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Clinical Trial
. 2021 Jan:100:106224.
doi: 10.1016/j.cct.2020.106224. Epub 2020 Nov 18.

Zero suicide implementation-effectiveness trial study protocol in outpatient behavioral health using the A-I-M suicide prevention model

Barbara Stanley  1 , Christa D Labouliere  2 , Gregory K Brown  3 , Kelly L Green  3 , Hanga C Galfalvy  2 , Molly T Finnerty  4 , Prabu Vasan  4 , Anni Kramer Cummings  4 , Milton Wainberg  2 , Jay W Carruthers  4 , Lisa B Dixon  2
Affiliations
Clinical Trial

Zero suicide implementation-effectiveness trial study protocol in outpatient behavioral health using the A-I-M suicide prevention model

Barbara Stanley et al. Contemp Clin Trials. 2021 Jan.

Abstract

Background: The treatment of suicidal patients often suffers owing to a lack of integrated care and standardized approaches for identifying and reducing risk. The National Strategy for Suicide Prevention endorsed the Zero Suicide (ZS) model, a multi-component, system-wide approach to identify, engage, and treat suicidal patients. The ZS model is a framework for suicide prevention in healthcare systems with the aspirational goal of eliminating suicide in healthcare. While the approach is widely endorsed, it has yet to be evaluated in a systematic manner. This trial evaluates two ZS implementation strategies statewide in specialty mental health clinics.

Methods/study design: This trial is the first large-scale implementation of the ZS model in mental health clinics using the Assess, Intervene, and Monitor for Suicide Prevention (A-I-M) clinical model. Using a hybrid effectiveness-implementation type 1 design, we are testing the effectiveness of ZS implementation in 186 mental health clinics in 95 agencies in New York State. Agencies are randomly assigned to either: "Basic Implementation" (BI; a large group didactic learning collaboratives) or "Enhanced Implementation" (EI; participatory small group learning collaboratives; enhanced consultation for site champions). Primary outcomes include suicidal behaviors, hospitalizations and Emergency Department visits; implementation outcomes include protocol adoption, protocol fidelity and barriers/facilitators to implementation.

Discussion: This project has the potential to have a significant public health impact by determining the effectiveness of the ZS model in mental health clinics, a setting where suicide attempts and suicides occur at a higher rate than any other healthcare setting. It will also provide guidance on the implementation level required to achieve uptake and sustainability of ZS.

Trial registration: N/A.

Keywords: Effectiveness; Hybrid trial; Implementation; Learning collaborative; Outpatient mental health; Suicide prevention; Zero Suicide.

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Conflict of interest statement

Competing Interests

The authors declare that they have no competing interests. Drs. Brown and Stanley receive royalties for the commercial use of the C-SSRS from the Research Foundation for Mental Hygiene, Inc.

Figures

Figure 1.
Figure 1.
Clinical procedures for the Assess, Intervene, and Monitor for Suicide Prevention (AI-M) model.
Figure 2.
Figure 2.
The Precede-Proceed model applied to Zero Suicide implementation using the Assess, Intervene, and Monitor for Suicide Prevention (A-I-M) model.
Figure 3.
Figure 3.
ZS study flow chart
See this image and copyright information in PMC

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