Tag: Implementation and evaluation research

A comparative effectiveness trial of strategies to implement firearm safety promotion as a universal suicide prevention strategy in pediatric primary care (ASPIRE)

Grant Details

Funder: NIMH

Grant number: R01MH123491

Project period: 08/15/2020 – 06/30/2025

Lead site: Northwestern University (PI Rinad Beidas)

Participating sites:

  • Kaiser Permanente Colorado (Site PI Jennifer Boggs)
  • Henry Ford Health System (Site PI Brian Ahmedani)
  • University of Pennsylvania (Site PI Kristin Linn)

Abstract: The proposed study will work to reduce firearm-related suicide deaths in young people by investigating the most effective way to implement a universal secure firearm storage program in pediatric primary care. The number of young people dying by suicide in the United States continues to rise, and risk for suicide death is much greater when there is an unlocked, loaded firearm in the home. A simulation study found that a modest increase in secure firearm storage could prevent up to 32% of firearm-related deaths in youth. Pediatric primary care is an ideal setting for universal suicide prevention strategies to reduce unauthorized access to firearms, and prior research has shown that both health care clinicians and parents find firearm safety to be an appropriate topic to discuss, yet these conversations do not happen routinely. Safety Check, an evidence-based practice for firearm safety promotion that involves brief counseling and provision of a free cable lock, has been shown to double the odds of self-reported secure storage among parents, but has not been implemented widely. Using feedback from pediatric clinicians, health system leaders, and firearm-owning parents regarding attitudes and barriers related to broader use of the program, the proposed study incorporates recommendations on how to boost the acceptability and feasibility of Safety Check for use as a universal suicide prevention strategy. Combining this feedback with insights from behavioral economics, we will conduct a hybrid type III effectiveness-implementation trial with a longitudinal cluster randomized design. The study will allow us to compare two approaches to implementing the program in pediatric primary care and evaluate the effectiveness of the adapted intervention, now named S.A.F.E. Firearm. The study will include 158 clinicians in 30 clinics who serve 48,475 youth annually in two MHRN health systems in Michigan and Colorado. All 30 clinics in the two participating health systems will receive S.A.F.E. Firearm materials, including brief training and cable locks. Half of the clinics (k = 15) will be randomized to receive the electronic health record (EHR) implementation strategy (Nudge); the other half will be randomized to receive Nudge plus 1 year of facilitation to target additional clinician and organizational implementation barriers (Nudge+). We will collect the primary implementation outcome, reach (proportion of eligible families that received the intervention), during the active implementation year and for 1 year following to allow for comparisons between the active and sustainment periods. Results will guide future efforts to promote firearm safety as a universal suicide prevention strategy. In Aim 1, we will identify the effect of the implementation strategies on implementation outcomes (i.e., reach, parent-reported receipt of the program [fidelity], cable lock distribution, acceptability, and cost). In Aim 2, we will also test potential implementation strategy mechanisms (i.e., how it worked). In Aim 3, we will examine clinical outcomes including parent-reported secure storage behavior. This study can improve implementation of firearm safety interventions and identify the best approach to national implementation, with the ultimate goal of saving the lives of American youth, in alignment with NIMH Objective 4.

Current status:

Enrolling by invitation.

Summary of findings:

The active implementation year will end in March 2023, and data analysis will be conducted during summer 2023. Manuscripts detailing study findings will submitted for peer review thereafter.

Publications:

Beidas, R. S., Ahmedani, B. K., Linn, K. A., Marcus, S. C., Johnson, C., Maye, M., … & Boggs, J. M. (2021). Study protocol for a type III hybrid effectiveness-implementation trial of strategies to implement firearm safety promotion as a universal suicide prevention strategy in pediatric primary care. Implementation Science, 16.

Davis, M., Johnson, C., Pettit, A. R., Barkin, S., Hoffman, B. D., Jager-Hyman, S., … & Beidas, R. S. (2021). Adapting Safety Check as a universal suicide prevention strategy in pediatric primary care. Academic Pediatrics, 21(7), 1161-1170.

