Symposia
Dissemination & Implementation Science
Marianne Goodman, M.D.
Professor
Icahn School of Medicine at Mount Sinai
Bronx, New York
Sapana Patel, PhD
Associate Professor
Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University; New York State Psychiatric Institute
new York, New York
Background: Minimal evidence exists for “suicide-specific” group treatment for high-risk patients offered over telehealth. This qualitative study assessed the acceptability, feasibility, safety, impact and implementation of telehealth delivery of Project Life Force (PLF); a group adaptation of dialectical behavior therapy (DBT) + suicide safety planning (SSP) intervention.
Methods: High-risk suicidal Veterans (n=17) participating in “Project Life Force- telehealth” (PLF-T); a manualized, 10-session SSP +DBT group completed semi-structured qualitative interviews focusing on PLF-T including measures of acceptability and feasibility (Weiner et al., 2017). Informed by the Consolidated Framework for Implementation Research (Damschroder et al., 2009), we conducted interviews with PLF-T therapists and coordinator about barriers and facilitators to implementing PLF-T. A directed content analysis approach (Hsieh & Shannon, 2005) was used to analyze qualitative data.
Results: Veteran participants were male (88%), age 50 (SD=15.6), ethnically diverse and either divorced or separated (54%). Suicide symptom severity upon study entry included past month ideation with methods consideration (100%) and past year aborted, interrupted or actual suicide attempt (59%).
Qualitative interviews revealed overall positive endorsement of telehealth delivery of PLF with enhanced suicidal disclosure, improved ability to manage urges and mitigate loneliness. Rated as highly acceptable with a range of 0-20, (M=17.50; SD=2.92) and feasible (M=18; SD=2.45), PLF-T provided enhanced convenience and access without compromising safety. Concerns over privacy, technological limitations including connectivity were identified. Adaptations to deliver PLF-T included using a communications coordinator to conduct assertive outreach to facilitate engagement and access, instituting a telehealth orientation session and restructuring sessions to review suicide severity and screensharing safety plans to maximize learning.
Conclusions: Suicide-specific group therapy combining suicide safety planning and DBT skills can be delivered effectively and safely over telehealth with some modification. This opens the possibility of delivery to hard-to-reach high-risk populations.