scholarly journals Development of the U.S. Army’s Suicide Prevention Leadership Tool: The Behavioral Health Readiness and Suicide Risk Reduction Review (R4)

2019 ◽  
Vol 185 (5-6) ◽  
pp. e668-e677 ◽  
Author(s):  
Justin M Curley ◽  
Elizabeth A Penix ◽  
Jayakanth Srinivasan ◽  
Dennis M Sarmiento ◽  
Leslie H McFarling ◽  
...  
Keyword(s):  
At Risk ◽  
Focus Groups ◽  
Behavioral Health ◽  
Risk Reduction ◽  
Suicide Prevention ◽  
Suicide Risk ◽  
Evidence Based ◽  
Institutional Barriers ◽  
Design Considerations ◽  
The U.S

Abstract Introduction Although numerous efforts have aimed to reduce suicides in the U.S. Army, completion rates have remained elevated. Army leaders play an important role in supporting soldiers at risk of suicide, but existing suicide-prevention tools tailored to leaders are limited and not empirically validated. The purpose of this article is to describe the process used to develop the Behavioral Health Readiness and Suicide Risk Reduction Review (R4) tools for Army leaders that are currently undergoing empirical validation with two U.S. Army divisions. Materials and Methods Consistent with a Secretary of the Army directive, approximately 76 interviews and focus groups were conducted with Army leaders and subject matter experts (SMEs) to obtain feedback regarding existing practices for suicide risk management, leader tools, and institutional considerations. In addition, reviews of the empirical literature regarding predictors of suicide and best practices for the development of practice guidelines were conducted. Qualitative feedback, empirical predictors of suicide, and design considerations were integrated to develop the R4 tools. A second series of 11 interviews and focus groups with Army leaders and SMEs was also conducted to validate the design and obtain feedback regarding the R4 tools. Results Leaders described preferences for tool processes (eg, incorporating engaged leadership, including multiple risk identification methods), formatting (eg, one page), organization (eg, low-intermediate-high risk scoring system), content (eg, excluding other considerations related to vehicle safety, including readiness implications), and implementation (eg, accounting for leadership judgment, tailoring process to specific leadership echelons, consideration of institutional barriers). Evidence-based predictors of suicide risk and practice guideline considerations (eg, design) were integrated with leadership feedback to develop the R4 tools that were tailored to specific leadership echelons. Leaders provided positive feedback regarding the R4 tools and described the importance of accounting for potential institutional barriers to implementation. This feedback was addressed by including recommendations regarding the implementation of standardized support meetings between different echelons of leadership. Conclusions The R4 development process entailed the simultaneous integration of leadership feedback with evidence-based predictors of suicide risk and design considerations. Thus, the development of these tools builds upon previous Army leadership tools by specifically tailoring elements of those tools to accommodate leader preferences, accounting for potential implementation barriers (eg, institutional factors), and empirically evaluating the implementation of those tools. Future studies should consider utilizing a similar process to develop empirically based resources that are more likely to be incorporated into the routine practice of leaders supporting soldiers at risk of suicide, very often located at the company level and below.

scholarly journals Methodology of the U.S. Army’s Suicide Prevention Leadership Tool Study: The Behavioral Health Readiness and Suicide Risk Reduction Review (R4)

2020 ◽  
Author(s):  
Justin M Curley ◽  
Farifteh F Duffy ◽  
Paul Y Kim ◽  
Kristina M Clarke-Walper ◽  
Katie L Nugent ◽  
...  
Keyword(s):  
Decision Making ◽  
Behavioral Health ◽  
Risk Reduction ◽  
Suicide Prevention ◽  
Evaluation Study ◽  
Repeated Measurements ◽  
Control Group ◽  
Walter Reed Army Institute ◽  
Quasi Experimental ◽  
The U.S

