Development of the Pharm-SAVES educational module for gatekeeper suicide prevention training for community pharmacy staff

Introduction

Pharmacists are one of the most accessible health professionals in the United States, who, with training, may serve as gatekeepers who recognize suicide warning signs and refer at-risk individuals to care. Our objective was to codesign a 30-min online gatekeeper training module (Pharm-SAVES) specifically for community pharmacy staff.

Methods

Over a period of 8 months, a nine-member pharmacy staff stakeholder panel and the Finger Lakes (New York) Veterans Research Engagement Review Board each worked with the study team to codesign Pharm-SAVES. Formative data from previous interviews with community pharmacists were presented to the panels and guided website development.

Results

Four key topics were identified for brief skills-based modules that could be delivered asynchronously online. To help pharmacy staff understand their opportunities as gatekeepers in suicide prevention, statistics and statements from the Joint Commission and pharmacy professional organizations were highlighted in Module 1 (‘Why Me?’). Module 2 (‘What can I do?’) presents the five gatekeeping steps (SAVES): (1) Recognize suicide warning S igns, (2) A sk if someone is considering suicide, (3) V alidate feelings, (4) E xpedite referral, and (5) S et a reminder to follow-up. Module 3 (‘How does it work?’) provides three video scenarios modeling SAVES steps and two interactive video cases for participant practice. Module 3 demonstrates use of the 24/7 National Suicide Prevention Lifeline, including the DOD/VA Crisis Line. Module 4 (Resources) includes links to national resources and a searchable zip code-based provider directory. Pharm-SAVES was codesigned with pharmacy and veteran stakeholders to deliver brief, skills-focused, video-based interactive training that is feasible to implement in busy community pharmacy settings.

Conclusion

Pharm-SAVES is a brief, online suicide prevention gatekeeper training program codesigned by researchers, community pharmacy and veteran stakeholders. By actively engaging stakeholders at each stage of the design process, we were able to create training content that was not only realistic but more relevant to the needs of pharmacy staff. Currently, Pharm-SAVES is being evaluated in a pilot randomized controlled trial for changes in pharmacy staff suicide prevention communication behaviors.

Patient or Public Contribution

Stakeholder engagement was purposefully structured to engage pharmacy staff and pharmacy consumers, with multiple opportunities for study contribution. Likewise, the involvement of patient/public contribution was paramount in study design and overall development of our study team.     

Aging in rural,indigenous communities: an intercultural and participatory healthcare approach in Mexico

From an ethno-gerontological perspective, new models are needed to fulfill the health needs of the indigenous older adult population in Mexico. In this paper we developed a comprehensive healthcare model, interculturally appropriate, designed to meet the needs of Mexican indigenous older adults. The model was constructed using a qualitative design with semi-structured interviews of older adults, health providers, and available health resources in three Mexican indigenous regions. An ethnographical review was carried out to contextually characterize these communities. At the same time, a comprehensive bibliographic revision was made to identify socio-demographic markers. Results pointed out that Mexican indigenous older adults are not covered by any type of social health insurance program. Their health problems tend in large part to be chronic in nature due to the lack of early diagnosis and treatment. There is a need for trained human resources in the field of gerontology encompassing the sociocultural context of the indigenous groups. The geographical location of these communities limits the permanent presence of healthcare givers and thus limits access to continuous care. Traditional healthcare givers, able to speak the native language, are a great asset allowing the invaluable possibility of direct verbal communication. Based upon the data gathered from indigenous older adults and service providers, in tandem with evidence from the literature, we identified key elements for successful intervention and designed an intervention model. We concluded that indigenous older adults are a more vulnerable group, given that aside from being elderly in a country where the health needs of these populations exceed the capacity of existing healthcare services, their ethnicity serves as an added barrier preventing their access to the limited available healthcare resources. To achieve uniformity in providing health care, today’s health systems need to address intercultural and participative aspects of healthcare models.     

Responding to rural social care needs: older people empowering themselves, others and their community

Older adult active retirement groups encompass health promotion, social and community psychological potential. However, little is known about the internal dynamics of these groups or their contribution to individual well-being and the community. This paper examines the Third Age Foundation as an example of one such group operating in a rural area in Ireland and explores the various relationships at work internally and externally. Methodology included: structured and semi-structured interviews, focus groups and a postal survey. A substantial contribution to members' well-being and community competence and cohesion was found. Findings are discussed in reference to the importance of individual and community empowerment, sustainability, social entrepreneurship/leadership and the potential of such models to support community-based living in older age.     

