Senior Program Manager MaineHealth Portland, Maine, United States
Abstract : Research Aims
MaineHealth Behavioral Health (MHBH) provides comprehensive mental and behavioral health care services to approximately 50,000 patients annually. As the behavioral health arm of MaineHealth, an integrated healthcare system covering 12 counties in Maine and New Hampshire, MHBH is a leader in suicide prevention. MHBH is on a journey to implement Zero Suicide across the organization. In 2021, the results of a Zero Suicide Workforce Survey identified low self-assessed knowledge and skills to screen for suicide risk among Outpatient clinicians. The MHBH Zero Suicide Champions Committee completed a multi-faceted project to increase suicide risk screening competence among Outpatient clinicians.
Methods
In 2021, all MHBH employees were invited to complete a Zero Suicide Workforce Survey to establish a baseline of staff readiness for Zero Suicide implementation. Results showed that only 30% of Outpatient staff responsible for suicide screening strongly agreed to having the knowledge and skills to screen for suicide risk, as compared to 47% of Inpatient staff. The Zero Suicide Champions Committee identified Outpatient staff as an opportunity for improvement in training and workflows for suicide screening. A sub-committee formed to focus on the suicide screening project, with a goal to develop a clinical pathway for outpatient behavioral health suicide screening.
Approximately 5 years prior to the project start, MaineHealth Behavioral Health selected the C-SSRS as its standard suicide screening tool. The Zero Suicide Champions sub-committee identified that there had been limited training and operational support for staff to use the tool. Early sub-committee activities included organizing initial training for 100% of Outpatient clinicians and psychiatrists on the C-SSRS tool and adding C-SSRS training to annual recertification modules. The group identified a need to build the C-SSRS tool in the electronic health record. The IT component of the project was the most significant, requiring 14 months of collaboration between Epic builders, clinical leaders, and frontline staff from each department that would be using the tool. The subcommittee and representatives from each Outpatient department wrote clinical pathways tailored to the level of clinical expertise and responsibility of the staff administering the C-SSRS. Each pathway defined the action steps a staff should take for each C-SSRS risk level.
In conjunction with the rollout of suicide screening project, the SAFE-T suicide assessment was selected as the organizational standard suicide assessment and risk stratification tool. Clinicians received training on using the SAFE-T and the pre-existing suicide assessment workflow. This empowered providers to move to the next step in the suicide care pathway if a patient screened positive for suicide risk on the C-SSRS tool.
Results
In 2024, the Zero Suicide Workforce Survey was readministered. Results showed that 50% of Outpatient staff responsible for suicide screening strongly agreed to having the knowledge and skills to screen for suicide risk, representing a 20 percentage-point increase over 3 years. Comparatively, 46% of Inpatient staff strongly agreed, representing little to no change over the same time period.
Conclusion
The Zero Suicide Champions Committee project achieved its goal to significantly increase self-assessed knowledge and skills among Outpatient staff. This improvement demonstrates that projects with a defined focus, multi-pronged approaches, and engagement from all departments affected can significantly advance staff skillsets in suicide care. The Inpatient staff serve as a comparator group: where there was no focused training and workflow development, there was no change in knowledge and skills.
MaineHealth Behavioral Health and its Zero Suicide Champions Committee are replicating the project approach to roll out training and workflows for all Outpatient non-clinical staff to recognize suicide warning signs and connect patients to clinical care. Learning Objectives At the conclusion of this presentation, the participant should be able to: 1. List the steps to successfully roll out an evidence-based suicide screening practice to a large behavioral healthcare organization. 2. Identify barriers and facilitators to implementing an evidence-based suicide screening practice. 3. Describe how the Zero Suicide Champions Committee Suicide Screening project approach can be applied for other types of suicide care projects.
