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Health Services Research & Development

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In this issue: Preventing Suicide among Veterans
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March 2021

Rapid Referral to Suicide Specific Intervention in Psychiatric Emergency Care

Feature Article


Takeaway: This project is innovative in its focus on transitional care interventions in the same-day psychiatric clinic setting and its integration of health information technology to facilitate rapid referral for Veterans at risk of suicide.


Same-day psychiatric emergency clinics are increasingly implemented and are a best practice in increasing access to mental healthcare—and in suicide prevention. Preliminary data indicate a high frequency of suicidal ideation and recent suicidal behavior among Veterans accessing same-day mental health evaluation, and yet fewer than half of Veterans with these risk factors engage in outpatient mental health appointments that are set following their initial acute evaluation. To reduce the risk of suicide during the transition from acute to outpatient care, it is unclear if models that “bridge” the transition should emphasize telephone outreach, as delivered by Suicide Prevention Coordination teams (available at all VA medical centers), or suicide-specific psychotherapy, such as Collaborative Assessment and Management of Suicidality (CAMS).

CAMS is a brief transdiagnostic evidence-based psychotherapy that is recognized by the Joint Commission and is a Zero Suicide Framework indicated for Veterans experiencing active suicidal ideation and/or recent suicidal behavior.

This ongoing study (October 2018 – September 2022) – a four-year randomized clinical trial – addresses questions regarding the relative impact of rapid referral to CAMS compared to outreach delivered by Suicide Prevention Coordinators for Veterans who receive same-day mental health evaluations, and who are gauged to be at elevated risk for suicide. Investigators will recruit Veterans from the same-day clinic setting who report recent or current active suicidal ideation and/or suicide attempt within the past three months. Veterans then will be randomized to timely initiation of CAMS or to telephone outreach from Suicide Prevention Coordinators. The primary outcome is the 12-month rate of suicide-related behavior or psychiatric hospitalization. Study investigators also will contrast indicators of operational efficiency between randomized conditions, including Veterans' rate of missed appointments at referred ongoing mental healthcare and urgent care representation. In addition, investigators will:

  • Evaluate secondary outcomes (e.g., suicidal ideation severity);
  • Examine the mediating impact of outpatient mental health treatment engagement on primary outcomes; and
  • Evaluate fidelity to CAMS and its association with outcomes.

Methods

Fidelity and in-person outcomes are measured by the information technology called eScreening, which is integrated with VA’s electronic health record and is used to coordinate rapid referral and measurement-based care.

Findings

Research results will inform best practices in suicide prevention in same-day mental health services where many at-risk Veterans are seen.

Anticipated Impact

This project builds on preliminary data which indicate that research recruitment and rapid referral to CAMS therapy in same-day settings is highly feasible, acceptable, and potentially impactful. This project is innovative in its focus on transitional care interventions in the same-day clinic setting and its integration of health information technology to facilitate rapid referral for Veterans at risk of suicide.

Principal Investigator: Colin Depp, PhD, is a Clinical Psychologist at the VA San Diego Healthcare System.

Publications

None to report at this time.

View study abstract

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