Abstract Introduction The Secretary of the U.S. Army issued two directives in late 2017 to directly combat the problem of suicide in the U.S. Army. The first was to develop an Army tool to assist commanders and first-line leaders in preventing suicide and improving behavioral health (BH) outcomes, which has been previously published as the BH Readiness and Risk Reduction Review (R4). The second was to conduct an evaluation study of the tool with Army units in the field. This study is the first to empirically examine the Army’s tool-based methods for identifying and caring for the health and welfare of soldiers at risk for suicide, and this article outlines the methodology employed to study the effectiveness of the R4 tools and accomplish the Secretary’s second directive. Methods The Walter Reed Army Institute of Research Institutional Review Board approved the R4 study. The study employed a repeated measurements in pre/post quasi-experimental design, including a nonequivalent but comparable business-as-usual control group. The R4 intervention consisted of the R4 tools, accompanying instructions, and an orientation. Samples were drawn from two geographically separated U.S. Army divisions in the continental United States, each composed of four comparable brigades. Study implementation consisted of three phases and three data collections over the course of 12 months. Soldiers completed anonymous survey instruments to assess a range of health factors, behaviors, characteristics, tool-related decision-making processes, and the frequency, type, and quality of interactions between soldiers and leaders. Results The R4 study commenced on May 6, 2019, and concluded on June 4, 2020. Sample size goals were achieved for both the divisions at all three data collection time points. Conclusions The methodology of the R4 study is critical for the U.S. Army from both a precedential and an outcome-based standpoint. Despite the use of many previous tools and programs for suicide prevention, this is the first time the Army has been able to empirically test the effectiveness of tool-supported decision-making among Army units in a rigorous fashion. The methodology of such a test is a critical marker for future interventional inquiries on the subject of suicide in the Army, and the results will allow for more informed decision-making by leaders when approaching these ongoing challenges.

scholarly journals Schizophrenia and bipolar disorder: No recovery without suicide prevention

2015 ◽  
Vol 207 (5) ◽  
pp. 371-372 ◽  
Author(s):  
Tom Foster
Keyword(s):  
Bipolar Disorder ◽  
Clinical Practice ◽  
Suicide Prevention ◽  
Suicide Risk ◽  
Personal Responsibility ◽  
Service Design ◽  
Mental Capacity ◽  
Evidence Based

SummarySuicide prevention for people with schizophrenia or bipolar disorder warrants an evidence-based approach to service design as well as clinical practice. The issue of personal responsibility (diminished when mental capacity is impaired) contributing to reduction of suicide risk has, arguably, been neglected.

Saving Lives: Recognizing and Intervening with Youth at Risk for Suicide

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Alejandra Arango ◽  
Polly Y. Gipson ◽  
Jennifer G. Votta ◽  
Cheryl A. King
Keyword(s):  
United States ◽  
At Risk ◽  
Suicide Risk ◽  
Empirical Support ◽  
The United States ◽  
Annual Review ◽  
Publication Date ◽  
Evidence Based ◽  
Psychotherapeutic Interventions ◽  
Youth At Risk

Suicide is the second leading cause of death for youth in the United States. Fortunately, substantial advances have been achieved in identifying and intervening with youth at risk. In this review, we first focus on advances in proactive suicide risk screening and psychoeducation aimed at improving the recognition of suicide risk. These strategies have the potential to improve our ability to recognize and triage youth at risk who may otherwise be missed. We then review recent research on interventions for youth at risk. We consider a broad range of psychotherapeutic interventions, including crisis interventions in emergency care settings. Though empirical support remains limited for interventions targeting suicide risk in youth, effective and promising approaches continue to be identified. We highlight evidence-based screening and intervention approaches as well as challenges in these areas and recommendations for further investigation. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 17 is May 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Characteristics and Proximal Outcomes of Calls Made to Suicide Crisis Hotlines in California

Crisis ◽  
2017 ◽  
Vol 38 (1) ◽  
pp. 26-35 ◽  
Author(s):  
Rajeev Ramchand ◽  
Lisa Jaycox ◽  
Pat Ebener ◽  
Mary Lou Gilbert ◽  
Dionne Barnes-Proby ◽  
...  
Keyword(s):  
At Risk ◽  
Suicide Prevention ◽  
Suicide Risk ◽  
Call Centers

