scholarly journals Implementation Determinants and Outcomes of a Technology-Enabled Service Targeting Suicide Risk in High Schools: Mixed Methods Study

10.2196/16338 ◽  
2020 ◽  
Vol 7 (7) ◽  
pp. e16338
Author(s):  
Molly Adrian ◽  
Jessica Coifman ◽  
Michael D Pullmann ◽  
Jennifer B Blossom ◽  
Casey Chandler ◽  
...  
Keyword(s):  
Mental Health ◽  
Data Collection ◽  
Suicide Prevention ◽  
Suicide Risk ◽  
School Setting ◽  
Usability Testing ◽  
School Personnel ◽  
Relative Advantage ◽  
Implementation Outcomes ◽  
Passive Data

Background Technology-enabled services (TESs), which integrate human service and digital components, are popular strategies to increase the reach and impact of mental health interventions, but large-scale implementation of TESs has lagged behind their potential. Objective This study applied a mixed qualitative and quantitative approach to gather input from multiple key user groups (students and educators) and to understand the factors that support successful implementation (implementation determinants) and implementation outcomes of a TES for universal screening, ongoing monitoring, and support for suicide risk management in the school setting. Methods A total of 111 students in the 9th to 12th grade completed measures regarding implementation outcomes (acceptability, feasibility, and appropriateness) via an open-ended survey. A total of 9 school personnel (school-based mental health clinicians, nurses, and administrators) completed laboratory-based usability testing of a dashboard tracking the suicide risk of students, quantitative measures, and qualitative interviews to understand key implementation outcomes and determinants. School personnel were presented with a series of scenarios and common tasks focused on the basic features and functions of the dashboard. Directed content analysis based on the Consolidated Framework for Implementation Research was used to extract multilevel determinants (ie, the barriers or facilitators at the levels of the outer setting, inner setting, individuals, intervention, and implementation process) related to positive implementation outcomes of the TES. Results Overarching themes related to implementation determinants and outcomes suggest that both student and school personnel users view TESs for suicide prevention as moderately feasible and acceptable based on the Acceptability of Intervention Measure and Feasibility of Intervention Measure and as needing improvements in usability based on the System Usability Scale. Qualitative results suggest that students and school personnel view passive data collection based on social media data as a relative advantage to the current system; however, the findings indicate that the TES and the school setting need to address issues of privacy, integration into existing workflows and communication patterns, and options for individualization for student-centered care. Conclusions Innovative suicide prevention strategies that rely on passive data collection in the school context are a promising and appealing idea. Usability testing identified key issues for revision to facilitate widespread implementation.

scholarly journals Implementation Determinants and Outcomes of a Technology-Enabled Service Targeting Suicide Risk in High Schools: Mixed Methods Study (Preprint)

2019 ◽  
Author(s):  
Molly Adrian ◽  
Jessica Coifman ◽  
Michael D Pullmann ◽  
Jennifer B Blossom ◽  
Casey Chandler ◽  
...  
Keyword(s):  
Mental Health ◽  
Data Collection ◽  
Suicide Prevention ◽  
Suicide Risk ◽  
School Setting ◽  
Usability Testing ◽  
School Personnel ◽  
Relative Advantage ◽  
Implementation Outcomes ◽  
Passive Data

BACKGROUND Technology-enabled services (TESs), which integrate human service and digital components, are popular strategies to increase the reach and impact of mental health interventions, but large-scale implementation of TESs has lagged behind their potential. OBJECTIVE This study applied a mixed qualitative and quantitative approach to gather input from multiple key user groups (students and educators) and to understand the factors that support successful implementation (implementation determinants) and implementation outcomes of a TES for universal screening, ongoing monitoring, and support for suicide risk management in the school setting. METHODS A total of 111 students in the 9th to 12th grade completed measures regarding implementation outcomes (acceptability, feasibility, and appropriateness) via an open-ended survey. A total of 9 school personnel (school-based mental health clinicians, nurses, and administrators) completed laboratory-based usability testing of a dashboard tracking the suicide risk of students, quantitative measures, and qualitative interviews to understand key implementation outcomes and determinants. School personnel were presented with a series of scenarios and common tasks focused on the basic features and functions of the dashboard. Directed content analysis based on the Consolidated Framework for Implementation Research was used to extract multilevel determinants (ie, the barriers or facilitators at the levels of the outer setting, inner setting, individuals, intervention, and implementation process) related to positive implementation outcomes of the TES. RESULTS Overarching themes related to implementation determinants and outcomes suggest that both student and school personnel users view TESs for suicide prevention as moderately feasible and acceptable based on the Acceptability of Intervention Measure and Feasibility of Intervention Measure and as needing improvements in usability based on the System Usability Scale. Qualitative results suggest that students and school personnel view passive data collection based on social media data as a relative advantage to the current system; however, the findings indicate that the TES and the school setting need to address issues of privacy, integration into existing workflows and communication patterns, and options for individualization for student-centered care. CONCLUSIONS Innovative suicide prevention strategies that rely on passive data collection in the school context are a promising and appealing idea. Usability testing identified key issues for revision to facilitate widespread implementation.

Protocol for Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH) (Preprint)

2021 ◽  
Author(s):  
Yatharth Ranjan ◽  
Malik Althobiani ◽  
Joseph Jacob ◽  
Michele Orini ◽  
Richard Dobson ◽  
...  
Keyword(s):  
Mental Health ◽  
Data Collection ◽  
Real Time ◽  
Remote Monitoring ◽  
Wearable Devices ◽  
Physical And Mental Health ◽  
Disease Trajectory ◽  
Passive Data ◽  
Active Data ◽  
Finger Pulse

BACKGROUND Chronic Lung disorders like COPD and IPF are characterised by exacerbations which are a significant problem: unpleasant for patients, and sometimes severe enough to cause hospital admission (and therefore NHS pressures) and death. Reducing the impact of exacerbations is very important. Moreover, due to the COVID-19 pandemic, the vulnerable populations with these disorders are at high risk and hence their routine care cannot be done properly. Remote monitoring offers a low cost and safe solution of gaining visibility into the health of people in their daily life. Thus, remote monitoring of patients in their daily lives using mobile and wearable devices could be useful especially in high vulnerability groups. A scenario we consider here is to monitor patients and detect disease exacerbation and progression and investigate the opportunity of detecting exacerbations in real-time with a future goal of real-time intervention. OBJECTIVE The primary objective is to assess the feasibility and acceptability of remote monitoring using wearable and mobile phones in patients with pulmonary diseases. The aims will be evaluated over these areas: Participant acceptability, drop-out rates and interpretation of data, Detection of clinically important events such as exacerbations and disease progression, Quantification of symptoms (physical and mental health), Impact of disease on mood and wellbeing/QoL and The trajectory-tracking of main outcome variables, symptom fluctuations and order. The secondary objective of this study is to provide power calculations for a larger longitudinal follow-up study. METHODS Participants will be recruited from 2 NHS sites in 3 different cohorts - COPD, IPF and Post hospitalised Covid. A total of 60 participants will be recruited, 20 in each cohort. Data collection will be done remotely using the RADAR-Base mHealth platform for different devices - Garmin wearable devices, smart spirometers, mobile app questionnaires, surveys and finger pulse oximeters. Passive data collected includes wearable derived continuous heart rate, SpO2, respiration rate, activity, and sleep. Active data collected includes disease-specific PROMs, mental health questionnaires and symptoms tracking to track disease trajectory in addition to speech sampling, spirometry and finger Pulse Oximetry. Analyses are intended to assess the feasibility of RADAR-Base for lung disorder remote monitoring (include quality of data, a cross-section of passive and active data, data completeness, the usability of the system, acceptability of the system). Where adequate data is collected, we will attempt to explore disease trajectory, patient stratification and identification of acute clinically interesting events such as exacerbations. A key part of this study is understanding the potential of real-time data collection, here we will simulate an intervention using the Exacerbation Rating Scale (ERS) to acquire responses at-time-of-event to assess the performance of a model for exacerbation identification from passive data collected. RESULTS RALPMH study provides a unique opportunity to assess the use of remote monitoring in the study of lung disorders. The study is set to be started in mid-May 2021. The data collection apparatus, questionnaires and wearable integrations have been set up and tested by clinical teams. While waiting for ethics approval, real-time detection models are currently being constructed. CONCLUSIONS RALPMH will provide a reference infrastructure for the use of wearable data for monitoring lung diseases. Specifically information regarding the feasibility and acceptability of remote monitoring and the potential of real-time remote data collection and analysis in the context of chronic lung disorders. Moreover, it provides a unique standpoint to look into the specifics of novel coronavirus without burdensome interventions. It will help plan and inform decisions in any future studies that make use of remote monitoring in the area of Respiratory health. CLINICALTRIAL https://www.isrctn.com/ISRCTN16275601

Students Responding to Natural Disasters and Terrorism

2012 ◽  
pp. 229-250
Author(s):  
Ryan P. Kilmer ◽  
Virginia Gil-Rivas ◽  
Steven J. Hardy
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
School Mental Health ◽  
School Setting ◽  
School Personnel ◽  
Emotional Needs ◽  
Cultural Considerations ◽  
School Based ◽  
The Impact

This chapter seeks to help teachers and school mental health professionals understand the needs of students who have faced a disaster or terrorism and identify strategies for school-based responses. The chapter provides an overview of the effects of these events on school children and youths, including relevant developmental and cultural considerations, and the impact on the school setting. Then, the discussion emphasizes recommendations for, and possible responses by, teachers, school-based mental health professionals, and administrators. Indeed, just as these traumas can affect multiple levels of school children’s lives, the needed response of school-based professionals can be framed as multi-level, ranging from curricular modification to interventions specifically targeting youngsters’ socio-emotional needs. The sections that follow seek to inform and guide responses for school personnel and provide clear, “actionable” recommendations.

Conducting IPT-AST in Schools

2016 ◽  
pp. 136-143
Author(s):  
Jami F. Young ◽  
Laura Mufson ◽  
Christie M. Schueler
Keyword(s):  
Mental Health ◽  
School Setting ◽  
School Personnel ◽  
Skills Training ◽  
Interpersonal Psychotherapy ◽  
Boards Of Education ◽  
Depression Prevention ◽  
School Settings ◽  
School Based ◽  
Mental Health Programs

This chapter discusses the delivery of Interpersonal Psychotherapy–Adolescent Skills Training (IPT-AST) in school settings. The literature on school-based mental health programs is reviewed. Advantages of delivering preventive interventions in schools and challenges to implementation are outlined. These challenges include obtaining agreement from school personnel and boards of education; identifying personnel who will take the lead in implementing IPT-AST; identifying adolescents who will be appropriate for these services; explaining IPT-AST to adolescents and parents to engage them in the program; and managing logistical and scheduling issues within the schools. The authors discuss strategies to address the challenges of implementing this depression prevention program in a school setting.

How to increase the role of social workers in suicide preventive interventions

2020 ◽  
Vol 32 (4) ◽  
pp. 186-195
Author(s):  
Joshua Levine ◽  
Leo Sher
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Social Work ◽  
Social Workers ◽  
Suicide Prevention ◽  
Suicide Risk ◽  
Preventive Interventions ◽  
Suicide Risk Factors ◽  
Suicidal Patients

AbstractObjective:Suicide is a serious public health issue that affects individuals, families and societies all over the world. International studies provide consistent evidence that the presence of psychiatrists in a region is associated with lesser suicide rates. However, many psychiatric patients including suicidal patients do not have access to psychiatrists. This indicates that mental health and non-mental health social workers need to be involved in suicide prevention efforts. This paper is the first comprehensive work that discusses how to increase the role of social workers in the area of suicide prevention.Methods:A review of the relevant literature.Results:Increasing the role of social workers in suicide prevention efforts may reduce suicide risk in groups and people at elevated risk for suicide, as well as the general population.Conclusion:Recommendations are provided for how the social work profession can improve upon suicide prevention while incorporating universal, selective and indicated suicide preventive interventions. Social work research efforts should focus on how to increase the role of social workers in suicide prevention and the management of suicidal patients. Social work education programmes should modify their curricula and increase their attention on suicide prevention. Mental health social workers need to educate the patient and their family on suicide risk factors. Furthermore, mental health and non-mental health social workers need to educate the general public on suicide risk factors.

OP6 An investigation into suicide amongst ambulance service staff

2019 ◽  
Vol 36 (1) ◽  
pp. e3.1-e3
Author(s):  
Kelly Hird ◽  
Fiona Bell ◽  
Becky Mars ◽  
Catheryn James ◽  
David Gunnell
Keyword(s):  
Mental Health ◽  
Occupational Health ◽  
Suicide Prevention ◽  
Suicide Risk ◽  
Ambulance Service ◽  
Health Strategy ◽  
Service Staff ◽  
The Status ◽  
The Uk ◽  
Return Data

BackgroundIn 2015, Ambulance Service Medical Directors raised concerns regarding a perceived increase in suicide deaths among ambulance service staff. The Association of Ambulance Chief Executives (AACE) then commissioned a research study to investigate these concerns and provide recommendations towards a suicide prevention strategy. The aim of this study was to determine whether staff who work in the UK ambulance services (AS) are at higher risk of suicide than staff who work in other professions.MethodsData was requested from the Office for National Statistics (ONS) regarding AS staff suicide. Eighteen AS were invited to return data on Occupational Health (OH). AS in England and Wales (n=11) were also asked to return data on staff suicides. Coroners were contacted to request permission to review the records of the deaths.ResultsThe ONS analysis of occupational suicide risk between 2011 and 2015 indicated that there were 20 suicide deaths amongst paramedics in England during that period. The risk of suicide amongst male paramedics was 75% higher than the national average.Over a 2 year period, 8 AS trusts identified 15 staff suicides (11 male, 4 female). The mean age of those dying by suicide was 42 years. Findings from coroners’ records indicated that the predominant suicide method used was hanging (66.7%).ConclusionsThe following recommendations have been accepted by the AACE: a) Develop a mental health strategy for all staff which includes specific emphasis on suicide prevention b) Review and assess suicide risk at times of increased vulnerability c) Collect and monitor data on AS suicides d) Review occupational health, counselling and support services e) Training for staff in identifying and responding to a colleague in distress f) Return to work discussions should consider and establish the status of an individual’s mental health and wellbeing.

Suicide risk following a new cancer diagnosis among veterans in Veterans Health Administration care.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12130-12130
Author(s):  
Kallisse R. Dent ◽  
Benjamin R. Szymanski ◽  
Michael J. Kelley ◽  
Ira Katz ◽  
John F. McCarthy
Keyword(s):  
Mental Health ◽  
Lung Cancer ◽  
Head And Neck ◽  
Suicide Prevention ◽  
Cancer Diagnosis ◽  
Suicide Risk ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Suicide Rates

12130 Background: Patients diagnosed with cancer are at an increased risk of adverse mental health outcomes including suicidal behavior. Suicide rates among Veterans are 50 percent greater than for non-Veteran US adults. To inform Veterans Affairs (VA) suicide prevention initiatives, it is important to understand associations between cancer and suicide risk among Veterans receiving VA healthcare from the Veterans Health Administration (VHA). Study aims were to assess associations between new cancer diagnoses and suicide among Veterans in VHA care to identify high risk diagnostic subgroups and risk-periods. Methods: We used a cohort study design, identifying 4,926,373 Veterans with VHA use in 2011 and either 2012 or 2013 and without a VHA cancer diagnosis in 2011. Incident cancer diagnoses, assessed between first VHA use in 2012-2013 and 12/31/2018, were characterized by subtype and stage using the VHA Oncology Raw Data. Data from the VA/Department of Defense Mortality Data Repository identified date and cause of death. Cox proportional hazards regression, accounting for time-varying cancer diagnosis, was used to evaluate associations between a new cancer diagnosis and suicide risk. An initial model adjusted for VHA regional network and patient age and sex. Cancer subtypes with significant associations with suicide were further assessed using a model that also adjusted for suicide attempts and mental health, tobacco use disorder, and other substance use disorder diagnoses in the prior year. Crude suicide rates following a new cancer diagnoses were calculated among Veterans with new diagnoses, 2012-2018 (N = 240,410). Rates were assessed up to 84 months following diagnosis. Results: On average, Veteran VHA users were followed for 6.0 years after their first VHA use in 2012-2013 and for 2.7 years following a new cancer diagnosis. Receipt of a new cancer diagnosis corresponded to a 43% (Adjusted Hazard Ratio [AHR] = 1.43, 95% CI: 1.29, 1.58) higher suicide risk, adjusting for covariates. The cancer subtype associated with the highest suicide risk was esophageal cancer (AHR = 5.93, 95% CI: 4.05, 10.51) and other significant subtypes included head and neck (AHR = 3.44, 95% CI: 2.65, 4.46) and lung cancer (AHR = 2.28, 95% CI: 1.79, 2.90). Cancer stages 3 (AHR = 2.29, 95% CI: 1.75, 3.01) and 4 (AHR = 3.45, 95% CI: 2.75, 4.34) at diagnosis were also positively associated with suicide risk. Suicide rates were highest in the first three months following a diagnosis (Rate = 128.3 per 100,000 person-years, 95% CI: 100.4, 161.6) and remained elevated through the first 12 months. Conclusions: Among Veteran VHA users, suicide risk was elevated following a new cancer diagnosis and was especially high in the initial 3 months. Additional screening and suicide prevention efforts may be warranted for VHA Veterans newly diagnosed with cancer, particularly among those diagnosed with esophageal, head and neck, or lung cancer or at stages 3 or 4.

scholarly journals Association between a national primary care pay-for-performance scheme and suicide rates in England: spatial cohort study

2018 ◽  
Vol 213 (4) ◽  
pp. 600-608
Author(s):  
Christos Grigoroglou ◽  
Luke Munford ◽  
Roger T. Webb ◽  
Nav Kapur ◽  
Tim Doran ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Quality Of Care ◽  
Suicide Prevention ◽  
Suicide Risk ◽  
Pay For Performance ◽  
Social Fragmentation ◽  
Practice Performance ◽  
The Relationship

BackgroundPay-for-performance policies aim to improve population health by incentivising improvements in quality of care.AimsTo assess the relationship between general practice performance on severe mental illness (SMI) and depression indicators under a national incentivisation scheme and suicide risk in England for the period 2006–2014.MethodLongitudinal spatial analysis for 32 844 small-area geographical units (lower super output areas, LSOAs), using population-structure adjusted numbers of suicide as the outcome variable. Negative binomial models were fitted to investigate the relationship between spatially estimated recorded quality of care and suicide risk at the LSOA level. Incidence rate ratios (IRRs) were adjusted for deprivation, social fragmentation, prevalence of depression and SMI as well as other 2011 Census variables.ResultsNo association was found between practice performance on the mental health indicators and suicide incidence in practice localities (IRR=1.000, 95% CI 0.998–1.002). IRRs indicated elevated suicide risks linked with area-level social fragmentation (1.030; 95% CI 1.027–1.034), deprivation (1.013, 95% CI 1.012–1.014) and rurality (1.059, 95% CI 1.027–1.092).ConclusionsPrimary care has an important role to play in suicide prevention, but we did not observe a link between practices' higher reported quality of care on incentivised mental health activities and lower suicide rates in the local population. It is likely that effective suicide prevention needs a more concerted, multiagency approach. Better training in suicide prevention for general practitioners is also essential. These findings pertain to the UK but have relevance to other countries considering similar programmes.Declaration of interestNone.

