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					   Pre-post quiz data from the Devereux
                Foundation
The following slides are used with the permission of the
  Devereux Foundation, Inc. These data were presented at the
  Spring 2003 annual meeting of the American Association of
  Suicidology, Santa Fe, New Mexico.

The QPRT mentioned is the suicide risk assessment inventory
  (with training), and the quiz scores bar-graphed are on pre-
  post, pass-fail performance on our standardized quiz.

For questions regarding this data and the Devereux Suicide Risk
  Reduction Program (DSRRP) please contact Paul LeBuff at
  610-542-309
     Best Practices for Suicide Risk
Four Goals of the DSRRP
                     Management
     Suicide prevention training for all Devereux
      staff

     Suicide risk assessment training for all
      clinicians

     Suicide risk assessments for all Devereux
      clients

     Crisis Response Plans
                                            Administrative
                                             Orientation, Policy
Suicide Risk Reduction Installation           and QI Function

                                        Clinical Supervisors
 everyone receives training            8 Hour QPRT Course
 training is mandatory                    +Supervisor's Package
 competency is required
                                         First Line Rx Staff
                               (not responsible for suicide risk assessment)
                                         8-hour Triage Training


                                               All Staff
                                             1 Hour - QPR
      Best Practices for Suicide Risk
Goal 1 - Question, Persuade, Refer (QPR)


        Research based

        Recognized by Joint Commission as a best
         practice

        Received the Negley Award

        Reviewed by expert clinicians and lawyers

        Developed by the QPR Institute, Spokane, WA
 Best Practices for Suicide Risk
         Management
Goal 2 - Train all Clinicians in Suicide Risk
Assessment

    Utilize the QPR Institute’s QPRT System

    Mandated of all Devereux clinicians

    8-hour training program

    Competency based
        Post-test of knowledge
        Skill demonstration
    Best Practices for Suicide Risk
QPRT Protocol
              Management
     Structured interview

     Interpersonal, existential and
      phenomenological focus
          limitations of risk factor approach
          limitations of rating scales

     Dual goal of detecting risk and producing
      required documentation to reduce
      malpractice exposure
Best Practices for Suicide Risk
        Management
     Goal 3 - Formally Assess all Clients for Suicide Risk

   At admission

   At discharge

   At significant transitions during treatment
        change in risk factors
        change in placement/caregivers

   Documented in core clinical record
       QPRT Monitoring Procedures
   Semiannual document peer review for psychiatrists
   Semiannual document supervisor review for all others
   Incorporation of reviews in recredentialing
   QPRT part of annual Gap Analysis
   Monitoring of Major Risk Events for increases or
    decreases in rates of suicidal injury as measure of risk
    reduction program effectiveness. Results captured in
    appropriate meeting notes (QM, Risk Management
    Committee, Medical staff, etc.)
             Pre-Test Results by Job Title (N=1,100)
                 Failed   Passed    Did not take
100

90
80

70
60

50
40
30
20

10
 0
      Psy   SW    Psych     Therapist    Nurse     Intern   Other
                 Post-Test Results by Job Title (N = 1,100
                    Failed   Passed   Did not take
100
 90
 80
 70
 60
 50
 40
 30
 20
 10
  0
      Psy   SW       Psych    Therapists     Nurse   Intern   Other
                    Devereux Results
   Effects on suicide rate (low base rate)? No suicides
    following proper QPRT in active patients over 4 years
    (average daily census = 17,000)
   Crisis Response Plans improved staff response
   QPRT has helped identify clients at risk
       Client with autism
       Dispelled myths about individuals with MR
       Established standard of care
   QPR heightened staff awareness and increased
    confidence
   Helped avert 4 staff suicides (5,000 plus staff)

				
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