Using Formative Evaluation Strategies to Support Implementation and Improvement of Suicide Prevention Practices in a Community Mental Health Clinic
摘要
Despite suicide being one of the top leading causes of death for individuals aged 10–64, evidence-based practices for suicide prevention are not routinely implemented in community settings, often due to limited capacity. While quality improvement processes may be best practices, many clinics lack the resources to support robust quality improvement to support evidence-based practice implementation. This study describes a quality improvement project informed by implementation science, conducted by a community mental health agency in a large urban area, aimed at enhancing suicide prevention practices. A sequential mixed methods design was employed, with a formative evaluation to guide subsequent implementation activities. A survey (N = 41) assessed staff knowledge, attitudes, and skills related to suicide prevention and identified preferred implementation strategies based on the Expert Recommendations for Implementing Change taxonomy. Key-informant interviews with ten supervisors were conducted to explore survey findings, particularly the impact of supervisory support on staff confidence and skills. Interviews revealed barriers affecting supervisors’ ability to support staff, including limited time, administrative burdens, workplace stress, secondary traumatic stress, and knowledge gaps in suicide prevention best practices. Findings informed the development of implementation supports, including a supervisory support tool, decision guides for crisis response coaching, and a debriefing protocol for clinicians responding to crises. Member checking confirmed high acceptability and perceived relevance among supervisors. This project demonstrates how formative evaluation can drive effective quality improvement in community settings. The resulting implementation supports are available through open access to facilitate broader dissemination of evidence-based practices for suicide prevention in community mental health clinics.