(PS5-20) Implementation leadership, but not implementation climate or clinician intentions, predicts clinician referral to evidence-based suicide prevention services

Abstract Text:

Background: Emergency departments (EDs) are a critical point of healthcare contact for individuals at risk for suicide, and, notably, risk of suicide death is markedly high after discharge from the ED. Brief, evidence-based interventions during and following ED admissions for suicide risk can prevent suicidal behavior and increase engagement in mental healthcare. However, EDs often lack the resources to implement these interventions with fidelity. As part of a larger trial seeking to implement the Stanley-Brown Safety Planning Intervention and follow-up services via a telehealth suicide prevention consultation center (SPCC), we surveyed clinicians to understand contextual factors that may impact reach of the consultation service.

Methods: Participants were 47 clinicians working in eight Philadelphia-area EDs. Prior to SPCC launch, participants completed the 18-item Implementation Climate Scale (ICS) and 12-item Implementation Leadership Scale (ILS) to assess climate and supervisory support, respectively, for suicide prevention evidence-based practice (EBP) implementation. Participants also completed 8-items assessing norms, attitudes, and intentions towards referring patients to the SPCC (rated on a 1-7 Likert scale) based on validated stems from the Theory of Planned Behavior. We computed descriptive statistics and conducted a series of linear regression analyses to examine whether aggregated site-level ICS scores, ILS scores, and individual clinicians’ intentions to refer patients to the consultation service predicted subsequent average monthly referrals to the SPCC.

Results: Clinicians were primarily white (74.5%), non-Hispanic (85.1%), and female (55.3%). ICS (M=1.52, SD=0.61) and ILS (M=2.17, SD=1.05) total scores were in the low-moderate range, demonstrating slight-to-moderate climates conducive to implementation and moderate perceptions of leadership support for the implementation of suicide prevention EBPs in EDs. Clinicians indicated strong intentions to refer their patients to the consultation service (M=5.59, SD=1.48) prior to the SPCC’s launch. Linear regression analyses indicated that implementation climate and clinician intentions did not significantly predict actual referrals made to the consultation service post SPCC launch. However, among sites with sufficient data to compute aggregate site-level ILS scores, implementation leadership predicted subsequent referrals to the SPCC (R2=.85, F(1,3)=17.6, p=.03), suggesting that perceived supervisory support for suicide prevention EBP implementation predicted greater use of a suicide prevention resource, the SPCC, for their patients. Additional data collection and analyses are in progress.

Discussion: Results suggest that implementation leadership may be a particularly important target in suicide prevention EBP implementation in EDs. Many suicide prevention implementation efforts to date have focused solely on training individual clinicians or utilizing organizational strategies such as policy mandates. To maximize public health impact, our results suggest that the critical role supervisors play in supporting suicide prevention EBP use should receive greater attention.