scholarly journals Implementing eScreening for suicide prevention in VA post-9/11 transition programs using a stepped-wedge, mixed-method, hybrid type-II implementation trial: a study protocol

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
James O. E. Pittman ◽  
Laurie Lindamer ◽  
Niloofar Afari ◽  
Colin Depp ◽  
Miguel Villodas ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Suicide Prevention ◽  
Mixed Method ◽  
Suicide Risk ◽  
Type Ii ◽  
Stepped Wedge ◽  
Hybrid Type ◽  
The Impact ◽  
Implementation Trial

Abstract Background Post-9/11 veterans who enroll in VA health care frequently present with suicidal ideation and/or recent suicidal behavior. Most of these veterans are not screened on their day of enrollment and their risk goes undetected. Screening for suicide risk, and associated mental health factors, can lead to early detection and referral to effective treatment, thereby decreasing suicide risk. eScreening is an innovative Gold Standard Practice with evidence to support its effectiveness and implementation potential in transition and care management (TCM) programs. We will evaluate the impact of eScreening to improve the rate and speed of suicide risk screening and referral to mental health care compared to current screening methods used by transition care managers. We will also evaluate the impact of an innovative, multicomponent implementation strategy (MCIS) on the reach, adoption, implementation, and sustained use of eScreening. Methods This is an eight-site 4-year, stepped-wedge, mixed-method, hybrid type-II implementation trial comparing eScreening to screening as usual while also evaluating the potential impact of the MCIS focusing on external facilitation and Lean/SixSigma rapid process improvement workshops in TCM. The aims will address: 1) whether using eScreening compared to oral and/or paper-based methods in TCM programs is associated with improved rates and speed of PTSD, depression, alcohol, and suicide screening & evaluation, and increased referral to mental health treatment; 2) whether and to what degree our MCIS is feasible, acceptable, and has the potential to impact adoption, implementation, and maintenance of eScreening; and 3) how contextual factors influence the implementation of eScreening between high- and low-eScreening adopting sites. We will use a mixed methods approach guided by the RE-AIM outcomes of the Practical Robust Implementation and Sustainability Model (PRISM). Data to address Aim 1 will be collected via medical record query while data for Aims 2 and 3 will be collected from TCM staff questionnaires and qualitative interviews. Discussion The results of this study will help identify best practices for screening in suicide prevention for Post-9/11 veterans enrolling in VA health care and will provide information on how best to implement technology-based screening into real-world clinical care programs. Trial registration ClinicalTrials.gov: NCT04506164; date registered: August 20, 2020; retrospectively registered

Practitioner Experiences Responding to Suicide Risk for Survivors of Human Trafficking in the Philippines

2021 ◽  
pp. 104973232110628
Author(s):  
Laura Cordisco Tsai ◽  
Catherine Carlson ◽  
Rhea Baylosis ◽  
Elizabeth Hentschel ◽  
Terriann Nicholson ◽  
...  
Keyword(s):  
Mental Health ◽  
Human Trafficking ◽  
Suicide Prevention ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Suicide Risk ◽  
Service Providers ◽  
The Philippines ◽  
Culturally Adapted ◽  
Prevention Interventions

Human trafficking survivors experience elevated suicide risk in comparison to the general population. Anti-trafficking service providers in the Philippines have identified capacity building in suicide prevention as a critical priority given the insufficient number of trained mental health professionals and lack of culturally adapted evidence-based interventions in the Philippines. We conducted a focused ethnography exploring the experiences of non-mental health professionals working in the anti-human trafficking sector in the Philippines in responding to suicidality among survivors of human trafficking ( n = 20). Themes included: emotional burden on service providers, manifestations of stigma regarding suicide, lack of clarity regarding risk assessment, lack of mental health services and support systems, transferring responsibility to other providers, and the need for training, supervision, and organizational systems. We discuss implications for training service providers in the anti-human trafficking sector, as well as cultural adaptation of suicide prevention interventions with human trafficking survivors in the Philippines.

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