Implementation Science in Suicide Prevention.

The COVID-19 pandemic of 2020 is a major global health challenge. At the time of writing, over 11.6 million people around the world had been registered as infected and 538,000 had died (Worldometers, 2020, accessed July 7, 2020). Public health responses to COVID-19 need to balance direct efforts to control the disease and its impact on health systems, infected people, and their families with the impacts from associated mitigating interventions. Such impacts include social isolation, school closure, health service disruption stemming from reconfiguring health systems, and diminished economic activity. The primary focus of both the United Nations (UN) and the World Health Organization (WHO) has been on addressing COVID-19 as a physical health crisis, but the need to strengthen mental health action, including suicide prevention, is increasingly recognized, as is the need for mental health research to be an integral part of the recovery plan (UN, 2020a). The impacts of the pandemic on physical and mental health will unfold differently over time and will vary depending on the duration and fluctuating intensity of the disease. Research is needed to help ensure that decision-making regarding all aspects of health, including mental health (Holmes et al., 2020), is informed by the best quality data at each stage of the pandemic. The pandemic poses a prolonged and unique challenge to public mental health, with major implications for suicide and suicide prevention (Gunnell et al., 2020; Reger, Stanley, & Joiner, 2020). A rise in suicide deaths in the wake of the pandemic is not inevitable. There is consensus, however, that the mitigation of risk will be contingent upon a proactive and effective response involving collaborative work between the state, NGOs, academia, and local governments and coordinated leadership across government ministries, including health, education, security, social services, welfare, and finance. Countries have responded in different ways to the pandemic, effectively creating a series of natural experiments. Thus, regions of the world affected later in the pandemic can draw on lessons from countries, such as China and Italy, affected in its early phase. Likewise, lessons learned early in the pandemic (e.g., on the impact of lockdown and physical distancing measures) can be used to inform responses to any future surges in the incidence of COVID-19. Although there are important parallels between countries in the course of the pandemic, some stressors, responses, and priorities are likely to differ between high- and low–middle-income countries and between cultures and regions. As COVID-19 appears to be disproportionately affecting Black, Asian, and minority ethnic communities, the response – and suicide prevention research carried out to inform the response – needs to be sufficiently granular and account for the complexity of risks in these groups (O'Connor et al., 2020). Throughout this editorial, when we refer to suicide and suicidal behavior, we mean to include both fatal and nonfatal suicidal behaviors and self-harm.

Suicide Prevention in an International Context.

Suicide research and prevention are complex. Many practical, methodological and ethical challenges must be overcome to implement effective suicide prevention interventions. Implementation science can offer insights into what works, why and in what context. Yet, there are limited real-world examples of the application of implementation science in suicide prevention. This study aimed to identify approaches to employ principles of implementation science to tackle important challenges in suicide prevention. A questionnaire about promoting implementation science for suicide prevention was developed through thematic analysis of stakeholder narratives. Statements were categorised into six domains: research priorities, practical considerations, approach to intervention design and delivery, lived experience engagement, dissemination and the way forward. The questionnaire (n=52 statements-round 1; n=44 statements-round 2; n=9 statements-round 3) was administered electronically to a panel (n=62-round 1, n=48-round 2; n=45-round 3) of international experts (suicide researchers, leaders, project team members, lived experience advocates). Statements were rated on a Likert scale based on an understanding of importance and priority of each item. Statements endorsed by at least 85% of the panel would be included in the final guidelines. Eighty-two of the 90 statements were endorsed. Recommendations included broadening research inquiries to understand overall programme impact; accounting for resources in the translation of evidence into practice; embedding implementation science in intervention delivery and design; meaningfully engaging lived experience; considering channels for dissemination of implementation-related findings and focusing on next steps needed to routinely harness the strengths of implementation science in suicide prevention research, practice and training. An interdisciplinary panel of suicide prevention experts reached a consensus on optimal strategies for using implementation science to enhance the effectiveness of policies and programmes aimed at reducing suicide.

