Significance: Our study will rigorously evaluate whether synchronous, within-visit telemental health
evaluation and intervention services can successfully overcome poor access to behavioral health and
substandard suicide-related care in emergency departments (EDs), including evaluating the impact on system
metrics, a primary goal of RFA-MH-20-226. Notably, our study will surpass this primary requirement, because it
will extend our understanding of the relative added value of the ED-SAFE post-visit telephone intervention and
will create knowledge about key factors related to implementation and sustainment.
Investigators: The team has extensive expertise in healthcare systems-based suicide prevention using
continuous quality improvement implementation strategies (Boudreaux, Larkin, Miller), telehealth for behavioral
health disorders (Boudreaux, Davis-Martin, Brown, Allen), using “big data” for outcome and intervention target
ascertainment (Mathew, Liu, Li, Clements), and implementation science (Boudreaux, Larkin, Davis-Martin).
Innovation: This will be the first study to evaluate telehealth for suicide prevention in the ED. It will use best-
practices in both telemental health and suicide prevention and is designed for rapid dissemination. Our study
design, an interrupted time series with a nested RCT and parallel Non-intervention control EDs, embodies cutting
edge implementation science methodology. Our analyses are modeled after NIMH's experimental therapeutics
paradigm, allowing us to evaluate intervention targets appropriate for healthcare service delivery studies.
Approach: We will compare three conditions across two Intervention EDs that currently do not have on-site
behavioral health specialists: (1) Treatment as usual (TAU), (2) Telehealth to Improve Prevention of Suicide
(TIPS), which will include within-visit telehealth components only, and (3) TIPS+EDSAFE, which will include
within- and post-visit components. Aim 1 will evaluate whether TIPS alone improves primary system metrics and
suicide-related care practices compared to TAU. Aim 2 will compare 12-month patient outcomes, including a
suicide composite outcome, across TAU, TIPS, and TIPS+EDSAFE. Aim 3 will evaluate factors related to
implementation and sustainability, including costs. Two Non-intervention EDs will be monitored to control for
macro system changes and secular trends. Existing big data sources, augmented by structured chart review,
will be leveraged for efficient outcome ascertainment that maximizes sample representativeness.
Environment: UMass has demonstrated its ability to support this study by its success with the NIMH-funded
System of Safety (SOS) study, a Zero Suicide pragmatic clinical trial, in addition to its successful telehealth
efforts funded through NIH and the Commonwealth of Massachusetts.
Impact: The TIPS will address numerous fundamental questions around the role of telehealth in suicide
prevention in a highly efficient, pragmatic clinical trial, maximizing the study's scientific and public health impact
and building a singular database that will serve as an enduring resource to the suicide prevention community.