Hoskins, K., Johnson, C., Davis, M., Pettit, A. R., Barkin, S., Jager-Hyman, S., … & Beidas, R. S. (2021). A mixed methods evaluation of parents’ perspectives on the acceptability of the S.A.F.E. Firearm program. Journal of Applied Research on Children: Informing Policy for Children at Risk, 12(2).

Hoskins, K., Linn, K. A., Ahmedani, B. K., Boggs, J. M., Johnson, C., Heintz, J., … & Beidas, R. S. (2022). Equitable implementation of S.A.F.E. Firearm: A multi-method pilot study. Preventive Medicine, 165.

Optimizing Firearm Suicide Prevention in Healthcare

Grant Details

Funder: CDC

Grant Number: 1 R01CE003460-01-00    

Project Period: 9/30/2022-9/29/2025

Brief Narrative: Suicide accounts for 60% of U.S. firearm deaths, with even higher rates in Alaska, Colorado, and Washington.  Firearms are the most common method of suicide in the U.S., and firearm access is linked to increased suicide risk. Most people who die by suicide see a health care provider in the prior year, including populations at higher risk for suicide such as youth and young adults and Alaska Native and American Indians (AN/AI). Many healthcare systems conduct systematic suicide risk screening; however, systematic screening for firearm access is uncommon, particularly in primary care. Promising clinical practices to prevent firearm suicide also include collaborative discussions about reducing firearm access. Unfortunately, gun ownership is a contentious issue in the U.S, and there is a dearth of evidence available to guide implementation of firearm access assessment and intervention. Our team has been recently addressing this evidence gap. We established that primary care and mental health patients will answer questions about firearms and limiting screening to mental health care recipients misses many at risk patients.  We found that concerns about privacy, autonomy, and ownership rights impact patient responses, and we catalogued patient/clinician suggestions for improving assessment and intervention.

      This study will build on these findings and address the critical need for patient-centered strategies to identify and engage patients at high-risk of firearm suicide through Objective One of CDC’s RFA-CE-22-004: Research to inform the development of innovative and promising firearm injury/mortality prevention strategies.  Human Centered Design and Community Based Participatory Research approaches will support Option B for new data collection activities and the implementation of prevention activities. We will employ CBPR and the Discover, Design and Build, and Test (DDBT) HCD framework to inform implementation strategies in three healthcare systems serving ~1.5 million people in communities with high rates of firearm ownership and suicide. We will:

1 (DISCOVER): Explore stakeholder (patient, clinician, leader) perspectives on clinical practices for identifying and engaging individuals at risk of firearm suicide, and to identify opportunities for practice improvement via retrospective chart review and descriptive analyses of medical records.

2 (DESIGN/BUILD):  Partner with clinical and quality improvement staff and leadership to design intervention strategies to support evidence-based clinical practices for firearm suicide prevention.

3 (TEST): Pilot test clinical intervention strategies in three healthcare systems to demonstrate feasibility, acceptability, and usability; and to measure reach for future effectiveness evaluations.

Our work will lay a strong foundation for future dissemination of patient-centered firearm suicide prevention practices and evaluations of effectiveness.

  • Lead Site:
    • KPWA (PI Julie Richards)
  • Participating Sites:
    • Southcentral Foundation (co-I Jennifer Shaw)
    • KPCO (co-I Jenn Boggs)

Current Status

Summary of Findings

none yet

Publications

none yet

Employing a Stepped-Wedge Design to Implement an Evidence-Based Psychotherapy for PTSD in Six Large, Diverse Health Care Systems

Grant Details

Funder: PCORI

Grant Number:

Project Period: 2022 – 2025

  • Lead Sites:
    • Yale (co-PI Joan Cook) and KPHI (co-PI Vanessa Simiola)
  • Participating Sites:
    • Henry Ford Health System (co-I Lisa Matero)
    • Kaiser Permanente Northwest (co-I Frances Lynch)
    • Kaiser Permanente Georgia (co-Is Ashli Owen-Smith, Kanetha Wilson, Courtney McCracken)
    • Essentia Health (co-I Melissa Harry)
    • Baylor Scott & White Health (co-I Katherine Sanchez)

