A systematic review of evidence-based aftercare for older adults following self-harm

Objective: Self-harm is closely associated with suicide in older adults and may provide opportunity to intervene to prevent suicide. This study aimed to systematically review recent evidence for three components of aftercare for older adults: (1) referral pathways, (2) assessment tools and safety planning approaches and (3) engagement and intervention strategies. Methods: Databases PubMed, Medline, PsychINFO, Embase and CINAHL were searched from January 2010 to 10 July 2021 by two reviewers. Empirical studies reporting aftercare interventions for older adults (aged 60+) following self-harm (including with suicidal intent) were included. Full text of articles with abstracts meeting inclusion criteria were obtained and independently reviewed by three authors to determine final studies for review. Two reviewers extracted data and assessed level of evidence (Oxford) and quality ratings (Alberta Heritage Foundation for Medical Research Standard Quality Assessment Criteria for quantitative and Attree and Milton checklist for qualitative studies), working independently. Results: Twenty studies were reviewed (15 quantitative; 5 qualitative). Levels of evidence were low (3, 4), and quality ratings of quantitative studies variable, although qualitative studies rated highly. Most studies of referral pathways were observational and demonstrated marked variation with no clear guidelines or imperatives for community psychiatric follow-up. Of four screening tools evaluated, three were suicide-specific and one screened for depression. An evidence-informed approach to safety planning was described using cases. Strategies for aftercare engagement and intervention included two multifaceted approaches, psychotherapy and qualitative insights from older people who self-harmed, carers and clinicians. The qualitative studies identified targets for improved aftercare engagement, focused on individual context, experiences and needs. Conclusion: Dedicated older-adult aftercare interventions with a multifaceted, assertive follow-up approach accompanied by systemic change show promise but require further evaluation. Research is needed to explore the utility of needs assessment compared to screening and evaluate efficacy of safety planning and psychotherapeutic approaches.

BIM Approach in Construction Safety—A Case Study on Preventing Falls from Height

The construction industry has one of the highest occupational accident incidence rates among all economic sectors. Currently, building information modelling (BIM) appears to be a valuable tool for analysing occupational safety issues throughout the construction life cycle of projects, helping to avoid hazards and risks and, consequently, increasing safety. This work investigates BIM methodology and the application of related technologies for building safety planning and demonstrates the potential of this technology for the integrated implementation of safety measures during the design phase and construction site management. The first step consisted of a literature review on applying BIM-related technologies for safety in the design and planning phases. Following this, to show the potentialities of construction simulation, a case study based on BIM 4D to prevent falls from height was developed. With BIM 4D, it is possible to follow the construction process over time, giving the construction safety technicians, designers, supervisors and managers the capability to analyse, in each phase, the potential risks and identify which safety measures should be implemented. BIM can effectively integrate safety measures from the design phase to the construction and use phase and enable integrated safety planning within construction planning, leading to reliable safety management throughout the construction process.

“Everyone is Living in the Same Storm, but our Boats are all Different”: Safety and Safety Planning for Survivors of Intimate Partner and Sexual Violence During the COVID-19 Pandemic

Survivors of intimate partner violence (IPV) and sexual assault (SA) faced increased violence, new safety risks, and reduced services access in the face of the COVID-19 pandemic. IPV and SA service providers have a critical role in safety planning and advocacy with survivors; however their patterns of working were dramatically impacted by changes brought on by the pandemic. Little is known about safety planning strategies and service adaptations employed in this context. Through semi-structured interviews with 33 service providers from across the United States, this study explores the experiences and perspectives of victim service agency staff with IPV and SA survivor safety and safety planning from March to December 2020. Qualitative data were analyzed using conventional content analysis. Four overarching themes related to survivor safety and safety planning emerged, including (1) “The violence is more severe, it’s more escalated,” describing an increase in the severity and frequency of violence; (2) “Perpetrating the violence through [technology],” describing a specific surge in technology based abuse (TBA) as the world shifted to virtual communication to facilitate social distancing; (3) “COVID-19 is now a tool in their toolbox,” describing the emergence of the COVID-19 pandemic and health guidance as a life generated risk that abusive partners used to further control and isolate their partner; and (4) “You just get real crafty,” highlighting the wide range of “work-arounds” and safety planning adaptations employed by victim service professionals trying to maintain services in a disrupted environment and in the face of evolving safety risks and increasing violence severity. These findings highlight the safety and safety planning challenges encountered as the COVID-19 pandemic unfolded and the many creative strategies employed by service providers to adapt in the moment.