Abstract. Background: Suicide hotlines are commonly used to prevent suicides, although centers vary with respect to their management and operations. Aims: To describe variability across suicide prevention hotlines. Method: Live monitoring of 241 calls was conducted at 10 suicide prevention hotlines in California. Results: Call centers are similar with respect to caller characteristics and the concerns callers raise during their calls. The proportion of callers at risk for suicide varied from 3 to 57%. Compliance with asking about current suicide risk, past ideation, and past attempts also ranged considerably. Callers to centers that were part of the National Suicide Prevention Lifeline (NSPL) were more likely to experience reduced distress than callers to centers that were not part of the NSPL. Conclusion: Because callers do not generally choose the center or responder that will take their call, it is critical to promote quality across call centers and minimize the variability that currently exists. Accrediting bodies, funders, and crisis centers should require that centers continuously monitor calls to ensure and improve call quality.

scholarly journals Making the Case for Suicide Risk Screening in Outpatient Podiatry Patients: An Opportunity for Injury Prevention

2021 ◽  
Author(s):  
Adam K. Spector ◽  
Annabelle M Mournet ◽  
Deborah J Snyder ◽  
Emmanuella Eastman ◽  
Maryland Pao ◽  
...  
Keyword(s):  
At Risk ◽  
Suicide Prevention ◽  
Suicide Risk ◽  
Clinical Decision Making ◽  
Positive Zero ◽  
Risk Screening ◽  
Improvement Project ◽  
Care Clinic ◽  
Clinic Staff ◽  
Suicide Risk Screening

Background: Despite prevention efforts, suicide rates continue to rise, prompting the need for novel evidence-based approaches to suicide prevention. Patients presenting with foot and ankle disorders in a podiatric medical and surgical practice may represent a population at risk for suicide, given risk factors of chronic pain and debilitating injury. Screening has the potential to identify people at risk that may otherwise go unrecognized. This quality improvement project (QIP) aimed to determine the feasibility of implementing suicide risk screening in an outpatient podiatry clinic and ambulatory surgical center. Methods: A suicide risk screening QIP was implemented in an outpatient podiatry clinic and ambulatory surgical center in collaboration with a National Institute of Mental Health (NIMH) suicide prevention research team. Following training for all staff, patients ages 18 years and older were screened for suicide risk with the Ask Suicide-Screening Questions (ASQ) as standard of care. Clinic staff were surveyed about their opinions of screening. Results: Ninety-four percent of patients (442/470) agreed to be screened for suicide risk and nine patients (2%; 9/442) screened non-acute positive; zero for acute risk. The majority of clinic staff reported that they found screening acceptable, felt comfortable working with patients who have suicidal thoughts, and thought screening for suicide risk was clinically useful. Conclusions: Suicide risk screening was successfully implemented in an outpatient podiatry clinic. Screening with the ASQ provided valuable information that would not have been ascertained otherwise, positively impacting clinical decision-making and leading to improved overall care for podiatry patients.

Towards a Working Profile of Medical Bankruptcy

2018 ◽  
Vol 29 (1) ◽  
pp. 75-90 ◽  
Author(s):  
Donald D. Hackney ◽  
Daniel L. Friesner ◽  
Erica H. Johnson
Keyword(s):  
At Risk ◽  
Evidence Based ◽  
Medical Conditions ◽  
Policy Makers ◽  
Medical Debt ◽  
Eastern Washington ◽  
Medical Bills ◽  
The U.S

Medical bankruptcy refers to individuals with serious medical conditions who feel compelled to file for bankruptcy to seek relief from their medical debts. Noticeably lacking in the literature is a consistent, evidence-based criterion to define who may be classified as medically bankrupt. A more concrete definition would allow policy makers to understand the magnitude of the problem and allow financial counselors to better inform certain households about seeking bankruptcy protection when faced with medical bills. This study uses data drawn from the U.S. Bankruptcy Court’s Eastern Washington District to create an empirical profile of bankruptcy petitioners with medical debt. We then identify those characteristics statistically associated with being “at-risk” of a medical bankruptcy to better understand and define medical bankruptcy.

