Presentation is loading. Please wait.

Presentation is loading. Please wait.

A Comprehensive Approach to Suicide Risk Management in Behavioral Healthcare Settings Paul A. LeBuffe Devereux Center for Resilient Children.

Similar presentations

Presentation on theme: "A Comprehensive Approach to Suicide Risk Management in Behavioral Healthcare Settings Paul A. LeBuffe Devereux Center for Resilient Children."— Presentation transcript:

1 A Comprehensive Approach to Suicide Risk Management in Behavioral Healthcare Settings Paul A. LeBuffe Devereux Center for Resilient Children

2 Suicide & Behavioral Health Providers  Suicidal ideation/behavior is the most common reason for adult psychiatric admissions  15-20% of completers die while in treatment  Of inpatient suicides, 1/3 occur in hospital, 1/3 on pass, 1/3 on AWOL status  High incidence of suicide at admission, near discharge and within the first 3 months post-discharge  Comprise 13% of sentinel events reviewed by JCAHO

3 Consequences of Patient Suicide  Worst possible outcome for the patient  Tragedy for family  Increased risk for family, other patients & staff  Suicide clusters  25% of psychologists; 50% of psychiatrists lose a patient to suicide  Possible career or agency ending event  Possible malpractice exposure  Negative public relations

4 Malpractice  Suicide malpractice is the #1 cause of suits against all mental health practitioners  Few graduate programs in behavioral health disciplines provide explicit training in suicide assessment & management  Duty to protect ensure that resources are used for treatment  Type III error

5 Goals of Suicide Risk Reduction Program (SRRP)  Reduce the incidence of patient suicides & life- threatening attempts  Manage suicidal crises in a way that reduces the risk of a suicide cluster  Protect agency against unnecessary lawsuits  In the event of a suicide - provide assurance to staff that they exceeded the community standard of care

6  Train all staff in suicide prevention  Train all clinicians in suicide risk assessment  Assess all clients for suicide risk  Develop suicide-specific crisis response plans for each program Four Components of a SRRP

7 Component 1 –Train all Staff in Suicide Prevention  Gatekeeper training model  Endorsed by the Surgeon General  Train all staff  Selected the Question, Persuade, Refer (QPR) Program  Subject of an NIMH-funded randomized clinical trial  Recognized by Joint Commission as a best practice  Received the Negley Award  Developed by Paul Quinnett, QPR Institute, Spokane, WA

8  60 to 90-minute training  Designed to:  raise awareness  dispel myths & misconceptions  teach warning signs  teach 3 skills to avert suicide  Goal is to have staff escort client to clinician for evaluation Component 1 –Train all Staff in Suicide Prevention

9 Component 1 - Evaluation Results  Many accompanied referrals  Most, but not all of the time, clinicians knew of elevated risk  Clinicians appreciate additional information  Clinicians report that it sensitizes staff  100% of Devereux centers recommended continuing QPR training

10 Component 2 - Train all Clinicians in Suicide Risk Assessment  Utilize the QPR Institute’s QPRT System  Mandated of all clinicians  8 hour training program  Competency based  Post-test of knowledge  Skill demonstration  In the classroom (role plays)  In vivo

11 Results: Component 2 (Cumulative)

12 Component 2 – The QPRT  Structured interview format  Essential components  Assess suicidal thoughts and plans  Assess risk and protective factors  Assess willingness to commit to a safety plan  Outcome – assign a risk level with associated treatment intents  Justify decision  Consult  Document

13 Component 2- Evaluation Results  General Satisfaction – 43% “very valuable”  Advantages  Systematic approach – useful especially with new clinicians  Provides good documentation  Requires justification for risk & monitoring  However, needed revisions and adaptations to Devereux populations and programs  100% recommended continuing with revised QPRT

14 Component 3 - Formally Assess all Clients for Suicide Risk  At admission  At discharge  Prior to leaves/home visits  At significant transitions during treatment  change in risk factors/protective factors  change in placement/caregivers  Documented in core clinical record

15 QPRT Flow Chart Can client participate in a structured interview? Review history, interview caregivers regarding suicide, etc. Are there self- injurious behaviors present? Conduct FBA- Specific function hypothesized/identified? QPRT-P Chart specific function, and level of suicide risk 2 and treat as indicated Default is to treat behavior as suicidal. Chart level of suicide risk 2 and treat as indicated Chart level of suicide risk 2 and treat as indicated Y N Y Y N N Y Y N Are 1 or more of the 3 indicators present? 1 Y AGE Ages 10-18 Age > 18? Age 10-18? Age <10? Y QPRT

16 Malpractice Issues and Errors Type 1 Error: Failure to detect risk. Type 2 Error: Substandard care or treatment Type 3 Error: Postvention failure

17 Component 4 - Crisis Response Plans  Procedural document that details staff responsibilities in the event of a completed suicide or a life threatening attempt  Rationale  Importance of an “affectively calm” environment  Reduce risk of suicide clusters  Help staff, clients and families cope  Avoid unnecessary litigation

18 Component 4 - Crisis Response Plans  Content  First responder duties  Safety of clients  Needs of unit  Needs of staff  Needs of families  Reporting and documentation requirements  Management of outside contacts  QI and periodic review  Staff must be trained!

19 Evaluation Results Feedback  88% expressed one or more positive statements about the SRRP  Only 37% expressed one or more concerns

20 Evaluation Results  QPR  Clinicians welcome staff monitoring patien  Clinicians welcome staff monitoring patients  High compliance rates  QPRT  Established an attainable, universal “basal level” of suicide risk assessment  Quality and completeness must be monitored  Needed significant modifications (now available from QPR Institute)  Crisis response plans  Have been very effective in crisis management  But staff must be trained

21 Evaluation Results - Concerns   Does not include environmental safety   Training is time consuming – challenges with taking staff out of ratio for training   Challenges with independent contractors   Program fidelity and maintenance   Major risk events monitoring   Peer review   Quality site visits   Needs adaptation for individuals with mental retardation and young children

22 Outcomes and Benefits   QPR heightened staff awareness and increased confidence   QPRT has helped identify clients at risk   Client with autism   Dispelled myths about individuals with MR   Established standard of care   Crisis response plans improved staff response

23 Outcomes and Benefits   Effects on suicide rate.   Had a low base rate to begin with   Significant reduction in completed suicides   Significant reduction in life-threatening attempts   Helped avert at least 5 staff suicides

24 To Reach Me:  Paul LeBuffe: 610-542-3090 Devereux Center for Resilient Children 444 Devereux Drive Villanova, PA 19085

Download ppt "A Comprehensive Approach to Suicide Risk Management in Behavioral Healthcare Settings Paul A. LeBuffe Devereux Center for Resilient Children."

Similar presentations

Ads by Google