1. Phase 3: Intervention Site Training
Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE)
Phase 3: Intervention
Site Training 1

2. Outline of Presentation
Overview
New information for Phase 3
Changes in REDCap databases
Reminders

3. Outline of Presentation
Overview
New information for Phase 3
Changes in REDCap databases
Reminders

4. Overview In all phases: Similar to Phase 2, for Phase 3:
Patient enrollment in ED
5 follow-up phone calls
Similar to Phase 2, for Phase 3:
Staff KAP survey administered 3 months after the start of the phase
Chart reviews of randomly selected patients performed after the phase is complete
Expect that site enrollment goals will be met more quickly
Fidelity interviews of 60 randomly selected ED patients with no documentation of SI/SA in past week
First 2 weeks and last 2 weeks of the phase
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5. Site Enrollment Goal 60 subjects
30 subjects with suicidal ideation only in past week
30 subjects with suicidal attempt in past week
60 / 26 weeks = 2.3 / week
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6. In All Phases…
RAs will screen ED documentation (charts, electronic information systems) in “real time” to identify patients
RAs will further screen anyone with evidence of any intentional self-harm ideation or behavior in the past week, including the current visit
 Reminder: Administer eligibility screening questions even though questions about SI and SA have already been asked by clinical staff.
This will involve asking the clinicians for permission to approach the patient
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7. In All Phases…
While clinical staff’s cooperation is vital, we do not want to introduce treatment contamination
Emphasize that we don’t want clinical staff to do anything different than they ordinarily would
The clinical staff should not be told to let the RAs know when a suicidal patient is present (i.e., referral)
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8. Outline of Presentation
Phase overview
New information for Phase 3
Changes in REDCap databases
Reminders

9. New information for Phase 3
Subject ID numbers start in the 300s
(3-digit site # + sequential # starting with 301)
Example 
Subject ID for 3rd subject enrolled at site 600 =
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10. New for Phase 3 (cont’d) Use the Phase 3-specific consent form
Collect data on “incidental detections” in screening log (see Changes in REDCap databases)
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11. New for Phase 3 (cont’d)
The intervention for Phase 3 is called the Safety Assessment and Follow-up Telephone Intervention (SAFTI)
Purpose: to ensure that patients at-risk for suicide leave the care of the hospital with suicide prevention information
Discharge nurse will ensure that patient receives safety plan and community resource sheet
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12. New for Phase 3 (cont’d) Subject Interview
Same as Phases 1 and 2: Subjects enrolled will complete follow-up assessments at 6, 12, 24, 36, and 52-weeks following baseline enrollment
New for Phase 3: Subjects will receive up to 7 Advising Calls (previously labeled intervention counseling calls). In addition, if subject agrees, a significant other (chosen by the subject) also will receive up to 4 advising calls.
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13. New for Phase 3 (cont’d) Advising Calls
Based on an integration of case-management, cognitive-behavioral and family/significant other interventions.
To subject: 1, 2, 4, 10, 22, 34, and 48 weeks following enrollment
To significant other: 3, 8, 20, and 32 weeks following enrollment
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14. New for Phase 3 (cont’d) Advising Calls to Subject
Evaluate subject’s current status (e.g., suicide risk)
Review/evaluate safety plan
Assess potential suicide risk factors
Discuss potential solutions to identified issues/risk factors (problem solving)
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15. New for Phase 3 (cont’d) Advising Calls to Significant Other (SO)
Review SO’s concerns regarding subject
Brief psychoeducation regarding suicide and risk factors
Review of safety plan
Discuss problem solving techniques for dealing with identified issues/risk factors
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16. New for Phase 3 (cont’d) Subject Interview
Make sure to emphasize that it is up to 7 advising calls – this number is flexible depending on the needs/requests of the subject.
Avoid focusing on the calls being a certain length (e.g., 15 minutes), simply emphasize that the advising calls will be brief and that the subject will have control over the call length.
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17. New for Phase 3 (cont’d) Subject Interview
Subjects are NOT compensated for the advising calls
Advising calls are NOT counseling
Script for Phase 3 enrollment
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18. Outline of Presentation
Overview
New information for Phase 3
Changes in REDCap databases
Reminders

