Clinician Perspectives on Suicide Safety Planning and Its Implementation

Abstract

Objective

The safety planning intervention is an evidence-based practice shown to reduce suicide risk, but implementation of high-quality safety planning has proven challenging. We aimed to understand clinician perspectives on the safety planning intervention to inform future implementation efforts.

Method

This cross-sectional survey of clinicians who care for patients at risk of suicide in an academic medical center asked about comfort levels and fidelity to components of the safety planning intervention and assessed implementation barriers and facilitators. We used exploratory data analysis and regression analysis to explore clinician perspectives and assess the relationship between formal training and implementation.

Results

Ninety-two clinicians responded to the survey. Two-thirds of participants (64.9%) endorsed using all six core elements of the safety planning intervention. Participants who reported receiving formal training in safety planning were significantly more likely to report being comfortable completing a safety plan (p < .001); those with higher levels of comfort were significantly more likely to endorse using all of the core elements of the safety planning intervention (p < .001).

Conclusions

Training in the evidence-based safety planning intervention is associated with clinician comfort and awareness of the core elements of the intervention. Our results suggest that there are gaps in clinician training and that formal safety planning intervention training could have a positive effect on clinician comfort and treatment fidelity.

Keywords:

• Clinician education
• implementation science
• safety planning
• suicide prevention

ACKNOWLEDGMENTS

Not applicable.

ETHICAL APPROVAL

The study was reviewed and declared non-human subjects research by the Institutional review board at the Johns Hopkins Bloomberg School of Public Health (#18681). Participants completed a brief online consent form before completing the survey.

AUTHOR CONTRIBUTIONS

Emily E. Haroz: conceptualization, methodology, writing-original draft preparation; Mira Bajaj: data analysis, methodology, writing-original draft preparation; Paul Nestadt and John Campo: writing-reviewing and editing; Holly Wilcox: conceptualization, writing-reviewing and editing.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

DATA AVAILABILITY STATEMENT

The datasets used during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

E.E.H. and the research reported in this publication was supported by the National Institute Of Mental Health of the National Institutes of Health under Award Number K01MH116335. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. J.V.C. and H.C.W. are supported by the Patient-Centered Outcomes Research Institute (PCORI) (contract CER 2021C3-25009).

Notes on contributors

Emily E. Haroz

Emily E. Haroz, PhD, MHS, MA, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA and Department of International Health, Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

Mira A. Bajaj

Mira A. Bajaj, BA, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.

Paul S. Nestadt

Paul S. Nestadt, MD and Holly C. Wilcox, PhD, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA and Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.

John V. Campo

John V. Campo, MD, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.

Holly C. Wilcox

Paul S. Nestadt, MD and Holly C. Wilcox, PhD, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA and Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.