Perspectives of rural health and human service practitioners following suicide prevention training programme in Australia: A thematic analysis

There are well‐established training programmes available to support health and human services professionals working with people vulnerable to suicide. However, little is known about involving people with lived experience in the delivery of suicide prevention training with communities with increased rates of suicide. The aim of this paper was to report on a formative dialogical evaluation that explored the views of health and human services workers with regard to a suicide prevention training programme in regional (including rural and remote areas) South Australia which included meaningful involvement of a person with lived experience in the development and delivery of the training. In 2015, eight suicide prevention training workshops were conducted with health and human services workers. All 248 participants lived and worked in South Australian regional communities. We interviewed a subsample of 24 participants across eight sites. A thematic analysis of the interviews identified five themes: Coproduction is key, It is okay to ask the question, Caring for my community, I can make a difference and Learning for future training. The overall meta‐theme was “Involvement of a person with lived experience in suicide prevention training supports regional communities to look out for people at risk of suicide.” This paper highlights the need for suicide prevention training and other workforce development programmes to include lived experience participation as a core component in development and delivery.     

From rural beginnings to statewide roll‐out: Evaluation of facilitator training for a group‐based diabetes prevention program

Objective: To evaluate the approach used to train facilitators for a large‐scale group‐based diabetes prevention program developed from a rural implementation research project. Participants: Orientation day was attended by 224 health professionals; 188 submitted the self‐learning task; 175 achieved the satisfactory standard for the self‐learning task and attended the workshop; 156 completed the pre‐ and post‐training questionnaires. Main outcome measures: Two pre‐ and post‐training scales were developed to assess knowledge and confidence in group‐based diabetes prevention program facilitation. Principal component analysis found four factors for measuring training effectiveness: knowledge of diabetes prevention, knowledge of group facilitation, confidence to facilitate a group to improve health literacy and confidence in diabetes prevention program facilitation. Self‐learning task scores, training discontinuation rates and satisfaction scores were also assessed. Results: There was significant improvement in all four knowledge and confidence factors from pre‐ to post‐training (P < 0.001). The self‐learning task mean test score was 88.7/100 (SD = 7.7), and mean assignment score was 72.8/100 (SD = 16.1). Satisfaction with training scores were positive and ‘previous training’ interacted with ‘change in knowledge of diabetes prevention program facilitation’ but not with change in ‘confidence to facilitate.’ Conclusions: The training program was effective when analysed by change in facilitator knowledge and confidence and the positive mean satisfaction score. Learning task scores suggest tasks were manageable and the requirement contributed to facilitator self‐selection. Improvement in confidence scores in facilitating a group‐based diabetes prevention program, irrespective of previous training and experience, show that program‐specific skill development activities are necessary in curriculum design.     

Mobilizing communities to reduce risks for drug abuse: Lessons on using research to guide prevention practice

In May 1988, the authors initiated a risk-focused community mobilization project for drug abuse prevention. That project, TOGETHER! Communities for Drug Free Youth, is a state-wide collaboration involving 28 Washington communities. The project uses current research on risk and protective factors for adolescent drug abuse as its foundation. Through training and technical assistance, communities have been mobilized to design and implement comprehensive, risk-focused plans for adolescent drug abuse prevention. This paper describes the design of the project and examines the extent to which the participating communities formed planning teams that utilized an empirically based risk reduction approach in mobilizing to prevent drug abuse.     

