Suicide Prevention in Integrated Medical Settings Tuesday, March 10, 2015 Julie A. Rickard, PhD Physician and Healthcare Coaching Wenatchee, WA ACHIEVING ZERO SUICIDE FOR OUR INLAND NORTHWEST COMMUNITIES Tuesday, March 10, 2015 The Journey • Clinical Health Psychologist working at Columbia Valley Community Health (CVCH) for 10 years • Director for the Behavioral Medicine Department • Started the Integrated Primary Care Model at CVCH – Working collaboratively with Primary Care Providers – Up to 75% of unfounded psychosomatic complaints are driven by psychological issues – Psychologists meet with the patient within 15 minutes of acute issue ACHIEVING ZERO SUICIDE FOR OUR INLAND NORTHWEST COMMUNITIES Tuesday, March 10, 2015 Suicide Prevention Coalition of North Central WA • Founded the SPCNCW due to increase in suicides in Chelan/Douglas counties in 2012 • Zero tolerance for suicides within our community through prevention, training, education, & reducing stigma • Philosophy on united approach to learning through use of 1 prevention program vs. multifaceted approach… – Community leaders involved – Adopted QPR Institute prevention model ACHIEVING ZERO SUICIDE FOR OUR INLAND NORTHWEST COMMUNITIES Tuesday, March 10, 2015 Scope of the Problem Chelan/Douglas Counties 38 30 Chelan Douglas Both 30 23 15 8 0 2006 2007 2008 2009 2010 ACHIEVING ZERO SUICIDE FOR OUR INLAND NORTHWEST COMMUNITIES 2011 2012 2013 2014 2015 Tuesday, March 10, 2015 Curve of Forgetting • Curve of forgetting – People retain ~2-3% of information after 1 mth of time without reviewing it. Learning requires repetition. • The more the same information is repeated overtime the more info is retained long-term • Repeat the same QPR training throughout the community over the course of years and the theory supports information being retained long-term by participants ACHIEVING ZERO SUICIDE FOR OUR INLAND NORTHWEST COMMUNITIES Tuesday, March 10, 2015 Pro-Social Messaging • Social Learning Theory (Bandura, 1977) Viewing modeled behaviors results in imitation of those behaviors, emotions, and/or problem solving. • Prosocial Messaging – Seeing socially acceptable ways to behave – Problem solving with solutions – Correcting the inaccurate perceptions on statistics and sending messages to those in need that peers find solutions and get help ACHIEVING ZERO SUICIDE FOR OUR INLAND NORTHWEST COMMUNITIES Tuesday, March 10, 2015 Specific Training • QPR Gatekeeper Instructors - Trained 29 people in 8 sectors – Police/fire, probation/jail, Hispanic, mental health, education, faith, medical, stay at home parents – Each Instructor agreed to train 80 people in their sector (Total of 2,320 people trained) • Total of 3,215 people trained in 1 year ACHIEVING ZERO SUICIDE FOR OUR INLAND NORTHWEST COMMUNITIES Tuesday, March 10, 2015 QPRT 4 QPRT Instructors trained locally through grant funds Mental Health Clinicians • Matt Adler (HB2366) - 110 clinicians have been trained in Chelan/Douglas counties this year • 120 more by year end Medical Providers • (HB2315) – 500+ medical providers by years end • Training will begin June 2015 ACHIEVING ZERO SUICIDE FOR OUR INLAND NORTHWEST COMMUNITIES Tuesday, March 10, 2015 Medical Issues • Medical providers are often under-skilled at managing suicidal patients • Even with integration of mental health, behaviorists are underutilized • What you aren’t comfortable with … you avoid • Patients are not consistently screened – Cherry picked – crying, sad, commenting – Patient Health Questionnaire (PHQ-9) ACHIEVING ZERO SUICIDE FOR OUR INLAND NORTHWEST COMMUNITIES Tuesday, March 10, 2015 Medical Issues • Most frequent call from a new medical provider is regarding suicidal patient management • Encounter driven system that doesn’t accommodate interruptions or extra time with patients – Don’t ask don’t tell – Up to 75% of completed suicides presented