BACKGROUND/RATIONALE:
Suicide is the number one sentinel event reported to the Joint Commission on Accredited Health Organizations. In recent years, suicide prevention has received increased focus within the VA. This is in part, related to concerns regarding the mental health and associated suicide risk of OEF/OIF military personnel, and a recent study highlighting the increased risk of death by suicide for members of the Veteran population. A number of initiatives have been mandated and implemented by the VA with the goal of averting Veteran suicides. Ultimately, all of these efforts could be enhanced if a clinically feasible uniform language regarding self-directed violence (SDV) was readily available and adopted throughout the VA system. The VISN 19 MIRECC staff joined efforts with the Centers for Disease Control and Prevention (CDC) to finalize the Self-Directed Violence Classification System (SDVCS). The SDVCS is a taxonomy of terms and corresponding definitions for thoughts and behaviors related to suicidal and non-suicidal SDV. Data regarding implementation (feasibility and acceptability) of the SDVCS and Clinical Tool (CT) were collected as part of this VISN 19 MIRECC Rapid Response Project.

OBJECTIVE(S):
The aims of this investigation were as follows: (1) to implement the VISN 19 MIRECC training program for the SDVCS and CT in two clinical settings; (2) to evaluate organizational- and provider-level factors associated with implementation, including barriers and facilitators to change, and the feasibility of a QUERI Service Directed Project (SDP); and (3) to analyze the programmatic impact on health care system processes in the areas of suicide risk assessment and clinical decision making.

METHODS:
Implementation procedures were initiated at two VAMCs. This included initial focus groups with Mental Health (MH) leadership, formalized trainings for MH leadership and MH clinicians, follow-up focus groups and quality improvement surveys at 1- and 6-months post-training, and a review of participating clinicians' chart notes to evaluate term usage. Sixty-nine mental health professionals attended the formalized training, 43 at the urban site and 26 at the more rural site. Data was extracted from 39,298 electronic medical records.

FINDINGS/RESULTS:
Initial findings regarding post-test results suggested that individuals had difficulty utilizing novel terms. At the same time, feedback from the initial survey suggested that the CT and SDVCS were generally acceptable to clinicians. Qualitative data also indicated that the tools (CT and SDVCS) were acceptable and that barriers to implementation exist. Extensive chart review revealed highly limited adoption of the SDVCS terms. Within these records, nomenclature terms (exact match other than "suicide") were identified in less than thirty instances. Limited use of terms prohibited analysis to inform programmatic impact on health care system processes in the areas of suicide risk assessment and clinical decision-making.

IMPACT:
Overall, further effort, including a national strategy, may be required to implement the SDVCS.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Brenner LA, Breshears RE, Betthauser LM, Bellon KK, Holman E, Harwood JE, Silverman MM, Huggins J, Nagamoto HT. Implementation of a suicide nomenclature within two VA healthcare settings. Journal of Clinical Psychology in Medical Settings. 2011 Jun 1; 18(2):116-28. [view]

DRA: Mental, Cognitive and Behavioral Disorders
DRE: Diagnosis, Prevention
Keywords: Mental Health Care, Prevention, Risk factors
MeSH Terms: none