Implementation of Measurement Based Care and Electronic Safety Plans for Youth

Emma D. Whitmyre

Advisor: Christianne Esposito-Smythers, PhD, Department of Psychology

Committee Members: Debora Goldberg, Robyn Mehlenbeck

Online Location, Online
July 21, 2021, 02:00 PM to 04:00 PM


Suicide is the second leading cause of death among youth in the United States. Safety planning is a critical evidence-based intervention used to prevent suicide attempts among youth with suicidality in clinical care. Though several barriers to successful use and implementation of safety planning in community care exist, little research has been done to examine innovative ways to improve the dissemination and implementation (D&I) of evidence-based safety plans. One novel approach to improving the D&I of safety planning in community-based settings is through the use of a Measurement Feedback System (MFS). MFSs serve as a vehicle for delivery of Measurement Based Care (MBC), or the systematic use of patient-reported data to inform care decisions and monitor treatment progress. Integration of a standardized electronic safety plan (ESP) template into a MFS that delivers MBC allows for the integration of evidence-based suicide assessment with safety planning, two essential elements in the management of suicide risk. Such an integration holds the potential to improve consistency of use, quality, and follow-up of safety planning, as well as address many barriers to safety plan use in community-based settings. This dissertation broadly focuses on the implementation of measurement-based care (MBC) in mental health service systems for child and adolescent populations, with particular attention to addressing youth suicidality, and is comprised of two parts. The first paper includes a systematic literature review focused on the implementation of MBC, and the barriers and facilitators to implementation, across child and adolescent service settings. While several studies examining implementation of MBC in youth service settings have been conducted, few studies have examined implementation strategies in general and no published reviews exist that summarize the barriers, facilitators, and resultant implementation strategies across studies. The second paper summarizes the results of a mixed methods multi-site study conducted to evaluate the implementation process of an ESP, integrated into a MFS, within two community-based clinical psychology training clinics that offer treatment for youth at risk for suicide. Clinicians completed ESPs with youth who reported suicidal thoughts, plans, or behaviors, and their parents, in the context of mental health care. Results suggest that youth and parental completion of an ESP, with clinician guidance, is feasible via a web-based MFS platform. Factors that promote and hinder the adoption and effective use of ESPs for youth in this context are summarized to guide future research in this area.