Learning, Enjoying, Growing, Support model: an innovative collaborative approach to the prevention of conduct disorder in preschoolers in hard to reach rural families

OBJECTIVE: To develop, implement and evaluate a pilot program targeting rural families with preschool aged children at risk of conduct disorder. DESIGN: A prospective single group repeated measures design. SETTING: Communities in four local government areas in the Mid Western Area Health Service, New South Wales. SUBJECTS: A total of 33 families were referred to the program through community services where they were established clients. INTERVENTIONS: The Learning, Enjoying, Growing, Support model comprised a parenting program (Incredible Years; Kids Challenge and Change); a children's social skills program (Playing and learning to Socialise) and a transition to school component. Group programs were run simultaneously over 5-10 weeks. MAIN OUTCOME MEASURES: Measures of positive parenting and child problem behaviour and social skills were conducted on referral, and at completion of the program. RESULTS: There was a self-reported increase in utilisation of all positive parenting skills with significant increases in rewarding (median score on referral: 4 (range: 4-6); at completion of program 6 (4-6); (P = 0.02)) and ignoring (2 (0-6) to 3 (1-8); (P = 0.02)). Children increased their levels of social skills. Significant improvement was reported in cooperation: (median score: 24 (18-33) to 27 (19-33); (P = 0.02)); interaction (24 (6-9) to 26 (11-32); (P = 0.03)) and independence(25 (16-33) to 28 (20-33); (P = 0.008)). There was a downward trend in problem behaviour exhibited with a significant reduction in internalising behaviour (median score 19 (3-30) to 12 (0-32); (P = 0.04)). CONCLUSIONS: The positive impact of the model on parenting skills and child behaviour is promising and communities are continuing to run the programs. We recommend a broader adoption through rural communities.     

Harnessing the social capital of rural communities for youth mental health: an asset-based community development framework

In Australia, we are facing a period of mental health reform with the establishment of federally funded community youth services in rural areas of the country. These new services have great potential to improve the mental health of rural adolescents. In the context of this new initiative, we have four main objectives with this article. First, we consider the notion of social capital in relation to mental health and reflect on the collective characteristics of rural communities. Second, we review lessons learned from two large community development projects targeting youth mental health. Third, we suggest ways in which the social capital of rural communities might be harnessed for the benefit of youth mental health by using asset-based community development strategies and fourth, we consider the role that rural clinicians might play in this process.     

Predictors of rural and urban youth suicidal ideation by gender: a case for targeted approaches to prevention

Depressive symptoms and participation in health-harming behaviours are key risk factors for youth suicidal ideation, while self-esteem and perceived social support are protective factors. The purpose of the present article is to highlight differing patterns of these risk and protective factors for youth suicidal ideation by gender, as well as by rural and urban communities. Through structural equation modelling, the presence of differing patterns of risk and protective factors for youth suicidal ideation potentially supports the case for targeted approaches to prevention based on gender and geographic region.     

This is who we are: building community for HIV prevention with young gay and bisexual men in Beirut,Lebanon

Young gay men in Beirut are at significantly elevated risk of HIV infection compared with the general Lebanese population. Despite nascent HIV prevention efforts in the region, there is a need for effective community-level HIV prevention interventions tailored for young gay men. This qualitative study examined internal dynamics within Beirut’s gay community as a basis for developing community-level interventions. Peer ethnographers were trained to collect field notes on conversations between young gay men in public spaces in Beirut, and conducted follow-up focus groups with young gay men. Analyses revealed three major themes: (1) the need for safe spaces in which to socialise, (2) the importance of being able to locate and connect with other young gay men, and (3) ambivalence regarding a gay community that was supportive in some ways but also fragmented and often judgemental. Study findings also confirm the existence of external threats to community such as stigma, cultural and familial norms regarding heterosexuality and criminalisation of refugee status. Understanding such community dynamics and the environmental context is central to designing effective community-based HIV prevention programmes.     

Analysis Grid for Environments Linked to Obesity (ANGELO) framework to develop community‐driven health programmes in an Indigenous community in Canada

Indigenous First Nations people in Canada have high chronic disease morbidity resulting in part from enduring social inequities and colonialism. Obesity prevention strategies developed by and for First Nations people are crucial to improving the health status of this group. The research objective was to develop community‐relevant strategies to address childhood obesity in a First Nations community. Strategies were derived from an action‐based workshop based on the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. Thirteen community members with wide‐ranging community representation took part in the workshop. They combined personal knowledge and experience with community‐specific and national research to dissect the broad array of environmental factors that influenced childhood obesity in their community. They then developed community‐specific action plans focusing on healthy eating and physical activity for children and their families. Actions included increasing awareness of children's health issues among the local population and community leadership, promoting nutrition and physical activity at school, and improving recreation opportunities. Strengthening children's connection to their culture was considered paramount to improving their well‐being; thus, workshop participants developed programmes that included elders as teachers and reinforced families' acquaintance with First Nations foods and activities. The research demonstrated that the ANGELO framework is a participatory way to develop community‐driven health programmes. It also demonstrated that First Nations people involved in the creation of solutions to health issues in their communities may focus on decolonising approaches such as strengthening their connection to indigenous culture and traditions. External funds were not available to implement programmes and there was no formal follow‐up to determine if community members implemented programmes. Future research needs to examine the extent to which community members can implement programmes on their own and whether community action plans, when implemented, lead to short‐ and long‐term benefits in health outcomes.     

