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| ID | Type | Description | Link |
|---|---|---|---|
| 1P50MH127511-01 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| National Institute of Mental Health (NIMH) | NIH |
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The purpose of this study is to evaluate the effectiveness and implementation of a suicide prevention strategy delivered via telehealth in Emergency Departments. We will compare implementation of the Safety Planning Intervention plus follow-up calls (SPI+) delivered by Emergency Department (ED) staff to SPI+ delivered via ED referral to an off-site Suicide Prevention Consultation Center (SPCC).
Individuals at high risk for suicide often present to acute care settings, such as emergency departments (EDs), and then typically are hospitalized or referred for outpatient mental health treatment. Patients are at increased risk of suicide attempts and suicide following an ED visit and nearly half do not attend outpatient treatment. Brief, evidence-based clinical interventions, such as the Safety Planning Intervention with post-discharge telephone follow-up (SPI+), can reduce suicide risk, decrease hospitalizations, and increase engagement in outpatient services for suicidal patients discharged from the ED. Leveraging insights from implementation science and collaborative care, we propose a model in which ED staff will connect patients at risk for suicide to ED-credentialed mental health clinicians who are located external to the ED. These off-site clinicians will provide SPI+ via telehealth for ED patients prior to discharge and provide follow-up services after ED discharge as part of an innovative Suicide Prevention Consultation Center (SPCC). All participating EDs will begin in the Enhanced Usual Care phase, in which ED staff will deliver SPI+ to suicidal patients. EDs will then be randomized in pairs to begin referral to the SPCC in 3 month intervals. We will also conduct a cost evaluation to help determine scalability and sustainability.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Enhanced Usual Care | Active Comparator | ED staff deliver SPI+ (Safety Planning Intervention plus 2 or more post-discharge telephone calls) to suicidal patients who are not admitted to an inpatient unit. |
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| Suicide Prevention Consultation Center | Experimental | ED staff refer suicidal patients not admitted to an inpatient unit to the off-site Suicide Prevention Consultation Center (SPCC). SPCC clinicians will deliver SPI+ (Safety Planning Intervention plus 2 or more post-discharge telephone calls) to patients via telehealth. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| SPI+ Delivered by ED Staff | Behavioral | ED staff will deliver SPI+ (Safety Planning Intervention plus follow-up phone calls) to patients at risk for suicide in the ED who are not admitted to an inpatient unit. |
| Measure | Description | Time Frame |
|---|---|---|
| Suicide Behavior Composite | Number of patients who had a documented suicide attempt or death by suicide | 6 months after index ED visit |
| Outpatient Treatment Engagement - Count | Number of behavioral healthcare visits following discharge from index ED visit | 6 months after index ED visit |
| Outpatient Treatment Engagement - Type | Types of behavioral healthcare visits following discharge from index ED visit | 6 months after index ED visit |
| Safety Planning Intervention Scoring Algorithm (SPISA) | Fidelity of written safety plans post-discharge from index ED visit | At index ED visit |
| Fidelity of Follow-up Calls | Number of patients who had 2 or more follow-up calls post-discharge from index ED visit | 1 month after index ED visit |
| Reach/Penetration of Safety Plans | Proportion of patients with a completed safety plan documented in the medical record out of all patients identified as at risk for suicide by the ED staff | At index ED visit |
| Reach/Penetration of Follow-up Calls | Proportion of patients who receive 2 or more telephone follow-up attempts out of all patients who received a safety plan | 1 month after index ED visit |
| Measure | Description | Time Frame |
|---|---|---|
| Suicide-related ED Visits and Psychiatric Hospitalizations | Number of ED visits and/or inpatient psychiatric admissions for suicidal ideation/behavior | 6 months after index ED visit |
| Suicide Attempts |
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Aim 1/Aim 3:
Inclusion Criteria:
Exclusion Criteria:
- Inpatient admission following the index ED visit per the EHR
Aim 2:
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Gregory K Brown, PhD | University of Pennsylvania | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Pennsylvania Health System | Philadelphia | Pennsylvania | 19104 | United States |
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| ID | Term |
|---|---|
| D013405 | Suicide |
| D059020 | Suicidal Ideation |
| D004630 | Emergencies |
| ID | Term |
|---|---|
| D016728 | Self-Injurious Behavior |
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |
| D020969 | Disease Attributes |
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Stepped-wedge cluster-randomized controlled design
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| SPI+ Delivered by SPCC Clinicians | Behavioral | The Suicide Prevention Consultation Center (SPCC) will be located external to the Emergency Department (ED). ED staff will be able to refer patients at risk for suicide to the SPCC. Licensed and credentialed mental health clinicians will deliver SPI+ (Safety Planning Intervention plus follow-up phone calls) via telehealth to patients at risk for suicide in the ED who are not admitted to an inpatient unit. |
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Number of patients who had a documented suicide attempt
| 6 months after index ED visit |
| Adoption | Proportion of clinicians with eligible patients who refer the patient to the SPCC | At index ED visit |
| Utilization of Screening of Suicide Risk Among ED Patients | Proportion of ED patients who received the Columbia Suicide Severity Rating Scale or equivalent evidence-based measure of suicide risk during index ED visit | At index ED visit |
| Index ED Visit Inpatient Admission Disposition | Proportion of patients admitted for inpatient hospitalization out of all patients identified as at risk for suicide | At index ED visit |
| Feasibility of SPCC | Will be assessed through semi-structured qualitative interviews with a randomly selected sample of clinicians, leaders, and patients, as well as by using the Feasibility of Intervention Measure (FIM) | 9-12 months after ED crosses over to SPCC condition |
| Acceptability of SPCC | Will be assessed through semi-structured qualitative interviews with a randomly selected sample of clinicians, leaders, and patients, as well as by using the Acceptability of Intervention Measure (AIM) | 9-12 months after ED crosses over to SPCC condition |
| Cost to Emergency Department of SPCC | We will assess average personnel and non-personnel costs to Emergency Department practices of delivering SPCC and EUC strategies, using Time-Driven Activity-Based Costing | After ED crosses over to SPCC condition (2.25 - 3 year range, average of 2.625 years) |
| Cost to Emergency Department of EUC | We will assess average personnel and non-personnel costs to Emergency Department practices of delivering EUC strategies, using Time-Driven Activity-Based Costing | Before ED crosses over to SPC condition (1 - 1.75 year range, average of 1.375 years) |
| D010335 |
| Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |