suicide-related care. (Bryan et al, 2018;Stanley & Brown, 2012), which usually included lethal means assessment (i.e., discussions about prescription medications, firearms, and planning how to limit access). Researchers cataloged varying safety planning workflows and documentation practices across sites and providers (Yarborough et al, 2019); however, a shift toward practice standardization was underway.…”

Section: Cognitive Participation and Collective Actionmentioning

confidence: 99%

An implementation evaluation of “Zero Suicide” using normalization process theory to support high-quality care for patients at risk of suicide

Richards

Simon

Boggs

et al. 2021

Implementation Research and Practice

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Background: Suicide rates continue to rise across the United States, galvanizing the need for increased suicide prevention and intervention efforts. The Zero Suicide (ZS) model was developed in response to this need and highlights four key clinical functions of high-quality health care for patients at risk of suicide. The goal of this quality improvement study was to understand how six large health care systems operationalized practices to support these functions—identification, engagement, treatment and care transitions. Methods: Using a key informant interview guide and data collection template, researchers who were embedded in each health care system cataloged and summarized current and future practices supporting ZS, including, (1) the function addressed; (2) a description of practice intent and mechanism of intervention; (3) the target patient population and service setting; (4) when/how the practice was (or will be) implemented; and (5) whether/how the practice was documented and/or measured. Normalization process theory (NPT), an implementation evaluation framework, was applied to help understand how ZS had been operationalized in routine clinical practices and, specifically, what ZS practices were described by key informants ( coherence), the current state of norms/conventions supporting these practices ( cognitive participation), how health care teams performed these practices ( collective action), and whether/how practices were measured when they occurred ( reflexive monitoring). Results: The most well-defined and consistently measured ZS practices (current and future) focused on the identification of patients at high risk of suicide. Stakeholders also described numerous engagement and treatment practices, and some practices intended to support care transitions. However, few engagement and transition practices were systematically measured, and few treatment practices were designed specifically for patients at risk of suicide. Conclusions: The findings from this study will support large-scale evaluation of the effectiveness of ZS implementation and inform recommendations for implementation of high-quality suicide-related care in health care systems nationwide. Plain Language Summary Many individuals see a health care provider prior to death by suicide, therefore health care organizations have an important role to play in suicide prevention. The Zero Suicide model is designed to address four key functions of high-quality care for patients at risk of suicide: (1) identification of suicide risk via routine screening/assessment practices, (2) engagement of patients at risk in care, (3) effective treatment, and (4) care transition support, particularly after hospitalizations for suicide attempts. Researchers embedded in six large health care systems, together caring for nearly 11.5 million patients, are evaluating the effectiveness of the Zero Suicide model for suicide prevention. This evaluation focused on understanding how these systems had implemented clinical practices supporting Zero Suicide. Researchers collected qualitative data from providers, administrators, and support staff in each system who were responsible for implementation of practices supporting Zero Suicide. Normalization process theory, an implementation evaluation framework, was applied following data collection to: (A) help researchers catalog all Zero Suicide practices described, (B) describe the norms/conventions supporting these practices, (C) describe how health care teams were performing these practices, and (D) describe how practices were being measured. The findings from this evaluation will be vital for measuring the effectiveness of different Zero Suicide practices. This work will also provide a blueprint to help health care leaders, providers, and other stakeholders “normalize” new and existing suicide prevention practices in their own organizations.

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“…Reductions in the severity of suicidal ideation post‐intervention are significantly correlated with two components of the CRP, self‐management strategies and social support networks (Bryan et al, ), a finding that suggests these procedures are key to reducing suicide risk. Evidence also suggests that the CRP's efficacy might be enhanced with the addition of a component focused on identifying a suicidal patient's reasons for living (Bryan, Mintz, Clemans, Burch, et al, ).…”

Section: Cognitive Behavioral Therapy For Suicide Preventionmentioning

confidence: 99%

Cognitive behavioral therapy for suicide prevention (CBT‐SP): Implications for meeting standard of care expectations with suicidal patients

Bryan

2019

Behavioral Sci & The Law

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Accumulating evidence supports the efficacy of cognitive behavioral therapy for suicide prevention (CBT‐SP) as an empirically supported treatment approach for suicidal patients. In light of these findings, several procedures pulled from CBT‐SP have been recommended for standard care with suicidal patients. The present article provides an overview of the procedures used in CBT‐SP and discusses how these procedures meet, or even exceed, standard of care expectations for outpatient mental healthcare clinicians. Finally, the relevance of clinician fidelity to the CBT‐SP model when evaluating standard of care expectations is discussed.

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Use of crisis management interventions among suicidal patients: Results of a randomized controlled trial

Abstract: Both CRPs have high acceptability ratings. The effect of both CRPs on reduced suicide ideation is associated with patient recall of components. More frequent use of the E-CRP is associated with larger reductions in suicide ideation.

Cited by 30 publications

References 26 publications

Self-reported Access to Firearms Among Patients Receiving Care for Mental Health and Substance Use

Self-reported Access to Firearms Among Patients Receiving Care for Mental Health and Substance Use

An implementation evaluation of “Zero Suicide” using normalization process theory to support high-quality care for patients at risk of suicide

Cognitive behavioral therapy for suicide prevention (CBT‐SP): Implications for meeting standard of care expectations with suicidal patients

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