Working Sensitively and Effectively to Reduce Suicide Risk Among Older Adults

2016 ◽  
Author(s):  
Marnin J. Heisel ◽  
Paul R. Duberstein
Keyword(s):  
Older Adults ◽  
At Risk ◽  
Suicide Prevention ◽  
Suicide Risk ◽  
Later Life ◽  
Human Response ◽  
Decisive Action ◽  
And Behavior ◽  
Risk Assessment And Management ◽  
Made In

Suicide is a uniquely human phenomenon, necessitating a human response. Suicide disproportionately claims the lives of older adults, and men in particular. Effective clinical practice with at-risk older adults requires sensitivity to contributing developmental, intrapersonal, social, and existential factors. Whereas the presence of suicide thoughts and behavior may be conceptualized as potential signs of an incipient mental health emergency, demanding quick and decisive action, working clinically with at-risk older adults nevertheless extends temporally beyond moments of behavioral crisis and conceptually beyond risk assessment and management. The field of later-life suicide prevention is in its relative infancy; however, progress is being made in investigating associated risk and resiliency factors and in developing, testing, and disseminating approaches to assessment and intervention. We provide an overview of the literature and call for a more sensitive, compassionate, and effective approach to suicide prevention among older adults, drawing on individually tailored and humanistic-existential approaches to care.

scholarly journals Suicide prevention skills, confidence and training: Results from the Zero Suicide Workforce Survey of behavioral health care professionals

2020 ◽  
Vol 8 ◽  
pp. 205031212093315
Author(s):  
Sara Wakai ◽  
Elizabeth A Schilling ◽  
Robert H Aseltine ◽  
Ellen W Blair ◽  
Jill Bourbeau ◽  
...  
Keyword(s):  
Health Care ◽  
At Risk ◽  
Behavioral Health ◽  
Suicide Prevention ◽  
Health Care Professionals ◽  
Statistical Significance ◽  
Behavioral Health Care ◽  
Warning Signs ◽  
Comfort Level ◽  
Patients At Risk

Introduction: In behavioral health care settings, a workforce well trained in suicide prevention is critically important for behavioral health care professionals across different disciplines and service sectors who are likely to have considerable exposure to patients at risk for suicidal behavior. This study examined the types of training behavioral health care professionals received, their self-reported skills, comfort level and confidence related to suicide prevention, the association of types and length of training with skills, comfort level and confidence, and areas in which participants would like more training. Methods: The Zero Suicide Workforce Survey was administered electronically to behavioral health care professionals at six behavioral health treatment centers with both inpatient and ambulatory programs in Connecticut, USA. Item numbers and percentages were calculated for 847 respondents with behavioral health care roles. The chi-square tests were performed to determine the statistical significance of group differences. Non-parametric sign tests were performed to determine the statistical significance of the collective differences in direction among items between groups. Results: Suicide prevention training is associated with increased levels of behavioral health care professionals’ skills and confidence, but one-third of behavioral health care professionals in the sample received no formal training in suicide prevention/intervention. Even brief training appears to have a positive impact on behavioral health care professionals’ assessment of their skills and confidence. Prominent topics for additional training include suicide-specific treatment approaches, suicide prevention and awareness, and identification of risk factors and warning signs. Conclusion: Although behavioral health care professionals may often encounter patients at risk for suicide, many have not obtained any relevant training. The findings highlight the need to strengthen suicide identification, assessment and treatment within behavioral health care treatment settings as part of an effort to prevent suicide.

scholarly journals Feasibility and Initial Outcomes of a Group-Based Teletherapy Psychiatric Day Program for Adults with Serious Mental Illness: An Open, Non-Randomized Trial in the Context of COVID-19 (Preprint)

2020 ◽  
Author(s):  
Ajeng J Puspitasari ◽  
Dagoberto Heredia ◽  
Brandon J Coombes ◽  
Jennifer R Geske ◽  
Melanie T Gentry ◽  
...  
Keyword(s):  
Mental Health ◽  
At Risk ◽  
Mental Illness ◽  
Behavioral Health ◽  
Suicide Risk ◽  
Psychiatric Hospitalization ◽  
Patient Level ◽  
Cohen’S D ◽  
Cohen's D ◽  
Day Program

