A Health System/Community Partnership for Enhanced Outreach to Prevent Suicide Attempts

Massachusetts General Hospital, Boston MA

Investigators

Linked publications, trials & patents

Abstract

The period after discharge from an emergency department (ED) represents a critical time of increased risk for suicide and related behavior (SRB). Brief “caring contact” interventions that provide follow-up and support after a healthcare visit have been shown to reduce SRB and are now recommended best practices for suicide prevention in healthcare systems. However, the optimal structure of outreach remains unknown and system- and individual-level barriers to implementation exist. For example, deployment of brief contact interventions within an existing system requires system-level shifts, such as dedicated resources and staffing within already overburdened healthcare settings, and even single-session interventions require robust provider training and adoption for successful implementation. We propose an effectiveness-implementation Hybrid Type I randomized trial to evaluate a recently developed Enhanced Outreach Intervention (EOI) for post-ED discharge that combines multiple evidence-based suicide prevention components and is delivered through a partnership between MGB and a volunteer organization (Samaritans) that specializes in crisis services. Combining multiple evidence-based interventions (e.g., caring outreach, safety planning) has the potential to increase effectiveness over usual practices and partnering with a national, community organization vastly increases the generalizability and scalability of this approach. This proposal leverages our existing automated suicide risk algorithm to identify patients at the higher end of the risk distribution for the EOI, thus increasing power to observe intervention effects on SRB. Our specific aims are to: 1) Pilot test the implementation of the EOI for post-ED discharge prevention of SRB, delivered through an MGB-Samaritans partnership. We will develop operational workflows for using our suicide risk algorithm to identify patients for EOI, conduct a small open pilot (N=20), and assess the individual- and system-level barriers and facilitators, and feasibility, acceptability, and fidelity of implementing the EOI at an academic medical setting through mixed methods to inform intervention refinement; 2) Conduct a Hybrid Type randomized I trial (N=300) of the EOI vs. care as usual after ED discharge to test effectiveness (including impact on reduction of suicide attempts over 3 months) and explore implementation-related factors. Participants will be individuals drawn from the Signature Project (SIG) and stratified to the top 50% of predicted suicide risk via our automated suicide risk algorithm; 3) Explore moderators of intervention effects. Potential moderators of intervention effects will include, age, sex, race/ethnicity, and predicted risk stratum. These analyses can inform future efforts to optimize intervention matching for individual patients. This project will evaluate the feasibility, acceptability, and effectiveness of a scalable health system/community partnership for the prevention of suicide among high-risk patients in the acute aftermath of ED visits.