19. REDCap Screening Logs No change in the way data are entered
However, enter Phase 3 data into Phase 3-specific database
New for Phase 3: Questions for identifying “incidental detection” cases. These cases are patients who present to the ED with non-psychiatric complaints, but screen positive for recent SI or SA on the Patient Safety Screener (PSS).
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20. REDCap Screening Logs
New Question #1: Visit related to psychiatric complaint? (Yes/No)
Yes = Patient has documentation from ED visit that one of the reasons for visit was a psych-related issue (e.g., suicidal thoughts/behavior, depression, alcohol intoxication, substance withdrawal, accidental overdose)
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21. REDCap Screening Logs New Questions #2-4 (in yellow):
Any documented thoughts or behaviors related to intentional self-harm, including suicidal and non-suicidal, on patient chart?
Yes, past self-harm ideation/behavior only (patient screened and endorsed self-harm ideation/behavior in past, but not currently)
Yes, current self-harm (patient screened and endorsed self-harm ideation/behavior currently)
Was this self-harm ideation/behavior documented in the Patient Safety Screener? No
Yes
Did the patient report that over the past 2 weeks, he/she had thoughts of killing him/herself? (Yes/No)
Did the patient report attempting to kill him/herself <6 months before the current ED visit? (Yes/No)
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22. REDCap Shift Summary No change to Shift Screening Summary Database
Enter Phase 3 data into existing database
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23. Longitudinal Database
No change to the Longitudinal Database
Enter Phase 3 data into existing database
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24. Chart Review Database No change to chart review form/ functionality
However, enter Phase 3 data into Phase 3-specific database
No change in the way data are entered
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25. REDCap Fidelity Interview
No change in Fidelity Interview database
Enter Phase 3 data into existing database
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26. Outline of Presentation
Overview
New information for Phase 3
Changes in REDCap databases
Reminders

27. Case Identification
Do not use documentation of self-harm ideation/behavior from the patient’s medical history
Only patients who endorse past/present self-harm ideation/behavior during the current visit should be approached (if all other eligibility criteria are met)
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28. Case Identification
If chart or MD identifies transient exclusion criteria (e.g., intoxication) the patient should be “pending” or “warm” and approached later
Pending patients should be “resolved” at the end of every shift
Stable exclusion criteria
Left ED before RA approach
End of RA shift
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29. Eligibility
Some may be eligible and interested, but the time may not be opportune (e.g., too distracted to participate during ED visit, busy with tests, being transferred to inpatient setting)
May consent admitted or “boarded” patient within 48 hours of ED discharge
“Warm” transfer
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30. Screening Log
Review all documentation available in the ED for the current ED visit
At minimum, review the triage nursing notes (if patient presents with SI/SA/other self-harm
Stop the review once you identify any self-harm and approach the patient
When possible, review charts in order, but do not miss people with SI/SA
If opportunity presents itself, enroll an attempter over an ideator
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31. Eligibility Considerations
Ask to speak one-on-one with the patient if others are in the room
Ask about self-harm and suicidal behavior even if the patient does not report self-harm or suicidal ideation
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32. Eligibility Screening
Self-harm and suicidal behavior and ideation
Thoughts of self-harm in past week
Thoughts of ending life in past week
Tried to hurt self in past week
Tried to kill self in past week
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33. Wallet Card
All patients approached – regardless of whether or not they are enrolled – receive a wallet card with a national hotline phone # and safety plan tips
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34. Patient Resources
Give all patients who decline to participate or meet exclusion criteria site-specific resources used by the ED for patients with psychiatric issues
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35. Baseline Assessment General Concepts
If a patient refuses to answer a question, leave it blank in REDCap
For questions that ask for exact numbers (e.g., # of suicide attempts) enter whole numbers. If a subject gives a range, take the average.
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36. Baseline Assessment (cont'd)
May be completed after the subject leaves the ED if the subject:
already signed the written consent form
is willing to finish the assessment in person or by phone within 48 hours
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37. Brochure
All patients enrolled also receive a brochure that describes the study and expectations of participants.
Enrolled subjects do NOT receive the list of patient resources.
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38. Chart Review In each phase, 2 groups have chart reviews:
Enrolled subjects (performed after index ED visit)
Randomly selected ED patients from the period in which the site enrolled patients
Note: For TAU, the retro chart review served as #2. For Phases 2 and 3, the chart review will be done after patient enrollment is complete.
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39. Chart Review (cont’d) Same form for all ED chart reviews
Use any documentation that occurred while the patient was in the ED
If a patient has both a current and past history of an item, document the most recent time period in which the indicator was present
We will contact you at the end of Phase 3 to discuss random selection of charts
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40. REDCap Password Reset
Need to reset your password if you haven’t logged into REDCap in the last 30 days
Complete this form to reset your password
On form, enter “Mardi Coleman” as study coordinator
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41. Questions?
REDCap inquiries: Mardi Coleman
General ED-SAFE or AE inquiries: Sarah Ting
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