Brief Narrative: Written Exposure Therapy (WET) is a five-session exposure-based EBP for PTSD that was efficacious in randomized controlled trials for treating PTSD from different types of traumas. In addition to PCORI’s recognition, WET is recommended as a first-line treatment by the Department of Veteran Affairs (VA) and the Department of Defense (DoD). In two recent trials, WET was non-inferior to the more time-intensive, gold-standard EBP, Cognitive Processing Therapy. Thus, WET seems to meet the need for alternative PTSD treatments that are brief, with little dropout, and require less clinical training. Indeed, WET’s brevity and tolerability make it an ideal first-level intervention, appealing to patients who have opted not to seek out more time- and therapist-intensive EBPs. WET addresses significant barriers to other EBPs for PTSD at the patient, provider, and system levels.

The project will employ a stepped wedge design to implement WET in six, large, diverse, integrated, civilian health care systems across the United States— Kaiser Permanente (KP) Hawaii, Henry Ford Health System, Kaiser Permanente Northwest, Kaiser Permanente Georgia, Essentia Health, and Baylor Scott & White Health — with all sites receiving the intervention during the project period. The healthcare systems are members of the Mental Health Research Network (MHRN), a consortium of 14 research centers. Sites will be assigned to one of two implementation groups. Every site will receive WET training, consultation, and multi-component implementation strategies, promoting equity and advancing the field of implementation science.

The specific aims of this project are to:

  1. Employ multi-component implementation strategies to help mental health providers implement WET for their PTSD patients in mental health settings in six health care systems.
  2. Use Consolidated Framework for Implementation Research (CFIR) to understand the determinants and process of implementation.
  3. Utilize RE-AIM framework to evaluate implementation outcomes for mental health providers and patients.

Implementing Predictive Models for Identifying Suicide Risk in Adolescents

Grant Details

Funder: NIMH (MHRN III Feasibility Pilot Program)

Grant Number: U19MH121738

Project Period: 7/1/2022 – 6/30/2023

Narrative:

Background: Adolescent suicide is an urgent public health crisis. Suicide is currently the second leading cause of death among adolescents ages 10-24. Despite decades of research, suicide attempt rates continue to rise across the U.S., particularly among adolescents. Furthermore, new data suggests that adolescents were disparately impacted by the COVID-19 pandemic, with some states reporting increased rates of suicide among youth, galvanizing the urgency for increased prevention. People who die by suicide often see healthcare providers, and specifically primary care providers prior to death, including adolescents. Therefore, identifying suicide risk in healthcare settings among adolescents is an important prevention opportunity.

Mental Health Research Network (MHRN) researchers (led by Greg Simon) have developed suicide risk prediction algorithms that have potential to vastly improve identification of individuals at high risk of suicide, including adolescents. While promising, there is very little evidence to guide routine use of this powerful suicide risk identification method during healthcare encounters with adolescents. A recently completed MHRN project (led by Bobbi Jo Yarborough) explored barriers and facilitators of the use of suicide risk algorithms among adult patients, clinicians, and administrators across three MHRN systems. These stakeholders were generally supportive of implementation, but some patient participants expressed concerns about suicide risk information resulting in coercive treatment, and clinician participants expressed desire for opportunities supporting their role in implementation decision-making.

No studies (to our knowledge) have explored perspectives of adolescents, their parents/guardians or adolescent providers about how suicide risk prediction models should be implemented. Therefore, we plan to build from prior MHRN work and qualitatively elicit adolescent care providers’ perceived barriers and facilitators to implementation of these models in care delivery and their ideologies regarding risk thresholds and risk-concordant care. Simultaneously, we plan to build a qualitative understanding adolescents and family perceptions, ideas, and preferences regarding the use of suicide risk prediction models in their care.

