Abstract
Abstract.Background: In 2008, the Veterans Health Administration (VHA) implemented the use of safety planning for suicide prevention. A safety plan is a list of strategies, developed collaboratively with a provider, for a patient to use when suicide risk is elevated. Despite the use of safety plans in VHA, little is known about implementation fidelity, the extent to which safety plans are delivered as intended, or patient-level outcomes of safety planning. Aims: This study aimed to explore the implementation fidelity of safety planning in a regional VHA hospital and examine the associations between safety plan quality and completeness with patient outcomes. Method: A comprehensive chart review was conducted for patients who were flagged as high risk for suicide (N = 200). Completeness and quality were coded, as well as information about patient and provider interactions regarding safety plan use. Results: Safety plans were mostly complete and of moderate quality, although variability existed, particularly in quality. Limited evidence of follow-up regarding safety planning was found in the medical charts. Higher quality was associated with fewer subsequent psychiatric hospitalizations. Conclusion: Variability in implementation fidelity and infrequent follow-up suggest a need for additional training and support regarding the use of safety plans for suicide prevention.
References
2007). A conceptual framework for implementation fidelity. Implementation Science, 2(40), 1–9.
(2001). Self-harm behavior and no-suicide contracting in psychiatric inpatient settings. Archives of Psychiatric Nursing, 15(3), 99–106. 10.1053/apnu.2001.23748
(1999). The temporal relation of adherence and alliance to symptom change in cognitive therapy for depression. Journal of Consulting and Clinical Psychology, 67(4), 578.
(2003). The "suicide-prevention contract": A dangerous myth. Psychiatric News, 38(14), 3.
(2005). Suicide prevention strategies: A systematic review. Journal of the American Medical Association, 294(16), 2064–2074. 10.1001/jama.294.16.2064
(2009). Suicide mortality among patients receiving care in the Veterans Health Administration System. American Journal of Epidemiology, 169(8), 1033–1038. 10.1093/aje/kwp010
(1998). Talisman or taboo: The controversy of the suicide-prevention contract. Harvard Review of Psychiatry, 6(2), 78–87.
(2009). Implementation research in mental health services: An emerging science with conceptual, methodological, and training challenges. Administration and Policy in Mental Health and Mental Health Services Research, 36(1), 24–34.
(2002). No-suicide contracts: An overview and recommendations. Death Studies, 26(1), 51–74.
(2011). Toward the effective and efficient measurement of implementation fidelity. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 32–43.
(1999). The suicide prevention contract: Clinical, legal, and risk management issues. Journal of the American Academy of Psychiatry and the Law Online, 27(3), 445–450.
(2008). Safety plan treatment manual to reduce suicide risk: Veteran version. Washington, DC: United States Department of Veteran Affairs.
(2010). The process of change in cognitive therapy for depression: Predictors of early inter-session symptom gains. Behaviour Research and Therapy, 48(7), 599–606.
(2001). The no-suicide contract: Possibilities and pitfalls. American Journal of Psychotherapy, 55(3), 414–419.
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