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Integration of a Suicide-Specific Treatment Program Within a Psychiatric Residency and Large Hospital System of Care: a Twelve-Month Journey.
Academic Psychiatry ( IF 2.385 ) Pub Date : 2020-03-02 , DOI: 10.1007/s40596-020-01209-w
Katherine Walukevich-Dienst 1 , Kathleen A Crapanzano 2 , Mark H Zielinski 2 , Richard J Vath 3 , Raymond P Tucker 1
Affiliation  

In 2019, The Joint Commission issued accrediting requirements for all health care organizations to reduce suicide risk among patients by incorporating evidence-based suicide-specific training procedures [1]. In response to these new requirements, there is a need to implement suicide-specific training within psychiatry residency programs. The majority of psychiatry residency programs provide some form of training in suicide prevention, but it is often minimal and focused on assessment instead of intervention, which leaves many psychiatry residents desiring more guidance [2]. Suicide-specific care conceptualizes suicide as the primary target for patient care rather than as a byproduct of other mental health conditions [3]. Data suggest that suicide-specific care reduces the risk of suicidal thoughts and behaviors (STBs) among adults relative to treatment as usual, which commonly includes treatment of a primary mental health disorder, while suicide risk is managed (and thus not directly intervened upon) [3]. One framework that has been proposed as an evidence-based clinical standard of suicide care [4] is the Collaborative Assessment and Management of Suicidality (CAMS; 5). CAMS is a multi-session intervention that prioritizes outpatient management of suicidality through assessment and tracking of risk and protective factors for suicide, collaborative identification and treatment of an individual’s drivers of suicidality, and repeated and flexible outpatient safety planning [5]. Further, clinical trials regarding the efficacy and acceptability of CAMS have included providers from a variety of disciplines (e.g., psychologists, psychiatrists, andmaster’s levelmental health providers) [6]. CAMS appears to reduce risk factors for STBs in multiple service delivery systems, including both inpatient and outpatient psychiatric settings [6]. We chose to implement CAMS for two main reasons: (1) psychiatry residents and associated staff (e.g., social workers) could use CAMS in multiple settings across the hospital (e.g., consultation-liaison service, the mental and behavioral health emergency department, and outpatient clinic) and thus provide continuity of patient care, and (2) one of the authors (RT) had prior expertise and experience implementing CAMS in a hospital setting. In our residency program, psychiatry residents were trained in suicide risk assessment, triage, and appropriate precautions for suicidal patients. However, there was no training in evidencebased suicide-specific care. Research about implementing a suicide-specific training program in a psychiatry residency program is limited. Thus, the current article focuses on training psychiatry residents and implementing an evidence-based suicide-specific framework in a psychiatry residency program and hospital system.

中文翻译:

在精神病院和大型医院护理系统中整合针对自杀的治疗计划:十二个月的旅程。

2019 年,联合委员会发布了对所有医疗保健组织的认证要求,以通过纳入基于证据的自杀特定培训程序来降低患者的自杀风险 [1]。为了响应这些新要求,有必要在精神病住院医师计划中实施针对自杀的培训。大多数精神病学住院医师计划提供某种形式的自杀预防培训,但通常很少,而且侧重于评估而不是干预,这使得许多精神病学住院医师希望获得更多指导 [2]。自杀特异性护理将自杀概念化为患者护理的主要目标,而不是其他心理健康状况的副产品 [3]。数据表明,与常规治疗相比,针对自杀的护理降低了成年人的自杀念头和行为 (STB) 风险,常规治疗通常包括治疗原发性精神疾病,同时控制自杀风险(因此不直接干预) [3]。已被提议作为基于证据的自杀护理临床标准的一个框架 [4] 是自杀性协作评估和管理 (CAMS; 5)。CAMS 是一种多阶段干预,通过评估和跟踪自杀的风险和保护因素、协作识别和治疗个人的自杀驱动因素以及重复和灵活的门诊安全计划,优先考虑门诊自杀管理 [5]。进一步,关于 CAMS 的有效性和可接受性的临床试验包括来自不同学科的提供者(例如,心理学家、精神科医生和硕士水平的心理健康提供者)[6]。CAMS 似乎可以降低多种服务提供系统中 STB 的风险因素,包括住院和门诊精神病院 [6]。我们选择实施 CAMS 的主要原因有两个:(1) 精神病学住院医师和相关工作人员(例如,社会工作者)可以在医院的多个环境中使用 CAMS(例如,咨询联络服务、心理和行为健康急诊科,以及门诊),从而提供患者护理的连续性,并且(2)其中一位作者(RT)具有在医院环境中实施 CAMS 的先前专业知识和经验。在我们的居住计划中,精神病学住院医师接受了自杀风险评估、分类和对自杀患者的适当预防措施的培训。但是,没有针对基于证据的自杀特异性护理的培训。关于在精神病学住院医师计划中实施针对自杀的培训计划的研究是有限的。因此,本文的重点是培训精神病学住院医师,并在精神病住院医师计划和医院系统中实施基于证据的自杀特定框架。
更新日期:2020-03-02
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