Research questions: (1) What perspectives do primary care providers have on suicide risk prediction algorithms and what suggestions or considerations do they have for clinical practice? (2) How do primary care providers envision risk concordant care delivery to look like in clinical practice? (3) What are adolescent and parent/caregiver perceptions and preferences on the use of suicide risk predications models as a tool for enhanced clinical care? (4) What ideas or suggestions do adolescents and parents/caregivers have for comfortable and effective implementation of risk prediction algorithms in primary care?

Methods: Provider interview guides will be developed based on interview findings by the prior qualitative MHRN study (described above) which used the Consolidated Framework for Implementation Research (CFIR), with additional questions aimed at understanding risk thresholds and associated concordant care. Caregiver and adolescent interviews will explore their thoughts, ideas, and preferences regarding EHR-based suicide risk prediction models as part of patient standard of care. We will aim to interview 10-15 adolescent care providers and 10-15 caregiver-adolescent dyads across the two sites. Care providers will be purposively selected in consultation with KPWA leaders involved in an initiative to improve adolescent access to timely mental health care. The suicide risk prediction algorithm will be used to purposively sample adolescents at high risk of suicide and their parent/guardian caregivers. Identified dyads will be recruited via mailed and telephone invitation materials (developed from a prior project recruiting adolescents & caregivers). Interviews will be audio-recorded, transcribed and double-coded to support thematic content analysis.

Planned products: A synthesis of stakeholder needs/perspectives to support suicide risk prediction model implementation in routine care delivery for adolescents. This key deliverable will be used to support: 1) current predictive analytic implementation efforts across MHRN sites 2) an external grant submission to NIMH focused on application of Human-Centered Design methods to design, build, and test clinical decision support for identifying and engaging adolescents at high-risk of suicide in evidence-based healthcare, 2) a peer-reviewed manuscript submission led by Taylor Ryan, MS (PhD student in Health Systems & Population Health at the University of Washington) & Julie Richards, MPH, PhD (MHRN researcher and faculty advisor at UW).

Lead Site: KPWA (PI Julie Richards)

Participating Sites: N/A

Current Status:

Summary of Findings:

Publications:

Syncing Screening and Services for Suicide Prevention across Health and Justice Systems

Grant Details

Title: Project 1: Syncing Screening and Services for Suicide Prevention across Health and Justice Systems

Funder: NIMH

Parent project number: 1P50MH127512

Sub-project ID: 8576

Project period: 08/22/2022 – 07/31/2027

Brief Narrative: This is a 5-year Signature Project within the NIMH-funded P50 Suicide Prevention Center, titled The National Center for Health and Justice Integration for Suicide Prevention. As suicide rates in the United States continue to rise, with nearly 50,000 suicide deaths and over 1 million suicide attempts annually per most recent data, increased attention has been paid to how to best integrate and coordinate suicide risk identification and prevention across multiple sectors, where some of our most vulnerable community members “fall through the cracks” in the continuum of care. Perhaps nowhere is this need for coordination and integration more pronounced than at the intersection of the US jail system, with over 10 million admissions per year, and the community healthcare system; an intercept known to impact individuals at disproportionately high risk for suicide. Given that roughly 10% of all suicides in the US with known circumstances occur following a recent criminal legal stressor (often arrest and jail detention), reducing suicide risk in the year after jail detention could have a noticeable impact on national suicide rates. There is thus a vital need to develop suicide risk care pathways between jails and healthcare systems to offer immediate access to care. Yet this process has been stymied by major fissures in the integration of data and clinical information between jails and health systems, preventing effective coordination of care between these community sectors. To address these needs, the proposed Signature Project is a Hybrid Type I effectiveness-implementation trial that harmonizes local jail booking and release data with healthcare records at two large healthcare systems in Minnesota and Michigan, to identify health system patients who are released from jail, and to pair the data linkage with randomization into usual care or a multi-level health system suicide prevention care pathway (consisting of care coordination, Safety Planning, Caring Contacts, and a telehealth delivered Coping Long- Term with Active Suicide Program). In so doing, this project leverages the study team’s experience in health system data linkage in the NIMH-funded Mental Health Research Network, from which the participating healthcare systems were chosen, as well as in suicide prevention around the period of jail detention and release (i.e., in the SPIRIT Trial), and in telephone-based suicide prevention intervention (i.e., in ED-SAFE). The proposed project will randomize 1050 individuals into the 5S intervention at both sites (comparing to more than 60,000 people in a usual care no contact comparison arm). Findings on suicide attempt and death outcomes, healthcare utilization mechanisms, cost- effectiveness, and implementation factors will provide data for a future fully scaled implementation trial and widespread adoption in community settings. Notably, the proposed Signature Project will be the first trial of a comprehensive health system intervention to prevent suicide in response to patients’ justice involvement.

