Suicide Prevention for Justice Involved Managed Care Subscribers

Study Overview
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Brief Summary
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The goal of this clinical trial is to test the effects of two suicide prevention interventions for individuals released from jail. The main questions it aims to answer are: Does the use of Caring Contacts improve subscriber engagement with healthcare services while reducing suicide-related outcomes? and Will providing training and resources to behavioral health providers improve re-engagement with healthcare services for patients recently released from jail? Participants will include (1) subscribers of a managed care organization (MCO) and (2) behavioral health providers within the MCO system. Interventions include sending subscribers Caring Contacts letters for 6-months following jail release and providing resources and training to behavioral health providers to target healthcare re-engagement and suicide prevention.

Official Title
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Managed Care Updates of Subscriber Justice System Involvement for Suicide Prevention

Conditions
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Suicide and Self-harm

Intervention / Treatment
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* Behavioral: Caring Contacts letters
* Behavioral: Reports, re-engagement, and training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18+ years old Behavioral health (BH) providers/staff employed at a CareSource BH agency Exclusion Criteria: None

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Caring Contact letters<br>Caring Contact letters will be mailed to a randomly selected group of managed care subscribers over a 6-month period following jail release. | Behavioral: Caring Contacts letters<br>* Caring Contacts involves sending individuals at risk for suicide brief, non- demanding messages of care.<br>|
| Experimental: Reports, re-engagement, and training<br>Behavioral health providers (n=120) will be trained in evidence-based suicide prevention screening and intervention practices, in addition to receiving weekly reports with information on clients who have been released from jail to encourage outreach efforts for re-engagement with the healthcare system. | Behavioral: Reports, re-engagement, and training<br>* Behavioral health providers will receive training in reaching out to and re- engaging patients who pass through the justice system, as well as training in suicide risk assessment (the Columbia Suicide Severity Rating Scale; C-SSRS) and response (the Safety Planning Intervention; SPI).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Suicide Attempt | A suicide attempt is defined as engaging in a potentially self-injurious behavior, associated with at least some intent to die as a result of the act. We will assess total number of subsequent attempts using the already-developed Mental Health Research Network (MHRN) algorithm for extracting suicide attempt information from claims data | 6-months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| All-cause injury and poisoning | All-cause injury and poisoning data will be extracted from ICD-10 data. | 6-months | 
| Outpatient behavioral health service linkage | We will extract number of outpatient behavioral health (i.e., mental health or substance use) visits during the 12 months prior to and 6 months following jail release from claims data. | 18 months | 
| CareSource Member Services (CMS) line use | Caring Contact messages will list the CMS phone number (which is answered by the Care Management Team, who are trained to assess and connect callers to the appropriate services) as a way to reach out. Care Source will track calls to this line by subscribers in all study conditions. | 6-months | 
| Inpatient and Emergency department mental health care visits | Data on inpatient and emergency department mental health visits will be extracted from claims data using MHRN algorithms. | 6-months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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suicidal behavior, jail release, behavioral health providers, suicide training