Development and evaluation of manualized approaches for telephone-based outreach in suicide prevention

We describe the process of development and evaluation of manualized approaches for two types of telephone outreach: Telephone contacts (TC) and Telephone-based psychosocial intervention (TBPI). TC comprised inquiry into suicidal ideation and reminders for mental health hygiene. TBPI comprised psychosocial counseling in addition to TC components. Trained research associates (RAs) delivered TC and TBPI to individuals with a history of suicide attempts. Telephone outreach was an addon to the usual follow-up care in such individuals.

We developed manuals from extensive literature review and consensus. We evaluated the approaches by fidelity assessments to specific components of the outreach and overall acceptability. We used a cross-sectional study design for evaluation of approaches. An independent rater evaluated fidelity by reviewing audio recordings of TC and TBPI. Individuals who received the telephone outreach rated the acceptability on a visual Likert scale of 1-10 (1 was the least and 10 was the maximum acceptable score).

We developed two telephone outreach manuals structured in a narrative format in an algorithmic approach with similar sections for rapport, inquiry into suicidal ideation and reminders for mental health hygiene. The TBPI manual included a psychosocial counseling section. Fidelity assessment of 168 telephone outreach sessions showed adherence of 80% or more to the manuals in 78.57% of the participants. The mean acceptability score was 7.6 out of 10 for the telephone outreach (SD: 1.75, n = 239).

We demonstrate that manualized approaches for telephone outreach in suicide prevention are an acceptable strategy that can be delivered with optimal fidelity.