A Global Call for Action to Prioritize Healthcare Worker Suicide Prevention During the COVID-19 Pandemic and Beyond.

Background: Tailoring implementation strategies to local contexts is a promising approach to supporting implementation and sustainment of evidence-based practices in health settings. While there is increasing research on tailored implementation of mental health interventions, implementation research on suicide prevention interventions is limited. This study aimed to evaluate implementation and subsequently develop a tailored action plan to support sustainment of an evidence-based suicide prevention intervention; Collaborative Assessment and Management of Suicidality (CAMS) in an Australian public mental health service. Methods: Approximately 150 mental health staff working within a regional and remote Local Health District in Australia were trained in CAMS. Semi-structured interviews and focus groups with frontline staff and clinical leaders were conducted to examine barriers and facilitators to using CAMS. Data were analysed using a reflexive thematic analysis approach and mapped to the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and followed by stakeholder engagement to design a tailored implementation action plan based on a 'tailored blueprint' methodology. Results: A total of 22 barriers to implementing CAMS were identified. Based on the perceived impact on implementation fidelity and the feasibility of addressing identified barriers, six barriers were prioritised for addressing through an implementation action plan. These barriers were mapped to evidence-based implementation strategies and, in collaboration with local health district staff, goals and actionable steps for each strategy were generated. This information was combined into a tailored implementation plan to support the sustainable use of CAMS as part of routine care within this mental health service. Conclusions: This study provides an example of a collaborative approach to tailoring strategies for implementation on a large scale. Novel insights were obtained into the challenges of evaluating the implementation process and barriers to implementing an evidence-based suicide prevention treatment approach within a geographically large and varied mental health service in Australia. Plain language abstract: This study outlines the process of using a collaborative stakeholder engagement approach to develop tailored implementation plans. Using the Exploration Preparation Implementation Sustainment Framework, findings identify the barriers to and strategies for implementing a clinical suicide prevention intervention in an Australian community mental health setting. This is the first known study to use an implementation science framework to investigate the implementation of the clinical suicide prevention intervention (Collaborative Assessment and Management of Suicidality) within a community mental health setting. This work highlights the challenges of conducting implementation research in a dynamic public health service.

A Public Health, Whole-of-Government Approach to National Suicide Prevention Strategies

In this editorial, we discuss how mobile phone technology has the potential to move the field forward in terms of understanding suicide risk as well as laying foundations for the development of effective treatments/interventions. We have focused on mobile health technology given the rapid growth of mobile health approaches in suicide prevention (De Jaegere & Portzky, 2014; Mishara & Kerkhof, 2013) and psychological research more generally (Myin-Germeys et al., 2009; Nock, Prinstein, & Sterba, 2009; Palmier-Claus et al., 2011) and because mobile phone use is ubiquitous, with 75% of the world having access to a mobile phone (Kay, 2011). (aut. ref.)

Suicide research and prevention in developing countries in Asia and the Pacific

Scaling-up Evidence-based Interventions for Communities of Color With Marked Health Disparities: Lessons Learned From COVID-19 Can Be Applied to Reduce Morbidity and Mortality and Achieve Health Equity.

Methodological Issues in Child Welfare and Children’s Mental Health Implementation Research