BACKGROUND In the context of COVID-19, many behavioral health services transitioned to teletherapy to continue delivering care for patients with mental illness. Studies that evaluate the outcome. OBJECTIVE This single-arm, non-randomized pilot study aimed to assess the feasibility and initial patient-level outcomes of a psychiatric transitional day program that switched from an in-person to a video teletherapy group during COVID-19. METHODS Patients with transdiagnostic conditions who were at risk of psychiatric hospitalization were referred to the Adult Transitions Program (ATP) at a large academic medical center in the United States. ATP was a 3-week intensive outpatient program that implemented group teletherapy guided by cognitive and behavioral principles delivered daily for 3 hours per day. Feasibility was assessed via retention, attendance rate, and rate of securing aftercare appointments prior to ATP discharge. Patients completed standardized patient-reported outcome measures at admission and discharge to assess program effectiveness for improving quality of mental health, depression, anxiety, and suicide risk. RESULTS Patients (N = 76) started the program between March to August of 2020. Feasibility was established with 70 (92.1%) completing the program, mean attendance of 14.43 (SD = 1.22) days, and 71 (94.7%) had at least one behavioral health aftercare service scheduled prior to ATP discharge. All patient-level reported outcomes demonstrated significant improvement on depression (95% Cl: -3.6 to -6.2; Cohen’s d = 0.77; p < 0.0001), anxiety (95% Cl: -3.0 to -4.9; Cohen’s d = 0.74; p < 0.0001), overall suicide risk (95% Cl: -0.5 to-0.1; Cohen’s d = 0.41; p = 0.019), wish to live (95% Cl: 0.3 to 1.0; Cohen’s d = 0.39; p = 0.0005), wish to die (95% Cl: -0.2 to-1.4; Cohen’s d = 0.52; p = 0.011), and overall mental health (95% Cl: 1.5 to 4.5; Cohen’s d = 0.39; p = 0.0003) from admission to discharge. CONCLUSIONS Rapid adoption and implementation of a group-based teletherapy day program for adults at risk of psychiatric hospitalization appeared to be feasible and effective. Patients demonstrated high completion and attendance rates and reported significant improvements on psychosocial outcomes. Larger trials should be conducted to further evaluate the efficacy and effectiveness of the program through randomized controlled trials.

A Model for Analyzing Suicide Prevention

Crisis ◽  
2000 ◽  
Vol 21 (2) ◽  
pp. 80-89 ◽  
Author(s):  
Maila Upanne
Keyword(s):  
Risk Factors ◽  
Theoretical Model ◽  
Protective Factors ◽  
Suicide Prevention ◽  
Suicide Risk ◽  
Practical Work ◽  
Individual Risk ◽  
Self Assessment ◽  
Prevention Project ◽  
Individual Risk Factors

This study monitored the evolution of psychologists' (n = 31) conceptions of suicide prevention over the 9-year course of the National Suicide Prevention Project in Finland and assessed the feasibility of the theoretical model for analyzing suicide prevention developed in earlier studies [ Upanne, 1999a , b ]. The study was formulated as a retrospective self-assessment where participants compared their earlier descriptions of suicide prevention with their current views. The changes in conceptions were analyzed and interpreted using both the model and the explanations given by the subjects themselves. The analysis proved the model to be a useful framework for revealing the essential features of prevention. The results showed that the freely-formulated ideas on prevention were more comprehensive than those evolved in practical work. Compared to the earlier findings, the conceptions among the group had shifted toward emphasizing a curative approach and the significance of individual risk factors. In particular, greater priority was focused on the acute suicide risk phase as a preventive target. Nonetheless, the overall structure of prevention ideology remained comprehensive and multifactorial, stressing multistage influencing. Promotive aims (protective factors) also remained part of the prevention paradigm. Practical working experiences enhanced the psychologists' sense of the difficulties of suicide prevention as well as their criticism and feeling of powerlessness.

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