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Emergency Departments: A Key Setting for Suicide Prevention

Tuesday, June 16, 2015 - 3:00pm - 4:30pm
EST

With close to 500,000 patients visiting emergency departments (EDs) for self-inflicted injuries each year (NEISS, 2012), EDs have a pivotal role to play in preventing suicide. However, EDs face challenges addressing the needs of suicidal patients due to the fast-paced environment, the complex nature of suicide, stigma, and barriers to accessing follow-up care. This webinar will bring together experts in emergency medicine, emergency psychiatry, and research to describe: the rationale for ED-focused suicide prevention; barriers and solutions to integrating suicide prevention in EDs; and introduce a new guide, Caring for Adult Patients with Suicide Risk: A Consensus Guide for Emergency Departments.

Learning Objectives:

  • Summarize the rationale for emphasizing emergency department settings in suicide prevention efforts
  • Understanding the roles and responsibilities of ED professionals
  • Discuss barriers to implementing suicide prevention strategies and ways to address them
  • Describe a new resource to support implementation of suicide prevention approaches in emergency departments
Event Contact
Lieu Dominique
Presenter(s) 
Dr. Marian (Emmy) Betz, MD, MPH, Assistant Professor, Department of Emergency Medicine, University of Colorado School of Medicine
Leslie S. Zun, MD, MBA, System Chair of the Department of Emergency Medicine, Sinai Health System; Chairman & Professor, Department of Emergency Medicine; Secondary Appointment, Department of Psychiatry at the Rosalind Franklin University of Medicine and Science/Chicago Medical School
Michael H. Allen, MD, Professor of Psychiatry and Emergency Medicine, University of Colorado School of Medicine; Medical Director, Rocky Mountain Crisis Partners
Edwin Boudreaux, PhD, Director of Research, Department of Emergency Medicine, University of Massachusetts Medical School
Moderator 
Lisa Capoccia, MPH, Assistant Manager Clinical Initiatives, Suicide Prevention Resource Center
Presenter Biographies 

Dr. Marian (Emmy) Betz, MD, MPH is a board-certified emergency physician who works clinically at the University of Colorado Hospital Emergency Department (ED) and also conducts research in injury epidemiology and prevention. She is an Assistant Professor of Emergency Medicine at the University of Colorado School of Medicine and an Assistant Professor of Epidemiology at the Colorado School of Public Health. She received her medical degree and Masters in Public Health degree from Johns Hopkins. In 2014, she was selected to serve on the Colorado Suicide Prevention Commission, and she chairs the Commission's committee on emergency services.Dr. Betz's areas of research expertise are "lethal means restriction" (i.e., limiting access to guns and other lethal methods for those who are suicidal) and the care of suicidal patients in EDs. She has worked with various national organizations on issues of suicide prevention, including the Suicide Prevention Resource Center, the American Foundation for Suicide Prevention, and the Injury Control and Emergency Health Services Section of the American Public Health Association. Her research has received funding from the National Institute of Mental Health, the American Foundation for Suicide Prevention, and the Emergency Medicine Foundation, and she has served as Site Principal Investigator for the multi-site ED-SAFE trial. Her prior work has included publications and presentations related to ED provider attitudes towards lethal means restriction for suicide prevention, suicidality among older adults, as well as the epidemiology of suicide by altitude, rural residence, and Hispanic ethnicity. She also conducts research related to geriatric injury prevention and is a current recipient of a Paul Beeson Career Development Award from the National Institute on Aging.

Leslie S. Zun, M.D., M.B.A. is the System Chair of the Department of Emergency Medicine in the Sinai Health System in Chicago, Illinois and Chairman & Professor, Department of Emergency Medicine and a secondary appointment in the Department of Psychiatry at the Rosalind Franklin University of Medicine and Science/Chicago Medical School in North Chicago, Illinois. His background includes a medical degree (M.D.) from Rush Medical College and a business degree (M.B.A.) from Northwestern University's JL Kellogg School of Management. He is board certified in Emergency Medicine by the American Board of Emergency Medicine. Dr. Zun was a chief operating officer and acting chief executive officer for a 200 bed hospital in Chicago. Dr Zun?s research interests include healthcare administration, violence prevention and behavioral emergencies. His publications have addressed the administration of the hospitals and emergency departments, physicians? bonus and incentive plans and quality improvement topics. He has presented his research and lectured on these topics both nationally and internationally. He is a board member of American Academy of Emergency Medicine and the President Elect for the American Association for Emergency Psychiatry. He is the chief editor of the Behavioral Emergencies for Emergency Physicians textbook and course director for the past five years for the National Update on Behavioral Emergencies conference.

Edwin Boudreaux, PhD is a clinical psychologist and Professor of Emergency Medicine, Psychiatry, and Quantitative Health Sciences at the University of Massachusetts Medical School. He is Vice Chair for Research in the Department of Emergency Medicine. He has extensive experience with screening, brief intervention, and referral to treatment (SBIRT) for a range of behavioral health conditions in medical settings, with a particular focus on acute medical settings like the emergency department. Target behaviors include suicide and substance abuse. He brings expertise in Cognitive Behavioral Therapies, Motivational Interviewing, and a variety of strategies designed to improve screening, assessment, and management of suicide risk. A primary focus of his research has been developing and studying a variety of technologies designed to assist with identification and management of behavioral health needs in medical settings and fostering behavior change and connection to outpatient care after an acute medical encounter.

