Barriers and Facilitators of Suicide Risk Assessment in an Emergency Department: Perspectives from Health Care Providers

Emergency departments (EDs) are critical sites for identifying patients with heightened suicide risk but there are no practice guidelines for the assessment of such patients. This study aimed to inform ED suicide risk assessment practices by examining ED providers\u27 perspectives on this practice via a mixed methods approach. ED providers (n = 92) from two hospital systems completed an online survey that assessed demographic information, occupational information related to screening for suicide risk and related conditions, attitudes toward suicide prevention, and knowledge of suicide risk factors. A subset of ED providers (n = 19) completed a qualitative interview to gain further information about their views on the barriers and facilitators of suicide risk assessment and their perspectives on the strengths and weaknesses of different assessment methods. The results suggested that negative attitudes toward suicide prevention were related to less knowledge about suicide risk factors. Furthermore, knowledge of suicide risk factors, attitudes toward suicide prevention, and marital status predicted providers\u27 comfort in asking patients about suicidal ideation. Hospital system and provider type were not significantly related to attitudes toward suicide prevention, knowledge of suicide risk factors, or occupational experiences related to assessing suicide-related concerns. Qualitative results suggested that suicide risk assessment practices in EDs should be brief, place little demand on the patient, involve a standardized protocol, and include consultation with others. Findings are further discussed in the context of improving suicide prevention efforts in this critical setting

Psychology Doctoral Students’ Perspectives on Addressing Spirituality and Religion with Clients: Associations with Personal Preferences and Training

Students (n = 543) in doctoral clinical and counseling psychology programs were surveyed about training experiences with regard to addressing the spiritual and religious beliefs and practices (SRBP) of their patients. About one fourth of the respondents indicated they had received no training related to patients’ SRBP. Another half had only read material on their own or discussed such issues with a supervisor. Nonetheless, respondents almost universally endorsed the idea that patients should be asked about spirituality and religiousness. Participants also rated the appropriateness of spiritual and religious queries that might be asked of patients. As expected, queries about the relevance of SRBP were rated as the most appropriate, whereas queries that implied a disrespectful or challenging tone were rated as the least appropriate. Participants’ personal SRBP and training that was specific to patients’ SRBP were weakly but significantly associated with appropriateness ratings. The results suggest that students are formulating ideas about how to ask patients about their spiritual and religious issues despite potentially inadequate formal instruction

Discrepancy between Parents and Children in Reporting of Distress and Impairment: Association with Critical Symptoms

Background: We examined discrepant parent–child reports of subjective distress and psychosocial impairment. Method: Parent–child pairs (N = 112 pairs) completed the Health Dynamics Inventory at intake for outpatient therapy. Results: Average parent scores were significantly higher than average child scores on distress, impairment, and externalizing symptoms, but not internalizing symptoms. There were significant associations between parent–child discrepancy (i.e. children who reported greater distress or impairment than parents or vice versa) and child endorsement of several notable symptoms (rapid mood swings, panic, nightmares, and suicidal ideation). Conclusion: Parents tended to report more externalizing symptoms, distress, and impairment than children reported; however, when children report more distress and impairment than parents, this may indicate serious psychological problems

Communication of Recommendations for the Disposal of Unused Prescription Opioid Medications by Stakeholders in the News Media

Objective The opioid epidemic is a national public health emergency that requires a comprehensive approach to reduce opioid-related deaths. Proper and timely disposal of unused prescription opioids is one method to deter improper use of these medications and prevent overdose. The objective of this study was to understand how recommendations for disposing of unused prescription opioids, including both take-back programs and toilet disposal, are communicated to the public. Methods Two hundred sixty-three US newspaper articles published between January 1, 2014, and June 30, 2017, containing information on opioids and take-back programs were found using LexisNexis. Using content analysis, articles were coded for the presentation of and recommendation for opioid disposal practices, beliefs about environmental harm from toilet disposal, and additional strategies to reduce opioid supply. The entity responsible for the statement was also captured. Results Take-back programs were presented as a recommended disposal strategy for unused prescription opioids in 88.6% of coded articles. Toilet disposal was presented as a recommended disposal strategy for unused prescription opioids in 3.4% of articles and as harmful to the environment in 16.0% of articles. Individuals from health care, government, and law enforcement were primarily involved in discussing opioid disposal practices. Conclusions Although toilet disposal is recommended by the US Food and Drug Administration (FDA) for disposal of unused prescription opioids when a take-back program is not readily available, it was infrequently presented or recommended in news media articles. These results highlight the importance of improving communication of FDA guidelines for opioid disposal in the media, particularly by health care providers, government employees, and law enforcement officials

The Utility of an Efficient Outcomes Assessment System at University Counseling Centers

Due to increased demands placed on university counseling centers (UCCs) in recent years, there is a need for these centers to enhance the efficiency and effectiveness of their psychological services. Regularly monitoring client progress is one approach to increase the likelihood of positive clinical outcomes. This article describes the use of the Behavioral Health Measure–20 (BHM-20; Kopta & Lowry, 2002) in monitoring the progress of 13,803 clients at 23 UCCs across the United States from 2006–2011. Results show that the BHM-20, via the CelestHealth System–MH (CHS-MH), is an effective instrument for the electronic administration, scoring, and tracking of client progress. Overall, clients improved over the course of treatment and the benefit from treatment peaked between 7 to 10 sessions. Three case vignettes using the CHS-MH in patient care are presented. Implications for continuing the use of monitoring individual client change at UCCs are discussed