  • Lead MHRN site: HFHS (PI: Brian Ahmedani)
  • Participating site: HPI (co-I: Rebecca Rossom)

Evaluating Effectiveness and Implementation of a Risk Model for Suicide Prevention Across Health Systems

Grant Details

Title: Evaluating Effectiveness and Implementation of a Risk Model for Suicide Prevention Across Health Systems

Funder: NIMH

Grant number: 1R01MH130548

Project period: 08/23/2022 – 05/31/2026

Brief Narrative: Suicide is a major public health concern in the United States; nearly 50,000 individuals die by suicide annually and almost 1.5 million attempt suicide. To date, identification of individuals at risk for suicide has relied on suicide risk screening practices, including using a variety of self- report instruments. However, sensitivity of these measures are only moderate; more precise tools for identifying patients at risk for suicide are needed. Suicide risk models, developed by our team, incorporate health records data and historical self-report screening questionnaire responses to improve accuracy of risk prediction. Our models have outperformed traditional clinical screening and similar risk models for adults receiving care in outpatient mental health specialty settings. However, while accurate, they have not been evaluated in real world care; whether the models actually increase identification or result in patients receiving more suicide prevention services, fewer crisis services, or making fewer suicide attempts is unknown. There is substantial clinical interest in implementing suicide risk models but little scientific evidence about the effectiveness of these models in real world settings compared to standard screening practices alone. Additionally, there is almost no guidance for their implementation in healthcare. The proposed project leverages the NIMH-funded Mental Health Research Network (MHRN), a collaboration of large health systems with established clinical data infrastructure to support multi-site studies. MHRN members Henry Ford Health System, Kaiser Permanente Northwest, and HealthPartners will participate in this project and collectively serve >170,000 behavioral health patients per year. The patient populations are diverse, including thousands of individuals with Medicaid and Medicare. Each of these systems has implemented a suicide prevention care model in their behavioral health departments, including robust suicide risk screening and assessment processes. However, none of these systems has implemented a suicide risk model. The proposed project includes a pragmatic trial approach with randomization of behavioral health clinics across the three participating health systems. It is innovative because it seeks to implement an MHRN suicide risk model (intervention) into each system’s existing suicide prevention care model (usual care) to increase the reach and effectiveness of the suicide prevention care models. Sites will receive implementation planning support based on stakeholder feedback from preliminary studies and deliverables include an implementation planning tool kit to facilitate spread. This high-impact study has important clinical implications as health systems consider whether it makes sense to enhance their existing suicide prevention care models with a suicide risk model. It is timely because many health systems are advancing toward suicide risk model implementation without evidence to support this innovation.

  • Lead site:
    • KPNW (PI Bobbi Jo Yarborough)
  • Participating sites:
    • HFHS (co-I Brian Ahmedani)
    • HPI (co-I Rebecca Rossom)

Telehealth: Assessing Services in Kaiser Permanente (TASK)

Grant Details

Title: Telehealth: Assessing Services in Kaiser Permanente (TASK)

Funder: Kaiser Permanente Research

Grant Number: KPR-HPHQ-2021-01

Grant Period: 07/01/2021 – 12/31/2022

Brief Narrative: There is considerable optimism that telehealth –especially telephone and video-based visits –can transform care delivery within Kaiser Permanente (KP) and across the United States. Mental Health and Wellness (MHW) is the service line with the greatest potential to realize the benefits of expanding telehealth and transfer learning across service lines and regions. This mixed-methods project will study the quality, efficiency, and value of MHW services in six KP regions using generalized estimating equations, predictive analytics, and semi-structured interviews with members, clinicians, and administrators. The work will advance KP’s national telehealth strategy and inform capital and operational investments by improving our understanding of clinical, technical, and legal barriers and facilitators to telehealth as well as by furthering our ability to measure telehealth encounters and the relationship between telehealth and face-to-face care.

