Pre-post quiz data from the Devereux Foundation

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Pre-post quiz data from the Devereux Foundation

• The following slides are used with the permission
  of the Devereux Foundation, Inc. These data were
  presented at the Spring 2003 annual meeting of
  the American Association of Suicidology, Santa
  Fe, New Mexico.
• The QPRT mentioned is the suicide risk assessment
  inventory (with training), and the quiz scores
  bar-graphed are on pre-post, pass-fail
  performance on our standardized quiz.
• For questions regarding this data and the
  Devereux Suicide Risk Reduction Program (DSRRP)
  please contact Paul LeBuff at 610-542-309

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Best Practices for Suicide Risk Management
Four Goals of the DSRRP

• Suicide prevention training for all Devereux
  staff
• Suicide risk assessment training for all
  clinicians
• Suicide risk assessments for all Devereux clients
• Crisis Response Plans

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Administrative Orientation, Policy and QI Function
Suicide Risk Reduction Installation
Clinical Supervisors 8 Hour QPRT
Course Supervisor's Package

• everyone receives training
• training is mandatory
• competency is required

All Staff 1 Hour - QPR
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Best Practices for Suicide Risk
Goal 1 - Question, Persuade, Refer (QPR)

• Research based
• Recognized by Joint Commission as a best
  practice
• Received the Negley Award
• Reviewed by expert clinicians and lawyers
• Developed by the QPR Institute, Spokane, WA

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Best Practices for Suicide Risk Management
Goal 2 - Train all Clinicians in Suicide Risk
Assessment

• Utilize the QPR Institutes QPRT System
• Mandated of all Devereux clinicians
• 8-hour training program
• Competency based
• Post-test of knowledge
• Skill demonstration

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Best Practices for Suicide Risk Management
QPRT Protocol

• Structured interview
• Interpersonal, existential and phenomenological
  focus
• limitations of risk factor approach
• limitations of rating scales
• Dual goal of detecting risk and producing
  required documentation to reduce malpractice
  exposure
• Pediatric Adult forms for inpatient and
  outpatient settings

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Best Practices for Suicide Risk Management
Goal 3 - Formally Assess all Clients for Suicide
Risk

• At admission
• At discharge
• At significant transitions during treatment
• change in risk factors
• change in placement/caregivers
• Documented in core clinical record

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QPRT Monitoring Procedures

• Semiannual document peer review for psychiatrists
• Semiannual document supervisor review for all
  others
• Incorporation of reviews in recredentialing
• QPRT part of annual Gap Analysis
• Monitoring of Major Risk Events for increases or
  decreases in rates of suicidal injury as measure
  of risk reduction program effectiveness. Results
  captured in appropriate meeting notes (QM, Risk
  Management Committee, Medical staff, etc.)

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Pre-Test Results by Job Title (N1,100)
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Post-Test Results by Job Title (N 1,100
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Devereux Results

• Effects on suicide rate (low base rate)? No
  suicides following proper QPRT in active patients
  over 4 years (average daily census 17,000)
• Crisis Response Plans improved staff response
• QPRT has helped identify clients at risk
• Client with autism
• Dispelled myths about individuals with MR
• Established standard of care
• QPR heightened staff awareness and increased
  confidence
• Helped avert 4 staff suicides (5,000 plus staff)