Methods: Data are drawn from the first phase of a multiyear study designed to adapt and test the Family-Based Crisis Intervention for Suicidal Adolescents, a brief ED-based intervention for suicidal adolescents and their families, for use in Primary Care (FBCI-PC). In Phase 1, the investigative team conducted qualitative interviews with N=25 integrated behavioral health (IBH) stakeholders (primary care physicians, nurses, and social workers), all of whom are primary care providers, from four geographically unique primary care practices located across the state of Massachusetts to explore their experiences of working with suicidal patients in primary care settings, current practice protocols and processes related to suicide screening and assessment and intervention in the primary care setting). All interviews were audiorecorded and transcribed verbatim. Data were analyzed using thematic analysis (Braun & Clarke, 2006), utilizing conceptually clustered matrices for comparative analyses (Miles, Huberman, & Saldana, 2014).
Results: Findings revealed variability in practices related to suicide screening, prevention and intervention across the four primary care settings. These approaches were influenced substantially by the following four domains: a) availability of internal and external resources (e.g., staffing, protected time allocated for crisis management, supervision, proximity to additional supports), b) stage of IBH rollout and quality of relationship with behavioral health team, c) IBH clinician experience and comfort with working with suicidal adolescents and their families, and d) the degree to which practice leadership, which in all cases were primary care physicians without behavioral health specialized training, were knowledgeable about suicide risk assessment and treatment.
Implications: This study provides new knowledge about the experiences of primary care physicians, nurses and social workers in integrated behavioral health settings with respect to detecting and treating suicide risk in adolescents. Findings suggest intervention targets for providers (e.g., knowledge of best practice with suicidal youth) and primary care clinics (e.g., detection and referral to behavioral health clinicians) that would promote provider delivery of a primary-care setting based intervention. Such considerations are critical to inform the adaptation of EBP for suicidal adolescents for use in primary care settings.