Michael H. Allen, MD hails from the Carolina Low Country and grew up on the Marine bases at Parris Island and Quantico.  He attended Florida State University, received his medical degree from the Medical University of South Carolina and trained in psychiatry at the Institute of Living where he served as chief resident.  He went on to serve on the faculty of Cornell and later New York University School of Medicine.  While at NYU, he developed the model Comprehensive Psychiatric Emergency Program at Bellevue Hospital, mentioned in New York Magazine’s “Best Hospitals in New York.” Currently he is an attending at the Colorado Depression Center, part of the National Network of Depression Center, consultant at the University of Colorado Hospital and medical director of the new Rocky Mountain Crisis Partners. 

Dr. Allen was a principal investigator in the NIMH Systematic Treatment Enhancement Program for Bipolar Disorder, a part of the STEP-BD Suicide Work Group and author of five publications related to suicidal ideation and behavior in STEP-BD.  He developed and validated the Clinical Global Impression Scale for Schizoaffective Disorder.  He has been a principal investigator for many clinical trials and led investigator training at more than 50 meetings in the US, Europe, South America, Russia, India and Asia.  He received a NARSAD Independent Investigator award for the study of nicotine and agitation and was a principal investigator in the testing of inhaled loxapine for agitation.  He was a member the NIH Emergency Medicine Roundtable and an author of their recommendations for emergency services research on suicide, agitation and delirium.  He is now a co-investigator on the NIH Emergency Department Safety Assessment and Follow-up Evaluation study (ED SAFE) and PRISM, a MOMRP study of suicide screening in military primary care settings.      

He has served as president of the American Association and vice president of the International Association for Emergency Psychiatry, chair of the American Psychiatric Association Task Force on Psychiatric Emergency Services, lead expert for the Expert Consensus Guideline for the Management of Behavioral Emergencies, member of the American College of Emergency Physicians clinical policy committee, president of the board of the Carson J Spencer Foundation, and consultant to the US Department of Justice Civil Rights Division.  He has been a panelist for the Expert Consensus Guideline for Bipolar Disorder, the Colorado Clinical Guidelines Collaborative Depression Program, the Colorado Governor’s Advisory Panel on Suicide and the Substance Abuse and Mental Health Services Administration Co-occurring Disorders Guidelines.  He is currently a member of the Am Association of Suicidology Board Development Committee and Nominating Committees, a charter member of the Military Suicide Research Consortium, serves on the steering committee of the National Suicide Prevention Lifeline (800-273-TALK) and is a senior scientific advisor at ProPhase, LLC.  As a grantee of the Colorado Trust, he helped to enact legislation creating the Colorado Suicide Prevention Commission and serves as a Commissioner.   

He is the author or editor of three books, former editor of Emergency Psychiatry, a reviewer for the Cochrane Collaborative and is currently associate editor of General Hospital Psychiatry.  He is board certified in psychiatry with added qualifications in addictions and is a certified suicide prevention gatekeeper instructor.  He is a professor of Psychiatry and Emergency Medicine at the University of Colorado School of Medicine and a Distinguished Fellow of the American Psychiatric Association.

Check-in With You: The Older Adult Hopelessness Screening Program (OAHS)

Setting 
Primary Care
Type of Program 
Guidelines & Protocols
2001 NSSP Goals Addressed 
5.3, 5.4, 9.1 (2012)
Description 

Check-in With You: The Older Adult Hopelessness ScreeningProgram (OAHS), developed by Tulare County Health and Human Services Agency, assesses levels of hopelessness in older adults and provides early intervention services to reduce suicide risk, improve quality of care, and prevent the onset of serious mental illness. All adults 55+ receiving primary health care services are screened for hopelessness and suicidal intent.

Program Description 

Check-in With You: The Older Adult Hopelessness ScreeningProgram (OAHS), developed by Tulare County Health and Human Services Agency, assesses levels of hopelessness in older adults and provides early intervention services to reduce suicide risk, improve quality of care, and prevent the onset of serious mental illness. All adults 55+ receiving primary health care services are screened for hopelessness and suicidal intent. The Beck Hopelessness Scale®is administered before patients’ health appointments. Those who screen as moderate to severe are offered early intervention services. Patients who choose to participate receive ongoing support, mental health case management, short-term intervention, and warm linkages to local services that can help improve social, physical, environmental, emotional, and financial wellness.

Objectives 

Organizations that implement OAHS will:
1. Increase their capacity to identify suicide risk in older adult patients in primary care;
2. Improve their identification of older adults (55+) who are feeling hopeless or may be at risk of suicide;
3. Make more interventions available to older adults identified to be at risk of suicide; and
4. Increase both awareness of mental health and community resources, and access to these resources.

Implementation Essentials 

Primary care settings that use OAHS should have established protocols for managing patients who may be at risk for suicide.