  • Lead sites:
    • KPNW (Administrative lead site, Co-PI Greg Clarke)
    • KPWA (Scientific lead site, Co-PI Robert Penfold)
  • Participating sites
    • KPCO (Site PI Jennifer Boggs)
    • KPGA (co-Site PIs Teaniese Davis& Courtney McCracken)
    • KPHI (Site PI Yihe Daida)
    • KPSC (Site PI Corinna Koebnick)

Awarded budget (total cost): $998,145

Personnel Contact List

Human Subjects: NO. All participating sites’ IRBs made a determination of quality improvement.

Current Status

Analyses are ongoing. We are evaluating:

  1. Changes in depression treatment outcomes and follow-up care with the switch to virtual care
  2. Assessing the clinical content of unscheduled telephone visits and developing measures to differentiate meaningful clinical content at these visits.
  3. Interviewing clinicians and members about their experiences
  4. Developing an updated predicting model for “no-shows” in the new (mostly) virtual environment in specialty mental health care.

Summary of findings

Interim findings suggest that positive outcomes for depression treatment were not substantially reduced by the move to virtual care. Some differences in follow-up PHQ9 administration were observed by race/ethnicity.

Qualitatively, most KP members are happy (or happier) with virtual care because of its convenience. They report only minor differences in interacting with their providers. Moderate irritation with technical issues is pervasive.

Publications

None yet.

MHRN Post-Doctoral Fellowship Program

About

The MHRN T32 Post-Doctoral Fellowship is an NIMH-supported, two-year fellowship program. Aspiring independent researchers are trained broadly in health systems/health services research with a focus on mental health conditions and services, as well as suicide prevention. Areas of particular interest and training are in clinical interventions, healthcare service delivery, big data, implementation science, comorbidities, health equity, and health policy. The overall goal of the program is to support fellows in the transition to becoming independent mental health services researchers able to pursue NIMH-funding to support research within health system settings.

Fellows work locally alongside a primary mentor at HFHS or KPNC. They also receive high-quality mentorship and training from other scientists within multiple formats across the entire MHRN. In addition to one-on-one mentoring in the fellows’ areas of interest, they receive training in grant writing, manuscript development, health systems research methods (e.g., case-control designs, big data science, multi-site trials, dissemination and implementation), quantitative and qualitative methods, ethics, professional/career development, and conducting clinical trials. Teaching opportunities may also be available, as will clinical experiences for those seeking licensure.

Two fellows are enrolled each year. Applicants should have a PhD, MD, or other doctoral degree in a related field. Open to U.S. citizens or permanent residents enrolled in research or clinical doctoral or postdoctoral programs.

The Program Lead is Brian Ahmedani (HFHS). The Training Directors are Stacy Sterling (KPNC) and Jordan Braciszewski (HFHS).

A full description of the program and the application process can be viewed at https://www.henryford.com/hcp/research/public-population-research/health-policy/research .

Current Fellows

Seminar Schedule

seminar materials

Contact

For more information about the MHRN Fellowship program, contact MHRNT32@hfhs.org.

