S.A.F.E. Firearm (ASPIRE) Project

Researcher, Jennifer M. Boggs, PhD, leads the S.A.F.E. Firearm (ASPIRE) Project with help from co-investigators Matthew F. Daley, MD, and Debra P. Ritzwoller, PhD. S.A.F.E. Firearm (ASPIRE) Project is a program that champions firearm injury prevention among 5 to 17-year-olds by providing safe storage counseling and distributing cable gun locks to parents during well child visits.

The S.A.F.E. Firearm (ASPIRE) Project has achieved great success, with over half of the region's well child visits for 5 to 17-year-olds receiving safe storage counseling. Initially, healthcare clinicians had reservations about discussing firearms, but cable locks have proven to be a pivotal conversation starter. More than 10,000 cable gun locks have been distributed with plans to continue providing them through at least the end of 2024 as Dr. Boggs’ team looks for opportunities to fund additional locks as there is a desire to continue the program. Dr. Boggs credits the unwavering commitment of pediatricians and clinic champions in meticulously documenting these vital conversations during well child visits.

Dr. Boggs’ team presented preliminary study results at the International Summit on Suicide Research in Barcelona in early October and the National Research Conference for the Prevention of Firearm-Related Harms in Chicago in early November 2023. In January, a new grant, SCALE ASPIRE, was submitted to the National Institute of Mental Health (NIMH) that seeks to prevent youth and adult firearm injuries and death by adapting the S.A.F.E. Firearm program for delivery to all adults in primary care and obstetrics and gynecology (OB-GYN) settings.

Medication Safety Plan

Jennifer M. Boggs, PhD, leads the Medication Safety Plan project, funded by the American Foundation for Suicide Prevention. This study will address the risk of overdose in patients who have reported suicide ideation and take medications that put them at a higher risk for overdose.

Interviews with patients, primary care, mental health, and pharmacy clinicians informed the project’s plan to evaluate the effectiveness of self-directed medication safety plans with assistance from a Licensed Clinical Social Worker in preventing overdose. An important early finding that points to the importance of safe medication storage is that all patient overdoses were impulsive or not planned.

Zero Suicide Project: Comprehensive Safety Planning

In addition to medication safety planning, Dr. Boggs, Dr. Beck and colleagues across 6 health systems (Kaiser Permanente Colorado, Northwest, Northern California, Southern California, and Washington, and Henry Ford Health) found through the Zero Suicide project, that implementing screening, risk assessment and safety planning as part of a comprehensive “suicide prevention pathway” could result in population level reductions in suicide attempts and deaths.

Jennifer M. Boggs, PhD, and partners hope to secure three grants to build on the findings of the Zero Suicide project to:

• Understand how the completeness of safety plans, the quality of coping strategies, the presence or absence of lethal means, and who delivers the safety plan affects suicide outcomes.
• Develop and test new quality measures for suicide screening, risk assessment, and safety planning in partnership with the National Committee for Quality assurance (NCQA) and the Joint Commission.
• Study suicide screening measures specifically designed for 8 to 12-year-olds given the alarming increase in suicide rates among this age group and the potential inadequacy of adult measures to capture their needs.

Garfield Collaborative Care Model for Depression and Anxiety

With funding from Kaiser Permanente’s Garfield Memorial Fund, Arne L. Beck, PhD and team, are in the early stages of testing an evidence-based collaborative care program for patients dealing with depression and or anxiety in 4 primary care clinics at KPCO.

Patients who could benefit from consistent support within primary care will receive telephone outreach from care managers that includes distinct types of short-term therapies and medication management. Dr. Beck and his team will be assessing the program’s effectiveness and providing findings to help inform regional behavioral health leadership decisions about implementing the collaborative care program at KPCO.

Mindful Mood Balance (MMB) for Moms Project

The MMB for Moms project, led at KPCO by Arne L. Beck, PhD, is an online program coupled with personal coaching designed to deliver Mindfulness Based Cognitive Therapy (MBCT) for pregnant moms who have experienced depression in the past. The study compared the effectiveness of peer coaches who have experienced perinatal depression to mental health professionals. Early findings show differences in participant comfort levels with professional and peer coaches, but both groups displayed similar engagement in the program. The project yielded statistically significant reductions in depression symptoms, as well as significant decreases in anxiety symptoms and perceived stress, suggesting that peer coaches are equally effective in reducing symptoms and fostering patient engagement.

Engagement in digital therapies

Together with the University of Virginia, Drs. Boggs and Beck are testing groundbreaking health equity approaches to enhance patient engagement with digital mental health programs. As engagement rates in mental health programs delivered outside a typical clinical setting are low³, they along with colleagues, hope to develop methods that could reach more diverse patient populations through the primary care setting using population-based approaches.

Dr. Beck and Dr. Boggs are currently engaged in analyzing data from recently completed youth focused mental health projects.

Arne L. Beck, PhD, and colleagues at KP Washington are evaluating data they collected during the Safer Use of Antipsychotic Medications in Youth (SUAY) study that focused on improving prescribing practices for antipsychotic medications in youth.

Both Dr. Beck and Dr. Boggs are examining findings from the Guiding Good Choices program which worked with middle school age children (11 and 12 years old) and their parents to promote healthy family dynamics and substance use prevention. In addition to sharing future findings from the Guiding Good Choices program, new efforts are underway to look at potential changes in children’s recreational screen time over the past couple of years and to train KPCO clinicians to deliver the program on a routine basis.

Unearthing the Complexities of Pelvic Pain

Working in collaboration with KPCO gynecology and obstetrics clinicians and a local nonprofit agency, Wings, Arne L. Beck, PhD is currently looking at the relationship between pelvic pain, pain catastrophizing, and childhood sexual abuse. The goal of this study is to improve pelvic pain identification and treatment for patients who are survivors of childhood sexual abuse.

References

1. World Health Organization (WHO). (2021). Mental Health. https://www.who.int/news-room/fact-sheets/detail/mental-health
2. Boggs, JM, Quintana, LQ, Beck, A, Clarke, CL, Richardson, L, Conley, A, Buckingham, ET, Richards, JE, Betz, ME. (2024). A randomized control trial of a digital health tool for safer firearm and medication storage for patients with suicide risk. Prevention Science. In Press.
3. Lipschitz, J.M., Pike, C.K., Hogan, T.P. et al. The Engagement Problem: a Review of Engagement with Digital Mental Health Interventions and Recommendations for a Path Forward. Curr Treat Options Psych 10, 119–135 (2023). https://doi.org/10.1007/s40501-023-00297-3