(PS6-96) Adapting Suicide Prevention Services for Primary Care: Feedback from Primary Care Stakeholders and Lessons Learned

Abstract Text: Suicide is a leading cause of death among 10-to-24-year-olds in the United States, and suicidal thoughts and behaviors (STB) in adolescents are prevalent and increase risk of death by suicide. Nearly half of youth who die by suicide contact a primary care (PC) clinician within one month prior to suicide, making PC a clear target for preventing youth suicide. Unfortunately, many PC providers are reluctant to manage STB, and many youth with any STB are sent to the Emergency Department (ED). While EDs are an important resource, EDs are often poorly equipped to handle mental health and many youth with STBs are discharged with few mental health supports.

The current project was designed to gather PC stakeholder feedback from PC staff, 13–17-year-old adolescents, and caregivers through conducting needs assessments and subsequent user testing with an intervention and workflow prototype to inform requirements for adapting suicide prevention services to fit with both provider and patient needs in a PC setting.

 

Qualitative thematic analysis was used to identify common themes from needs assessments and user testing sessions. Themes were used to inform initial program and training requirements and highlighted unique limitations seen in PC settings including time limitations, lack of training in suicide prevention, and need for team-based approaches, streamlined pathways for moderate and moderate/high risk youth, and need for integration of screening and intervention components into electronic health systems and existing workflows. Needs assessments with adolescent and caregivers further informed program needs including preferred communication methods and content regarding suicide risk and care, how adolescents and caregivers want caregivers included in intervention, and what content and psychoeducation caregivers want to be provided.

 

Additionally, several program and training needs were later identified through quality improvement activities that were not initially identified in needs assessments. These include the importance of in person (versus asynchronous or video call based) trainings, and need for repeated and ongoing clinical and implementation training and support during intervention roll out to address provider questions and concerns in real time. Once implementing the workflow, PC staff identified additional patient needs, such as streamlining intervention and support for low acuity youth. Thus, ongoing assessment and check-ins with clinicians are needed to ensure fit when partnering with PC.  

 

Ultimately, implementing suicide prevention pathways in PC represents a key avenue to enhancing youth mental health and addressing the rising rates of suicide. The current project highlights the importance of ongoing partnership with stakeholders to inform and optimize a suicide care program for youth seen in PC to expand access to services. Maintaining a flexible approach to tailor pathways and implementation plans was also imperative to enhance program fit and to address practice needs. This presentation will further describe themes identified and lessons learned from our team in the adaptation and implementation of suicide care programming for youth in a local PC health system.