title: Assessing Variability and Implementation Fidelity of Suicide Prevention Safety Planning in a Regional VA Healthcare System.
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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1 National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.|2 Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.|5 Department of Psychology, University of California, Los Angeles, CA, USA.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Gamarra
authors.affiliation: 1 National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.|4 Department of Psychology, University of Memphis, TN, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Luciano
authors.affiliation: 1 National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.|2 Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.|3 Department of Psychiatry and Epidemiology, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Jaimie L
authors.initials: JL
authors.lastname: Gradus
authors.affiliation: 1 National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.|2 Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.|6 National Center for PTSD, VA Palo Alto Healthcare System, Palo Alto, CA, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Wiltsey Stirman
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000592:standards*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011787:Quality of Health Care; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards*; D014728:Veterans; D055815:Young Adult; D000092864:Suicide Prevention
keywords: fidelity; safety plan; suicide; veterans