MHRN III Pilot Project 1: Stakeholder Views on Implementation of Suicide Risk Prediction Models

Grant Details

Funder: NIMH

Grant Number: U19MH121738

Grant Period: 09/24/2019 – 6/30/2021

Narrative: Age-adjusted suicide rates have been increasing in the U.S. over the past two decades. In 2017, more than 47,000 Americans died of suicide. Health care visits represent opportunities for suicide prevention because most individuals make an outpatient health care visit within a year of their suicide death and almost half have a visit within a month of their death. However, suicide risk is not always easily recognizable to clinicians—traditional clinical prediction is hardly better than chance. Predictive modeling that identifies patterns in “big data” from administrative and electronic health records has proven superior to clinical suicide risk prediction and routinely used suicide screening instruments. While predictive modeling holds promise for suicide prevention, how models should be implemented in routine clinical practice and the contextual factors that influence their use are understudied. The potential benefits of any risk prediction model, including those designed to identify suicide risks, are dependent on making sure that the models are deployed in a manner that does not harm patients, supports clinical care management, and is sustainable for health care delivery systems. We propose a pre-implementation pilot study in three settings, using one-on-one, in-depth interviews to explore health system administrators’, clinicians’, and patients’ expectations, experiences with, concerns, and suggestions for the early use of suicide risk prediction models. In the first setting, health system administrators are still considering what might be the best implementation approach. Interviews will help us understand how various stakeholder expectations match what is actually occurring in the two other settings where small pilot studies will be in process. One of these settings is planning outreach to high-risk patients independent of health care visits while the other is planning delivery of risk scores at the point of care. By studying different implementation strategies, we can compare relative advantages and disadvantages. We are particularly interested in effects on clinical workflows, clinician-patient relationships, and patient experiences. While there is an emerging literature supporting the promise of predictive models in health care, implementation factors and patient impacts have been largely ignored. Yet decisions regarding design and modeling methods and implementation processes should be driven by stakeholder requirements. Results of this pilot study will have important clinical implications and will not only inform large-scale implementation of suicide risk prediction models in health systems across the country but will also inform development of future risk prediction models and associated care processes tailored to stakeholders needs more generally (not limited to suicide risk). The long-term goals of this pilot project are to inform ongoing health system-level efforts to reduce suicide prevalence and prevent suicides by optimizing the use of suicide risk prediction tools.

  • Lead Site:
    • Overall PI: KPNW (Bobbi Jo Yarborough)
  • Participating Sites/Subcontractors:
    • HPI (site project lead Rebecca Rossom)
    • KPWA (site project lead Julie Richards; site PI Greg Simon)
  • Funder Contacts
    • Science Officer: Susan Azrin
    • Program Official: Michael Freed
    • Grants Management Official: Julie Bergerud

Documents

Funding Announcement

Notice of Award

Personnel Contact List

Current Status

We have completed and analyzed interviews with 10 health care administrators, 30 clinicians in behavioral health departments, and 62 patients across three health systems.

Summary of Findings

Administrators and clinicians

  • Use of a suicide risk prediction model and two differing implementation approaches were acceptable.
  • Clinicians desired opportunities for input on implementation decision-making.
  • They wanted to know how this manner of risk identification enhanced existing suicide prevention efforts.
  • They wanted additional training on how the models determined risk and why some patients appeared at risk while others do not.
  • Clinicians were concerned about lack of suicide prevention resources for newly identified patients.
  • They wanted clear procedures for situations when they could not reach patients or when patients remained at-risk over a sustained period.
  • They would like consolidated suicide risk information in a dedicated module in the EHR to increase efficiency.

Patients

  • Patients were generally supportive of suicide risk prediction models derived from EHR data.
  • Concerns included: 1) apprehension about inducing anxiety and suicidal thoughts, or 2) triggering coercive treatment, particularly among those who reported prior negative experiences seeking mental health care.
  • Participants engaged in mental health care or case management expected to be asked about suicide risk and largely appreciated suicide risk conversations
  • Patients preferred conversations to come from clinicians comfortable discussing suicidality.

Publications

Yarborough BJH, Stumbo SP. Patient perspectives on acceptability of, and implementation preferences for, use of electronic health records and machine learning to identify suicide risk. Gen Hosp Psychiatry. 2021 May-Jun;70:31-37. doi: 10.1016/j.genhosppsych.2021.02.008.

Yarborough BJH, Stumbo SP, Schneider JL, Richards JE, Hooker SA, Rossom RC . Patient expectations of and experiences with a suicide risk identification algorithm in clinical practice. BMC Psychiatry. 2022 Jul 23;22(1):494. doi: 10.1186/s12888-022-04129-1 .

