A 1-Year Review of a Nationally Led Intervention to Improve Suicide Prevention Screening at a Large Homeless Veterans Clinic

Eileen Kay Ramos Temblique; Kayla Foster; Jeffrey Fujimoto; Kristin Kopelson; Katharine Maile Borthwick; Peter Capone-Newton

doi:10.12788/fp.0215

A 1-Year Review of a Nationally Led Intervention to Improve Suicide Prevention Screening at a Large Homeless Veterans Clinic

Fed Pract. 2022 Jan;39(1):12-18. doi: 10.12788/fp.0215. Epub 2022 Jan 12.

Authors

Eileen Kay Ramos Temblique¹, Kayla Foster¹, Jeffrey Fujimoto², Kristin Kopelson¹, Katharine Maile Borthwick^{1

2}, Peter Capone-Newton^{1

2}

Affiliations

¹ Veterans Affairs Greater Los Angeles Healthcare System.
² University of California, Los Angeles David Geffen School of Medicine.

Abstract

Background: Suicide is a national public health concern and veterans are a particularly vulnerable population. The Veterans Health Administration (VHA) Office of Mental Health and Suicide Prevention implemented a national, standardized process for suicide risk screening in October 2018, which was instituted at the West Los Angeles Veterans Affairs Medical Center Homeless Patient Aligned Care Team (HPACT) clinic.

Methods: This article examines the results of the screening initiative after implementation, describes difficulties faced in implementation, and suggests strategies that might be used to overcome those challenges.

Results: Over 1 fiscal year (October 1, 2018 to September 30, 2019) the HPACT clinic had 2932 unique veterans assigned to its care; 1876 (64%) received a primary screen of suicide risk, 523 (18%) were not screened, and 533 (18%) were exempt from screening by protocol. Of the 523 (18%) unscreened patients, 331 (11%) patients had no HPACT visit and 132 (5%) did not visit any VHA site during the period. There were 192 (7%) patients who visited but were not screened of which 19 (1%) declined screening.

Conclusions: Most missed screening opportunities were due to patients being lost to follow-up. There were 5 challenges identified for screening implementation, including health record factors, communication, clinician buy-in, system factors, and patient factors. Thus, promoting interprofessional collaboration, visualizing effective process flows, establishing clear lines of communication and roles for involved staff, and opening avenues for continuous feedback and troubleshooting were all effective in increasing comfort with suicide assessment and screening rates.