Contact Information 
 
 Christi Lupkes
MHSA Manager, Tulare County Health and Human Services Agency
5957 South Mooney Boulevard
Visalia, CA 93277
(559) 624-8000
clupkes@tularehhsa.org
www.tchhsa.org 
Organization 
Tulare County Health and Human Services Agency
Costs 

Check-in With You: The Older Adult Hopelessness Screening Programis available as a free PDF by contacting Christi Lupkes at clupkes@tularehhsa.org. The Beck Hopelessness Scale manual, forms, and scoring kit are available for purchase from www.beckscales.com.

Responding to grief, trauma, and distress after a suicide: U.S. National guidelines

These guidelines provide a unified, far-reaching blueprint for the development of suicide postvention at all levels of U.S. society. The overarching goal is to reduce the deleterious effects of exposure to suicide and facilitate the process of healing from a suicide loss. The guidelines call for an integrated and compassionate community response to deaths by suicide in every kind of community in the country.

Creator 
Survivors of Suicide Loss Task Force
Publisher 
Action Alliance for Suicide Prevention
Date published 
2015
Full Text Online 
Yes

The war within: Preventing suicide in the U.S. military

This review of the current evidence details suicide epidemiology in the military, identifies “state of the art” suicide prevention programs, describes and catalogs suicide prevention activities in the Department of Defense (DoD) and across each service, and recommends ways to ensure that the activities in the DoD and across each service reflect the best of prevention science. 

Creator 
Ramchand R, Acosta J, Burns RM, Jaycox LH, Pernin CG.
Publisher 
Rand Center for Military Health Policy Research
Contributor 
Office of the Secretary of Defense
Date published 
2011
Full Text Online 
Yes

Building the evaluation capacity of local programs serving American Indian/Alaska Native populations: Lessons learned

This report describes the activities of 34 tribal communities served by CAPT under SAMHSA’s Science to Service Initiative conducted between 2010 and 2014. The locally-developed programs addressed substance abuse and associated factors both causal (primarily historical trauma) and consequential (primarily suicide). The report discusses evaluation processes, results, challenges and barriers to those programs. 

Creator 
Center for the Application of Prevention Technologies (CAPT)
Publisher 
Education Development Center (EDC)
Contributor 
Substance Abuse and Mental Health Services Administration (SAMHSA)
Date published 
2014
Full Text Online 
Yes

National Center for Campus Public Safety

The National Center for Campus Public Safety brings together all forms of campus public safety, professional associations, advocacy organizations, community leaders, and others to improve and expand services to those who are charged with providing a safe environment on the campuses of colleges and universities. It promotes campus public safety efforts and develops comprehensive responses, resources and strategies, as well as delivering training and technical assistance to campus security teams, student affairs professionals and key stakeholders. 

Creator 
Margolis Healy & Associates, LLC.
Publisher 
Incubox
Full Text Online 
Yes

Opioid overdose toolkit

This toolkit equips communities and local governments with material to develop policies and practices to help prevent opioid-related overdoses and deaths. It addresses issues for first responders, treatment providers, and those recovering from opioid overdose.

Creator 
Center for Substance Abuse Treatment (CSAT)
Publisher 
Substance Abuse and Mental Health Services Administration (SAMHSA)
Date published 
2014
Full Text Online 
Yes

Towards evidence-based suicide prevention programmes

This monograph attempts to set out the basic framework for suicide prevention strategies. It provides details in formulating and evaluating suicide prevention programs. The public health approaches suggested offer a multilayer intervention model, which has been adopted by a number of developed countries for setting up national prevention strategies. However, there is no single solution in dealing with suicide in a heterogeneous environment. Suicide prevention programs need to be evaluated. Where there is not necessary evidence, novel approaches must be simultaneously implemented and rigorously evaluated.

Creator 
World Health Organization (WHO)
Publisher 
World Health Organization (WHO)
Date published 
2010
Full Text Online 
Yes

CDC Office of the Associate Director for Policy

This portal provides information concerning effective prevention and public health policies and interventions, as well as the use of credible evidence of prevention’s impact by policy makers, health care and the business community. It links to the CDC Health Policy Series, a collection of policy briefs designed to provide practical guidance to state and local public health practitioners, highlighting specific opportunities for public health to engage with health care to improve population health. The CDC Policy Process provides a framework which includes domains from problem identification through evaluation.

Creator 
Centers for Disease Control and Prevention (CDC)
Publisher 
Centers for Disease Control and Prevention (CDC)
Full Text Online 
Yes

Suicide risk in adolescents, adults and older adults: Screening

The Task Force concluded that although there was some evidence of effectiveness that screening may detect risk of suicide especially in adults, the evidence is insufficient at this time to recommend screening in primary care. It was noted that psychotherapy may prevent suicide attempts in some high-risk adults, but effective interventions for high-risk adolescents have not yet been proven. This statement updates an earlier statement published in 2004. This page links to the full set of recommendations and summaries.

Creator 
U.S. Preventive Services Task Force
Publisher 
Agency for Healthcare Research and Quality (AHRQ)
Date published 
2014
Full Text Online 
Yes
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