MHRN III Signature Project 1: Mindfulness-Based Cognitive Therapy to Prevent Perinatal Depression

Grant Details

Funder: NIMH

Grant Number: U19MH121738

Grant Period: 9/23/2019 – 6/30/2024

Narrative: An increasing number of digital mental health technologies are being developed to expand access to mental health treatments and deliver them in a cost-effective manner. Although efficacy trials of these technologies demonstrate improved patient outcomes, especially when combined with coaching support, there is little evidence that such digital tools can be widely implemented and sustained in routine care settings.

Perinatal depression is one area of significant public health concern where the role of digital mental health technology is especially relevant. Approximately 30-40% of women with histories of depression experience relapse during the perinatal period, a majority show poor adherence to antidepressants (ADs), the most common prevention treatment, and a majority express a preference for non-pharmacologic treatments. However, effective and easily accessible non-pharmacologic treatments are not widely available. Inadequate treatment for perinatal depression poses unique risks, including potential obstetrical and neonatal complications associated with perinatal depression itself and with fetal exposure to ADs. It is therefore imperative to test the implementation of effective and scalable non-pharmacological treatments to reduce the risk of depression relapse in the perinatal period.

Mindfulness-Based Cognitive Therapy (MBCT) is a promising preventive intervention for pregnant women with recurrent depression (as well as for adults in general), demonstrating significant reductions in rates of depressive relapse and residual depressive symptoms. MBCT is an eight-session in-person group intervention targeting risk factors for depressive relapse through a combination of mindfulness meditation and cognitive-behavioral strategies. Because of challenges in delivering in-person MBCT (difficulty for health systems to scale up the intervention, barriers to access for pregnant women), we developed a mobile-first digital adaptation of MBCT for pregnant women, Mindful Mood Balance for Moms (MMBFM).

The critical next phase of our work is to evaluate the potential of MMBFM as an effective intervention that can be more widely adopted, implemented, and sustained across heterogeneous patient populations and health care systems. We propose a large pragmatic hybrid type II effectiveness–implementation trial comparing MMBFM to usual care (UC) among pregnant women at risk for recurrent depression at four MHRN sites: KP Colorado, KP Southern California, HealthPartners, and KP Georgia to address the following aims:

AIM 1: Test the effectiveness of MMBFM in reducing depression symptoms, reducing risk of relapse or significant worsening, and improving perinatal outcomes when implemented in real-world health systems.

AIM 2: Evaluate the incremental cost-effectiveness of MMBFM compared to UC.

AIM 3: Evaluate healthcare system’s implementation of MMBFM using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) model.

  • Lead Site:
    • Overall PI: KPCO (Project lead Arne Beck)
  • Participating Sites/Subcontractors:
    • HPI (Site PI Kristen Palmsten)
    • KPGA (Site PI Courtney McCracken)
    • GSU (Site PI and site project lead for KPGA Ashli Owen-Smith)
    • KPNW (Site PI Frances Lynch)
    • KPSC (Site PI Karen Coleman)
    • UCB (Co-I Sona Dimidjian)
  • Funder Contacts
    • Science Officer: Susan Azrin
    • Program Official: Michael Freed
    • Grants Management Official: Julie Bergerud

Documents

Funding Announcement

Notice of Award

Personnel Contact List

Current status

Enrollment is approximately 80% complete for the randomized trial comparing depression outcomes for participants in the Mindful Mood Balance for Moms (MMBFM) online program who receive professional or peer telephonic coaching. All four sites have engaged their OB leaders and stakeholders and are starting the cluster randomized trial to assess the impact of  implementation strategies on participants’ initial engagement in the MMBFM program. Coaching trial enrollment will be complete by end of 2022, and implementation trial enrollment will be complete by second quarter of 2023. Follow-up data collection through three months postpartum and data analysis for both trials and for the cost-effectiveness analysis will be conducted from third quarter 2023 through third quarter of 2024.

Summary of findings

Not yet available

Publications

None