Measurement-Based Care for Suicide Risk Assessment and Management: Clinician and Client Experiences

Background and Purpose: Measurement-based care (MBC), involving the collection and collaborative discussion of patient-report outcome measures (PROMs), is widely supported to improve clinical outcomes and considered a gold-standard in mental health care. However, MBC is not widely implemented across the behavioral health field and negative sentiments persist among both mental health patients and clinicians. Further, research regarding its utility in the context of suicidality remains limited. This presentation explores the implementation of MBC and its role in facilitating suicide prevention interventions in Cohen Veterans Network (CVN), a community-based mental health network serving veterans, service members, and their families. Measurement-based care is a core aspect of the CVN model, with clients who screen at elevated (moderate or high) risk receiving and discussing weekly measures assigned based on mental health diagnoses.

Methods: Data for this presentation are drawn from two components of a multi-year study to enhance CVN’s suicide prevention ecosystem. Seventeen clinicians and eleven former clients who received a high-risk for suicide flag during care participated in 1-hour semi-structured interviews. Both groups were asked about their perspectives on the integration of standardized measures during care, with both groups identifying elements of MBC as the primary benefits of measure integration. Primary thematic analyses of interview data from participant groups produced themes relating to the utility of MBC in suicide prevention interventions. Given these initial findings, a secondary analysis was performed on the combined dataset to identify shared and diverging experiences with applications of MBC in the context of suicidality.

Results: Secondary thematic analysis revealed shared experiences and perspectives on MBC frameworks in the context of suicide prevention among mental health clinicians and elevated-risk clients. Standardized measures were identified by both groups as important tools to identify symptoms, track symptom changes, and normalize clinical discussions of suicidal thoughts and behaviors. Further, both groups emphasized the intervention value of the “share” and “act” stages of MBC. Integrating reviews of PROMs in clinical discussions created opportunities for deeper conversation, facilitated self-reflection and identification of treatment progress, and fostered opportunities to build resilience and coping skills. Additionally, clinician perspectives included reflections on MBC as a support tool to ensure comprehensive assessments, improve documentation and facilitate communication within care teams. Client perspectives included discussions of initial hesitancies towards standardized measures and actions taken by clinicians to address these hesitancies. Analysis is on-going with theme generation underway.

Conclusions: These findings demonstrate that MBC frameworks can play a meaningful role in clinical management and intervention for suicidality beyond risk assessment, with benefits for both clinicians and elevated-risk clients. Recommendations for clinical implementation include utilizing measure results in session by visually displaying changes in relevant scores and by linking scores and symptoms to prior weeks. Delivery of standardized measures should be done in ways that emphasize active listening and maintain human connection. As a part of broader suicide prevention strategies, MBC has the potential strengthen therapeutic alliance, support proactive interventions, and empower clients to identify and address drivers of suicidal ideation.