The past decade of research has continued to identify and understand health disparities for cancer prevention and control. Although emerging, progress in addressing these disparities continues to fall short achieving equity. Specifically, for cancer prevention and control, Khan and colleagues in 2021 showed a 15-year lag in implementation of evidence-based interventions (i.e., HPV vaccinations, cancer screenings, etc.). This gap highlights the lack of attention towards the implementation of scientific evidence, the complexity and fragmentation of health systems, and lays bare the structural causes of inequities that continue to persist from a population perspective. Integrating implementation science in cancer prevention and control research can provide a pathway to reduce the time to translation while addressing and advancing cancer equity. Implementation science is defined as the study of methods to promote the adoption and integration of evidence-based practices, interventions, and policies into routine health care and public health settings to improve the impact on population health. Implementation science has pushed the cancer prevention and control field to pay close attention to how we dissemination scientific information towards the adoption of interventions (i.e., dissemination research) and how we systematically study strategies (i.e., the building blocks) that aid in the implementation, scale-up, and sustainability of interventions (i.e., implementation science). With implementation research, there has been a push towards hybrid designs that considers intervention effectiveness and its implementation within the same study. Given the dearth of literature around the implementation of interventions, the science of implementation continues to build on a foundational theoretical base that further provide important opportunities for the promoting equitable outcomes for cancer prevention and control research. In this educational session, we will discuss why and how applying a health equity lens to implementation science is crucial to achieve equity in cancer prevention and control. Using ongoing and completed research studies as examples, this session will help attendees learn about core elements of implementation science including theories, models, and frameworks; implementation strategies; and focal areas of adaptations and de-implementation. Citation Format: Prajakta Adsul. Implementation science as an opportunity to address cancer equity [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA019.

Population health outcome models in suicide prevention policy.

BackgroundImplementation strategies can be a vital leveraging point for enhancing the implementation and dissemination of evidence-based suicide prevention interventions and programming. However, much remains unknown about which implementation strategies are commonly used and effective for supporting suicide prevention efforts.MethodsIn light of the limited available literature, a scoping review was conducted to evaluate implementation strategies present in current suicide prevention studies. We identified studies that were published between 2013 and 2022 that focused on suicide prevention and incorporated at least one implementation strategy. Studies were coded by two independent coders who showed strong inter-rater reliability. Data were synthesized using descriptive statistics and a narrative synthesis of findings.ResultsOverall, we found that studies most commonly utilized strategies related to iterative evaluation, training, and education. The majority of studies did not include direct measurement of suicide behavior outcomes, and there were few studies that directly tested implementation strategy effectiveness.ConclusionImplementation science strategies remain an important component for improving suicide prevention and intervention implementation. Future research should consider the incorporation of more type 3 hybrid designs as well as increased systematic documentation of implementation strategies.Trial registration < de-identified >

Suicide Prevention Across Countries and Continents: Lessons Learned

BackgroundVariation in the implementation of complex multilevel interventions can impact on their delivery and outcomes. Few suicide prevention interventions, especially multilevel interventions, have included evaluation of both the process of implementation as well as outcomes. Such evaluation is essential for the replication of interventions, for interpreting and understanding outcomes, and for improving implementation science. This paper reports on a process evaluation of the early implementation stage of an optimised suicide prevention programme (OSPI-Europe) implemented in four European countries.MethodsThe process analysis was conducted within the framework of a realist evaluation methodology, and involved case studies of the process of implementation in four European countries. Datasets include: repeated questionnaires to track progress of implementation including delivery of individual activities and their intensity; serial interviews and focus groups with stakeholder groups; and detailed observations at OSPI implementation team meetings.ResultsAnalysis of local contexts in each of the four countries revealed that the advisory group was a key mechanism that had a substantial impact on the ease of implementation of OSPI interventions, particularly on their ability to recruit to training interventions. However, simply recruiting representatives of key organisations into an advisory group is not sufficient to achieve impact on the delivery of interventions. In order to maximise the potential of high level ‘gatekeepers’, it is necessary to first transform them into OSPI stakeholders. Motivations for OSPI participation as a stakeholder included: personal affinity with the shared goals and target groups within OSPI; the complementary and participatory nature of OSPI that adds value to pre-existing suicide prevention initiatives; and reciprocal reward for participants through access to the extended network capacity that organisations could accrue for themselves and their organisations from participation in OSPI.ConclusionsExploring the role of advisory groups and the meaning of participation for these participants revealed some key areas for best practice in implementation: careful planning of the composition of the advisory group to access target groups; the importance of establishing common goals; the importance of acknowledging and complementing existing experience and activity; and facilitating an equivalence of benefit from network participation.