322 324 A referral coordinator or discharge planner may take many hours making

322 324 a referral coordinator or discharge planner

This preview shows page 49 - 51 out of 150 pages.

322-324 A referral coordinator or discharge planner may take many hours making the necessary phone calls, securing the necessary appointments, finding transporta- tion, and sending reminders and, thereby, improving compliance for the most difficult, chronically disturbed older patient. 325 Dealing with patients that have been non-adherent with prior discharge plans requires creative thinking and an alternative plan so as to avoid repeating the past failures. Patients with a pre- existing relationship with an outpatient mental health professional are most likely to follow-up. 326 Homelessness, substance use, and serious general medical problems make the process of dis- charge planning challenging. 49, 255 Predictably, adolescents from the most dysfunctional, least involved families are most unlikely to follow-up. 327 Patient-perceived absence of symptom im- provement and a dismissive staff attitude naturally predict dissatisfaction with inpatient treatment and non-adherence with the recommended discharge plan. 328 Overcoming these impediments is difficult. The application of specific and creative discharge procedures to these circumstances has
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Continuity of Care for Suicide Prevention and Research 50 had mixed results. Methods and procedures that improve adherence to the recommended treatment plan will be reviewed on later pages. Suffice it to say that new initiatives for getting patients to the first appointment have an average success rate of about 43 percent over baseline rates. Discharge planning procedures have limited effects on retention after the first appointment. 322, 323 As suggested by these findings, there is wide variation in what constitutes best practices for dis- charge planning. Best practices tend to be established by guidelines susceptible to varied interpre- tation and application. Since firearms and other means restriction prevent suicide, making means restriction a standard of care across settings is an improvement that will save lives. 214 Family involvement may be and often is critical to the success of discharge planning. Perhaps the most complete set of family-centered discharge planning recommendations have been issued by the American Association of Suicidology. 329 Among these are a family session and family education about suicide, warning signs, adherence to the recommended treatment plan, removal of means, and various outpatient observation, monitoring, and emergency procedures. For youth, such fam- ily sessions are critical to the success of discharge planning in general. 181, 236 The most comprehensive discharge planning guidance for high-risk inpatients comes from the United States Department of Veterans Affairs (VA). Examples include weekly evaluations dur- ing the first 30 days after discharge and specific follow-up for missed appointments.
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