160 These standards and best practices are in many ways evidence based much of

160 these standards and best practices are in many

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has a safety plan manual that is a useful resource for all health care systems. 160 These standards and best practices are in many ways evidence-based, much of which is contained in this report. Part Six of this report reviews evidence-based treatments for the prevention of sui- cide and suicide attempts. Evidence is provided that discontinuity of care tends to commingle with increasing suicide risk, attempts, and suicide death. Sustained outreach strategies, however, appear to do exactly the opposite. Giving patients a sense of connectedness to caregivers and providing them with concrete demonstration (e.g., personalized mailed letters and postcards, brief clinical contacts) of empathic concern are reasons for continuity of care’s success. These data motivated the VA to establish a mail program that supplies veterans with various forms of personal contact. The technical support for the mail program comes from the Veterans Integrated Service Network’s Center of Excellence in Canandaigua, New York. 330 The Blue Ribbon Work Group on Suicide Prevention in the Veterans Population was chartered on May 5, 2008, and completed its report and recommendations in September 2008. 406 While the VA’s overall strategy is praised heartily, the Blue Ribbon Work Group stated that: “Implementa- tion of such requirements may help prevent suicides, but evaluation will be critical to determine this. As this ambitious effort is a work in progress, continuous quality improvement efforts are essential.” Related research over the coming years may yield an abundance of information about
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Continuity of Care for Suicide Prevention and Research 96 how best to prevent suicide. Part Eight, page 102, contains descriptions of the Veterans Integrated Service Networks and Center for Excellence. Department of Health for New South Wales, Australia: Explicitness characterizes the continuity- of-care standards issued by the Department of Health for New South Wales. 420 Table 4 displays excerpts from both the inpatient and emergency department standards. These in fact exceed stan- dards; they constitute national protocols and algorithms for expected best practices. Care in the United States does not currently meet the high standards set by New South Wales, in that the norm in the U.S. is disconnected care provision and multiple health care providers and or- ganizations. Patients are free to change providers frequently and to go to multiple EDs and health systems, none of which may have easy access to the others’ medical records. Superimposed on this complexity is a layer of special legal and organizational prohibitions against sharing clinical information. 108 In contrast, New South Wales has developed linkages with community treatment facilities. Cooperation is expected in a health care system with universal coverage that is in the process of developing a unique health-care identifier for each citizen.
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