Clear not simple: an approach to community consultation for a maternal pneumococcal vaccine trial among Indigenous women in the Northern Territory of Australia

PneuMum is a randomised controlled maternal vaccination trial, using 23-valent Pneumococcal Polysaccharide Vaccine (23vPPV) during the third trimester or at delivery compared to vaccination at 7 months post delivery. The primary outcomes are infant middle ear disease and nasopharyngeal pneumococcal carriage at 7 months of age. PneuMum is the first vaccine trial to be conducted among Indigenous people in the Northern Territory. We describe the study design and the approach taken to develop the PneuMum message in collaboration with key Indigenous stakeholders and then to communicate the PneuMum message with Indigenous communities and potential participants. We hope that these methods will provide a model for future research involving Indigenous communities to ensure Indigenous involvement in research and ultimate improvements in Indigenous health.     

Preparing social workers to address HIV/AIDS prevention and detection: implications for professional training and education

The social work profession remains an untapped resource within the community for addressing HIV/AIDS prevention and early detection. This study investigated social workers' knowledge and practices relating to HIV prevention education, risk assessment, and case finding. A six page questionnaire was mailed to a random sample of 600 licensed social workers and licensed clinical social workers in Illinois. The sample was drawn from a list provided by the state department of professional regulation, stratified by geographic location. The final response rate for the survey was 51.3% (N = 308). Social work knowledge concerning HIV and AIDS was significantly related to the variables of age, geographic location, and practice setting. Respondents scored lower on knowledge items pertaining to their ability to perform a comprehensive sexual and drug risk assessment and to appropriately advise clients on HIV antibody testing. Most of the social workers in the sample provided minimal to no HIV-related services in their clinical practice. HIV-related behaviors were also significantly related to the variables of age, geographic location, and practice setting. Multiple logistic regression was used to test whether prior HIV/AIDS training predicted the presence of HIV-related practice behaviors, controlling for potential confounding factors. Both prior HIV-related training and education and prior work experience with HIV-infected clients were statistically significant and independent predictors of current HIV-related practice behaviors reported by social workers.     

Crisis resource management training for an anaesthesia faculty: a new approach to continuing education

BACKGROUND: Human error and system failures continue to play a substantial role in adverse outcomes in health care. Anaesthesia crisis resource management addresses many patient safety issues by teaching behavioural skills for critical events but it has not been systematically utilized to teach experienced faculty. METHODS: An anaesthesia crisis resource management course was created for the faculty of our medical school's anaesthesia teaching programmes. The course objectives were to understand and improve participants' proficiency in crisis resource management (CRM) skills and to learn skills for debriefing residents after critical events. Through surveys, measurement objectives assessed acceptance, utility and need for recurrent training immediately post-course. These were measured again approximately 1 year later along with self-perceived changes in the management of difficult or critical events. RESULTS: The highly rated course was well received in terms of overall course quality, realism, debriefings and didactic presentation. Course usefulness, CRM principles, debriefing skills and communication were highly rated immediately post-course and 1 year later. Approximately half of the faculty staff reported a difficult or critical event following the course; of nine self-reported CRM performance criteria surveyed all claimed improvement in their CRM non-technical skills. CONCLUSIONS: A unique and highly rated anaesthesia faculty course was created; participation made the faculty staff eligible for malpractice premium reductions. Self-reported CRM behaviours in participants' most significant difficult or critical events indicated an improvement in performance. These data provide indirect evidence supporting the contention that this type of training should be more widely promoted, although more definitive measures of improved outcomes are needed.