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PRiSMM Telehealth Practices
Telehealth practices all strategies
- Incorporate a Health Insurance Portability and Accountability Act (HIPAA) compliant telehealth dimension into your practice, as this can significantly extend your diagnostic and therapeutic reach.
- Familiarize yourself with your specialty's information regarding telehealth practice guidelines and patient-provider identification.
Identify and assist
- It is best to observe basic guidelines when working with a potentially suicidal patient:
- Request the person's location (address, apartment number) at the start of any session in case you need to contact emergency services.
- Request or make sure you have emergency contact information.
- Secure the patient's privacy during the telehealth session as much as possible.
- Inquire about increased access to potentially lethal means.
- Clinical management issues:
- Identify a method of increasing safety as part of your response repertoire, e.g., a safety plan.
- Provide crisis hotline (988).
- Identify individuals in the patient's current environment to help monitor suicidal thoughts and behaviors in-person or remotely; seek permission to have direct contact with those individuals.
- If the risk becomes imminent and cannot be managed remotely, arrange for the client to go to the nearest crisis center or medical ED.
- If the risk is imminent, stay on the phone with the patient until other care is present.
- Safety planning
- If the patient is found not to need emergent management, creating a safety plan with the patient is a way to stay safe without using more emergent settings.
- Arrange a way for the patient to get a copy of their plan (e.g., take a picture or scan, and e-mail or text to the patient).
Identify and Assist
- Review collaborative care.
- Have access to tools that can engage individuals such as interpretative services.
- Use resources that are useful for engagement.
Increase Help Seeking
- If possible, leverage the client's natural supports to assist them during care transitions. They might need someone to stay with them for a while.
- Ask your client about their Safety Plan; go over it with them and collaboratively make any adjustments to the plan if needed.
- Process the experience with your client of going to the emergency department or inpatient setting, etc. These events can be traumatizing, and your client will benefit from processing them.
- Use an evidenced-based treatment upon discharge that is targeted to suicidality (CAMS, DBT)
- Suggest the SPRC website; search for care transitions.
Respond to crisis
- Ask the person where they are calling from in case they become disconnected.
- Ask about their location and if anyone is with them.
- Evaluate the risk of access to lethal means and risk for implementation.
- Complete suicide risk assessment and determine the appropriate level of intervention required.
- Develop your practice crisis response.
Respond to Crisis
- Consider if an in-person meeting is needed in this circumstance (if at all possible.)
Reduce access to means
- Ask about their household firearm storage practices and make recommendations to increase the safe storage of firearms.
- Ask if all firearms can be or are safely stored (e.g., with a locking device such as cable locks, or trigger locks) or use locking containers (e.g., lockboxes, firearm safes, firearm cabinets.)
- Engage household members to support safe storage.
- Normalize gun ownership, speak with someone else in the home, move away from the computer when talking- trust is essential, and stress the importance of respecting their right to own a gun.
Reduce Access to Means
- Need to ensure participants have access to technology to utilize services and review guidelines for use of online group meetings.