Assessing Variability and Implementation Fidelity of Suicide Prevention Safety Planning in a Regional VA Healthcare System

Gamarra, Jennifer M.; Luciano, Matthew T.; Gradus, Jaimie L.; Wiltsey Stirman, Shannon

doi:10.1027/0227-5910/a000345

Cited by 107Suicide and Self-Harm StudiesPsychiatric care and mental health servicesHealth Policy Implementation Science

Assessing Variability and Implementation Fidelity of Suicide Prevention Safety Planning in a Regional VA Healthcare System

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Gamarra, Jennifer M., Luciano, Matthew T., Gradus, Jaimie L., Wiltsey Stirman, Shannon·2015·Crisis

DOI 10.1027/0227-5910/a000345PMC PMC4675034

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Abstract

BACKGROUND: In 2008, the Veterans Health Administration (VHA) implemented the use of safety planning for suicide prevention. A safety plan is a list of strategies, developed collaboratively with a provider, for a patient to use when suicide risk is elevated. Despite the use of safety plans in VHA, little is known about implementation fidelity, the extent to which safety plans are delivered as intended, or patient-level outcomes of safety planning. AIMS: This study aimed to explore the implementation fidelity of safety planning in a regional VHA hospital and examine the associations between safety plan quality and completeness with patient outcomes. METHOD: A comprehensive chart review was conducted for patients who were flagged as high risk for suicide (N = 200). Completeness and quality were coded, as well as information about patient and provider interactions regarding safety plan use. RESULTS: Safety plans were mostly complete and of moderate quality, although variability existed, particularly in quality. Limited evidence of follow-up regarding safety planning was found in the medical charts. Higher quality was associated with fewer subsequent psychiatric hospitalizations. CONCLUSION: Variability in implementation fidelity and infrequent follow-up suggest a need for additional training and support regarding the use of safety plans for suicide prevention.

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Authors: Gamarra, J. M., Luciano, M. T., Gradus, J. L., & Wiltsey Stirman, S.
Affiliations: Boston University (US)
VA Boston Healthcare System (US)
National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
ORCID: Luciano, Matthew T.
Gradus, Jaimie L.
Venue: Crisis
Publisher: Hogrefe Publishing Group
Published: 2015-11
Volume: 36
Issue: 6
Pages: 433-439
ISSN: 0227-5910 (ISSN-L)
2151-2396
DOI: 10.1027/0227-5910/a000345
PMC: PMC4675034
OpenAlex: W2196257019
Cited by: 107
References: 16
Citations by year: 2026: 14 · 2025: 18 · 2024: 22 · 2023: 12 · 2022: 8 · 2021: 13 · 2020: 6 · 2019: 11 · 2017: 2 · 2016: 1
FWCI: 1.24
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Crisis (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Mental Health (R00MH080100, R21MH099169, R25MH080916)
Topics: Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords: suicide prevention, safety planning, implementation fidelity, Veterans Health Administration, veterans, suicide risk, psychiatric hospitalization, follow-up, provider-patient interaction, implementation variability
MeSH terms: Suicide Prevention, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Pilot Projects, Quality of Health Care, United States, United States Department of Veterans Affairs, Veterans, Advance Care Planning, Young Adult

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Assessing Variability and Implementation Fidelity of Suicide Prevention Safety Planning in a Regional VA Healthcare System

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