Literature Collection

Suicide prevention in clinical settings requires coordination among multiple clinicians with expertise in different disciplines. We aimed to understand the benefits and challenges of a team approach to suicide prevention in primary care, with a particular focus on Veterans. The Veterans Health Administration has both a vested interest in preventing suicide and it has rapidly and systematically adopted team-based approaches for primary care interventions, including suicide prevention. We conducted eight focus groups and eight in-depth interviews with primary care providers (PCPs), behavioral health providers and nurses located in six regions within one Veterans Administration Catchment Area in the northeast of the US. Transcripts were analyzed using simultaneous deductive and inductive content analysis. Findings revealed that different clinicians were thought to have particular expertise and roles. Nurses were recognized as being well positioned to identify subtle changes in patient behavior that could put patients at risk for suicide; behavioral health providers were recognized for their skill in suicide risk assessment; and PCPs were felt to be an integral conduit between needed services and treatment. Our findings suggest that clinician role-differentiation may be an important by-product of team-based suicide prevention efforts in VHA settings. We contextualize our findings within both a processual and relational interprofessional framework and discuss implications for the implementation of team-based suicide prevention.

In the United States, about 5% of pediatric Emergency Department (ED) visits involve mental and behavioral health (MBH) emergencies, and EDs are often ill-equipped to provide timely, appropriate care, leading to prolonged stays and increased risks of trauma and harm for these children and their families. This study investigated technological barriers affecting safe and effective pediatric mental and behavioral healthcare in emergency departments through observational studies and semi-structured interviews with 55 medical professionals across four ED settings: pediatric MBH unit, pediatric ED, and adult ED. A total of 12 barrier themes were identified through the thematic analysis of the interviews relating to technology use that impacts the care of pediatric MBH patients. The major themes include issues due to limited electronic medical record data management, ineffective communication in the ED, and usability issues with ED technologies. Other concerns included inadequate infrastructure, absence of streamlined processes, unsafe and inefficient integration of technology, and lack of training. Challenges stemming from patients' reluctance to accept telepsychiatry further complicate providing effective care in these settings. Future research needs to focus on designing systems and solutions to eliminate the barriers, thereby supporting the caregiving process of pediatric MBH in EDs.