MIRECC / CoE

Recommendation Resources

Following discharge from acute services (e.g., emergency department [ED], inpatient), brief contact interventions are sometimes offered to patients. These interventions may involve psychoeducation, ongoing suicide risk assessment, safety planning, and treatment engagement support. The World Health Organization Brief Intervention and Contact (WHO BIC) treatment is one such intervention. It involves brief contacts during the high-risk time following an ED visit for a suicide attempt. The goals are to enhance treatment engagement, build self-efficacy and increase social support.

• Training/Clinical Resources
• Books
• Webinars
• Articles

Training and Clinical Resources

This section includes recommended trainings and/or clinical resources about brief contact interventions.

WHO-BIC

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The WHO BIC Program Content

WHO BIC Program Goals

• Enhance engagement
• Build self-efficacy
• Motivational Interviewing
• Increase social supporting

Brief Educational Intervention

• 1 hour; prior to discharge
• Education on suicide risk
• MI and Self-efficacy

Program Logistics

• WHO BIC Provider is a person with clinical training (e.g.nurse, psychologist, psychiatrist)
• In-person or phone

9 Follow-up Contacts

• 9 follow-up contacts in first 18 months after discharge
• MI and Self-efficacy
• Professional Support

• The WHO BIC intervention starts with an individual educational session as close to the time of ED discharge as possible. Afterwards, nine follow up contacts are conducted over eighteen months.
• Sessions can be offered in person or by telephone by a variety of professionally trained mental health providers (psychiatrist, psychologist, nurse, social worker).

Home-Based Mental Health Evaluation (HOME) Program

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HOME

Home-based Mental Health Evaluation

1. Enrollment while on the inpatient unit
2. Telephone follow-up within one day of discharge
3. Home visit during first week post-discharge
4. Ongoing telephone follow-up until engaged in care

Each post-discharge contact includes:

1. Suicide risk assessment
2. Review and update of Safety Plan
3. Appointment reminders
4. Identify and problem-solve around barriers to care

Veterans who participated in the HOME Program were more likely to engage in care, engaged in care more quickly, and attended more individual outpatient appointments in the 90 days post-discharge (Matarazzo et al., 2019).

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Efficacy of the Home-Based Mental Health Evaluation (HOME) Prgram for Engaging Patients in Care After Hospitalization (Matarazzo, et al 2019, Rocky Mountain MIRECC)

(n=302 patients admitted to inpatient psyciatric unit)

Background:

• Suicide risk is increased post-psyc hospitalization
• Lack of treatment engagement posthospitalization is associated with suicide

Current Study:

Home Program

• Phone- and home-based contacts
• Safety planning
• Problem solving (barriers to care)
• Suicide risk assessment

vs. Enhanced care as usual

Results:

HOME participants

• 1.33x more likely to engage in Treatment
• Engaged in treatment more quickly
• Attended 55% more individual appointments
• Attended 68% more group appointments

If you are interested in the HOME Program Manual or training, please email srmconsult@va.gov.

Books

This section includes recommended books about offering brief contact interventions.

Wasserman, Danuta (ed.), Oxford Textbook of Suicidology and Suicide Prevention, 2 end, Oxford Textbooks in Psychiatry (Oxford, 2021; online edn, Oxford Academic, 1 Jan. 2021).

Webinars

This section includes recommended webinars about brief contact interventions.

WHO-BIC as a Strategy to Prevent Suicide Presented by Dr. Natalie Riblet

Home Visits as a Suicide Prevention Strategy Presented by Dr. Bridget Matarazzo

Articles

This section includes recommended articles about brief contact interventions.

Fleischmann, A., Bertolote, J. M., Wasserman, D., De Leo, D., Bolhari, J., Botega, N. J., De Silva, D., Phillips, M., Vijayakumar, L., Värnik, A., Schlebusch, L., & Thanh, H. T. (2008). Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries. Bulletin of the World Health Organization, 86(9). 703–709. https://doi.org/10.2471/blt.07.046995

Matarazzo, B. B., Forster, J. E., Hostetter, T. A., Billera, M., Adler, G., Ganzini, L. K., Oslin, D. W., & Brenner, L. A. (2019). Efficacy of the Home-Based Mental Health Evaluation (HOME) Program for Engaging Patients in Care After Hospitalization. Psychiatric services (Washington, D.C.). 70(12), 1094-1100. https://doi.org/10.1176/appi.ps.201900002

Mousavi, S. G., Zohreh, R., Maracy, M. R., Ebrahimi, A., & Sharbafchi, M. R. (2014). The efficacy of telephonic follow up in prevention of suicidal reattempt in patients with suicide attempt history. Advanced biomedical research, 3. 198. https://doi.org/10.4103/2277-9175.142043

Riblet, N. B., Kenneally, L., Stevens, S., Watts, B. V., Gui, J., Forehand, J., Cornelius, S., Rousseau, G. S., Schwartz, J. C., & Shiner, B. (2022). A virtual, pilot randomized trial of a brief intervention to prevent suicide in an integrated healthcare setting. General hospital psychiatry, 75. 68–74. https://doi.org/10.1016/j.genhosppsych.2022.02.002

Riblet, N. B., Shiner, B., Schnurr, P., Bruce, M. L., Wasserman, D., Cornelius, S., Scott, R., & Watts, B. V. (2019). A Pilot Study of an Intervention to Prevent Suicide After Psychiatric Hospitalization. The Journal of nervous and mental disease, 207(12). 1031-1038. https://doi.org/10.1097/NMD.0000000000001061

Riblet, N., Shiner, B., Scott, R., Bruce, M. L., Wasserman, D., & Watts, B. V. (2019). Exploring Psychiatric Inpatients' Beliefs About the Role of Post-discharge Follow-up Care in Suicide Prevention. Military medicine, 184(1-2). e91-e100. https://doi.org/10.1093/milmed/usy129

Riblet, N. B., Stevens, S. P., Watts, B. V., Gui, J., Forehand, J., Cornelius, S., Powell, R., Lewicki, K., Wasserman, D., & Shiner, B. (2021). A Pilot Randomized Trial of a Brief Intervention to Prevent Suicide After Inpatient Psychiatric Discharge. Psychiatric services (Washington, D.C.), appips202000537. Advance online publication. https://doi.org/10.1176/appi.ps.202000537