A novel engagement of suicidality in the emergency department: Virtual Collaborative Assessment and Management of Suicidality

Dimeff, Linda A.; Jobes, David A.; Chalker, Samantha A.; Piehl, Brian M.; Duvivier, Leticia Lobo; Lok, Benjamin; Zalake, Mohan; Chung, Julie; Koerner, Kelly

doi:10.1016/j.genhosppsych.2018.05.005

Cited by 39 publications

(26 citation statements)

References 39 publications

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“…Marsha Linehan is perhaps the most famous person to poignantly describe her extensive experiences when she was a highly suicidal teenager [37]. In any case, there can be no question that the lived experience movement has had a significant impact on suicide prevention policy making [38], emerging clinical practices, and research (e.g., [39]).…”

Section: Key Developments That May Be Changing Our Mindsetmentioning

confidence: 99%

One Size Does Not Fit All: A Comprehensive Clinical Approach to Reducing Suicidal Ideation, Attempts, and Deaths

Jobes

Chalker

2019

IJERPH

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While the existence of mental illness has been documented for centuries, the understanding and treatment of such illnesses has evolved considerably over time. Ritual exorcisms and locking mentally ill patients in asylums have been fundamentally replaced by the use of psychotropic medications and evidence-based psychological practices. Yet the historic roots of mental health management and care has left a certain legacy. With regard to suicidal risk, the authors argue that suicidal patients are by definition seen as mentally ill and out of control, which demands hospitalization and the treatment of the mental disorder (often using a medication-only approach). Notably, however, the evidence for inpatient care and a medication-only approach for suicidal risk is either limited or totally lacking. Thus, a “one-size-fits-all” approach to treating suicidal risk needs to be re-considered in lieu of the evolving evidence base. To this end, the authors highlight a series of evidence-based considerations for suicide-focused clinical care, culminating in a stepped care public health model for optimal clinical care of suicidal risk that is cost-effective, least-restrictive, and evidence-based.

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Section: Key Developments That May Be Changing Our Mindsetmentioning

confidence: 99%

One Size Does Not Fit All: A Comprehensive Clinical Approach to Reducing Suicidal Ideation, Attempts, and Deaths

Jobes

Chalker

2019

IJERPH

Self Cite

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“…30 The CAMS approach encourages clients to engage in developing their own treatment plan and it can be used within various psychotherapies, including potentially through a virtual interface in EDs. 31 The type and quality of affective, cognitive, and somatic states among those at highest risk of suicide have been previously documented; they include desperation, hopelessness, rage, abandonment, guilt, anxiety, humiliation, sleep disturbance, avolition, and self-hatred. 32,33 substantive training in responding to clients experiencing strong emotions, most Masters-trained practitioners (who are typically the behavioral health specialists working in EDs) report feeling inadequately prepared to work with clients during their periods of highest suicide risk.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Lethal Means Counseling for Suicidal Adults in the Emergency Department: A Qualitative Study

Siry-Bove¹,

Knoepke²,

Ernestus³

et al. 2021

WJEM

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Introduction Lethal means counseling (to reduce access to firearms or other suicide methods) is a recommended critical yet challenging component of care of suicidal patients. Questions remain about communication strategies for those in acute crisis. Methods This qualitative study was an analysis of semi-structured interviews with English-speaking, community-dwelling adults with a history of lived-experience of suicidal ideation or attempts in themselves or a family member. We used a mixed inductive and deductive approach to identify descriptive themes related to communication and decision-making. Results Among 27 participants, 14 (52%) had personal and 23 (85%) had family experience with suicide ideation or attempts. Emergent themes fell into two domains: (1) communication in a state of high emotionality; and (2) specific challenges in communication: initiating, maintaining engagement, considering context. Conclusion Engaging suicidal individuals in lethal means counseling may be more effective when messaging and approaches consider their emotional state and communication challenges.

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“…The proposed system is also effective for those experiencing social complications. To reduce hospitalization of suicidal patients, an e-caring avatar was proposed in [29], which involves patients in self-care conversations and recommends relevant videos. To monitor chronic pain patients, Levin et al, proposed a Pain Monitoring Voice Diary that asks a sequence of questions and identifies the severity of pain accordingly [30].…”

Section: Finite State Assistantsmentioning

confidence: 99%

Medical Instructed Real-Time Assistant for Patient with Glaucoma and Diabetic Conditions

et al. 2020

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Virtual assistants are involved in the daily activities of humans such as managing calendars, making appointments, and providing wake-up calls. They provide a conversational service to customers around-the-clock and make their daily life manageable. With this emerging trend, many well-known companies launched their own virtual assistants that manage the daily routine activities of customers. In the healthcare sector, virtual medical assistants also provide a list of relevant diseases linked to a specific symptom. Due to low accuracy and uncertainty, these generated recommendations are untrusted and may lead to hypochondriasis. In this study, we proposed a Medical Instructed Real-time Assistant (MIRA) that listens to the user’s chief complaint and predicts a specific disease. Instead of informing about the medical condition, the user is referred to a nearby appropriate medical specialist. We designed an architecture for MIRA that considers the limitations of existing virtual medical assistants such as weak authentication, lack of understanding multiple intent statements about a specific medical condition, and uncertain diagnosis recommendations. To implement the designed architecture, we collected the chief complaints along with the dialogue corpora of real patients. Then, we manually validated these data under the supervision of medical specialists. We then used these data for natural language understanding, disease identification, and appropriate response generation. For the prototype version of MIRA, we considered the cases of glaucoma (eye disease) and diabetes (an autoimmune disease) only. The performance measure of MIRA was evaluated in terms of accuracy (89%), precision (90%), sensitivity (89.8%), specificity (94.9%), and F-measure (89.8%). The task completion was calculated using Cohen’s Kappa ( k = 0.848 ) that categorizes MIRA as ‘Almost Perfect’. Furthermore, the voice-based authentication identifies the user effectively and prevent against masquerading attack. Simultaneously, the user experience shows relatively good results in all aspects based on the User Experience Questionnaire (UEQ) benchmark data. The experimental results show that MIRA efficiently predicts a disease based on chief complaints and supports the user in decision making.

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A novel engagement of suicidality in the emergency department: Virtual Collaborative Assessment and Management of Suicidality

Cited by 39 publications

References 39 publications

One Size Does Not Fit All: A Comprehensive Clinical Approach to Reducing Suicidal Ideation, Attempts, and Deaths

One Size Does Not Fit All: A Comprehensive Clinical Approach to Reducing Suicidal Ideation, Attempts, and Deaths

Lethal Means Counseling for Suicidal Adults in the Emergency Department: A Qualitative Study

Medical Instructed Real-Time Assistant for Patient with Glaucoma and Diabetic Conditions

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