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Section 14
Determine Appropriate Care Setting

Question 14 | Test | Table of Contents

Department of Defense (DoD)

Key Points found in Scroll Box below:
1. Care setting:
-Inpatient hospital wards
-partial hospitalization programs
-outpatient specialty care clinics
-primary care clinics
-emergency departments; and
-numerous care options in deployed situation.
2. Matching Care level to Level of Risk
Level of Risk: High Acute
- Care Level: Emergency Department Evaluation with/without Hospitalization
Level of Risk: Intermediate Acute
- Care Level: Partial Hospitalization or Intensive Outpatient Programs (IOPs)
- Care Level: Outpatient or Integrated Mental Health
Level of Risk: Low Acute
- Care Level: Primary Care Follow-Up and Reassess me
3. Criteria for Transition to Less Restrictive Settings- If all three of the following conditions have been met:
A.Clinician assessment that the patient has no current suicidal intent
AND
B.The patient’s active psychiatric symptoms are assessed to be stable enough to allow for reduction of level of care
AND
C. The patient has the capacity and willingness to follow the personalized safety plan (including having available support system resources)
4. Hospitalization:
-Indications for admission
-Goals of Hospitalization
-Diagnostic Precision
-Treatment Initiation
-Maintenance of Safety
-Indication for Hospitalization
-Potential Harm of Hospitalization
-Suicide during Hospitalization
-Inpatient Treatment Interventions
5. Partial Hospitalization, Intensive Outpatient Program (IOPs)
6. Discharge Planning:
a. Re-assessment of the Suicide Risk
b. Education to patient and support system about the risks of suicide in the post-discharge time frame
c. Providing suicide prevention information (such as a crisis hotline) to the patient and family/unit members.
d. Post-discharge treatment plans for psychiatric conditions and for suicide-specific therapies
e. Safety plan with validation of available support systems
f. Coordination of the transition to appropriate of care setting with warm hand-offs
g. Identifying the responsible provider during the transition
h. Monitoring of adherence to the discharge plan for 12 weeks

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- The Assessment and Management of Risk for Suicide Working Group. (June 2013). VA/DoD Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide. Department of Veterans Affairs, Department of Defense, Version 1.0, p. 59-71.

Updated article...
- The Assessment and Management of Suicide Risk Work Group (2019) VA/DoD Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide. Department of Veterans AffairsDepartment of Defense, Version 2.0, p. 1-142.

The Importance of Active Engagement, Active Rescue,
and Collaboration between Crisis and Emergency Services

Key Points found in Scroll Box below:
1. Defining Imminent Risk
2. Confidentiality Issues
3. Discussion and Implications for Further Work

- Draper, J. Ph.D., Murphy, G. Ph.D., Eduardo, V. MA, Covington D. LPC,MBA, McKeon, R. Ph.D., MPH. Helping Callers to the National Suicide Prevention Lifeline Who Are at Imminent of Suicide: The Importance of Active Engagement, Active Rescue, and Collaboration between Crisis and Emergency Services. The Official Journal of the American Association of Suicidology. June 2015. Pg. 261-270.

Peer-Reviewed Journal Article References:
Dueweke, A. R., & Bridges, A. J. (2018). Suicide interventions in primary care: A selective review of the evidence. Families, Systems, & Health, 36(3), 289–302.

Jobes, D. A., Gregorian, M. J., & Colborn, V. A. (2018). A stepped care approach to clinical suicide prevention. Psychological Services, 15(3), 243–250.

Maragakis, A., Lindeman, S., & Nolan, J. (2018). Evidence based and intensity specific services in the integrated care setting: Ethical considerations for a developing field. Behavior Analysis: Research and Practice, 18(4), 425–435.

QUESTION 14
What is a major barrier in preventing critical information exchanges between crisis centers, external crisis and emergency services, and other third parties? To select and enter your answer go to Test.