to their PCP the month prior to their death ACHIEVING ZERO SUICIDE FOR OUR INLAND NORTHWEST COMMUNITIES Tuesday, March 10, 2015 Medical Issues • Lack of support from admin to change the system and ensure appropriate screening – PHQ Story – PCP not talking to me for 2 years – Written up • Requires a culture shift in medicine • Medical providers seek out guidance from behaviorist for difficult patient issues ACHIEVING ZERO SUICIDE FOR OUR INLAND NORTHWEST COMMUNITIES Tuesday, March 10, 2015 Medical Providers • Up to 50% of pts present with unfounded psychosomatic complaints at any given time (Edwards, 2010) • Bulk of psychopharmacology medications are prescribed by primary care • Under skilled at treating mental health issues • Under skilled at suicide management • Under skilled at difficult conversations (saying no) • Under skilled at managing difficult patients • Improved skill increases provider & pt satisfaction – Improves litigious actions – Improves safety ACHIEVING ZERO SUICIDE FOR OUR INLAND NORTHWEST COMMUNITIES Tuesday, March 10, 2015 Coaching Model • Initially assigned 4 medical providers – 2 MDs that precepted 2 new mid-level providers • Meet biweekly for 3 mths and then monthly after that for up to 1 year • Shadowing providers 0, 3, 6, 12 mths • Pre/post screening questionnaire • Within 1 quarter patient satisfaction scores improved for established providers by 20+% ACHIEVING ZERO SUICIDE FOR OUR INLAND NORTHWEST COMMUNITIES Tuesday, March 10, 2015 Coaching Model • Notable benefits on provider/staff relationships – Retention – Job satisfaction – Working at top of license – Improved relationships with providers • Improved competence in area of suicidal ideation, difficult conversations, saying no, agenda setting, etc. ACHIEVING ZERO SUICIDE FOR OUR INLAND NORTHWEST COMMUNITIES Tuesday, March 10, 2015 Coaching Expanded • Model is now expanded to ALL NEW medical providers starting and issues related to satisfaction surveys/evaluations • Incorporate suicide prevention training clinic wide at the time providers/staff start • Expanded to pods/teams • Teaching to Lean / Flow process • Expanded to nurses and medical assistant training in communication with medical providers, running meetings, managing difficult patients ACHIEVING ZERO SUICIDE FOR OUR INLAND NORTHWEST COMMUNITIES Tuesday, March 10, 2015 Coaching into the Future • Transferring medical centers to Confluence Health Systems (5000 employees) • Build a medical provider coaching program for the 1500 medical providers which includes suicide prevention as a regular part of the curriculum • Train psychologists and mental health clinicians as coaches to assist in building the program and working with providers ACHIEVING ZERO SUICIDE FOR OUR INLAND NORTHWEST COMMUNITIES Tuesday, March 10, 2015 • Identify medical providers as leaders to shadow and mentor new providers • Create inpatient/outpatient nursing protocol for suicidal patients ACHIEVING ZERO SUICIDE FOR OUR INLAND NORTHWEST COMMUNITIES Tuesday, March 10, 2015 Julie A. Rickard, PhD Physician & Healthcare Coaching jrickard@charter.net 509-881-8193 ACHIEVING ZERO SUICIDE FOR OUR INLAND NORTHWEST COMMUNITIES Tuesday, March 10, 2015 References 1.Bandura (1977). Social Learning Theory 2.Edwards, T. et al. (2010). The treatment of patients with medically unexplained symptoms in primary care: a review of the literature. Mental Health Family Medicine. 2010 Dec; 7(4): 209–221. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3083260/. 3.Fazekas, et al. (2009). Psychosomatic medicine in primary care: influence of training. 4.Kohn, A. (April 2014). Brain Science: Overcoming the Forgetting Curve. Learning Solutions Magazine. http://www.learningsolutionsmag.com/articles/1400/brainscience-overcoming-the-forgetting-curve. ACHIEVING ZERO SUICIDE FOR OUR INLAND NORTHWEST COMMUNITIES Tuesday, March 10, 2015