# Zero Suicide Implementation and Evaluation in Outpatient Mental Health Clinics

> **NIH NIH R01** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2020 · $732,217

## Abstract

PROJECT SUMMARY
 Despite development of evidenced-based treatments and assessment tools, the number of suicide
deaths in the US has risen dramatically in the past decade. The suicide rate of outpatients in behavioral health
care is 100x higher than the general population, and >25% who die by suicide and >50% of those who attempt
receive care in outpatient behavioral health settings in the prior year. Unfortunately, evidenced-based practices
have not found their way into routine outpatient care. As such, outpatient clinics are a critical location for
suicide prevention efforts, and improving suicide prevention practices holds promise for reducing suicide. The
ZS model is a multi-component (including assessment, intervention, and continuity of care), system-wide
approach based on the assumption that suicide within the health care system is preventable. Given that the ZS
approach is being promoted nationally, it is important to ascertain what factors affect its effectiveness and what
intensity of implementation achieves maximal uptake. In this project, we propose to conduct a large scale
implementation and evaluation of the ZS model in outpatient behavioral health. We will implement ZS
strategies in 145 clinics in New York State (NYS) serving >80,000 behavioral health clients. This project
combines efforts with the NYS Office of Mental Health’s Continuous Quality Improvement unit, and benefits
from the State's well-developed, existing administrative database infrastructure, including mandated reporting
of suicide attempts and deaths for individuals in care and client-, clinic-, and agency-level data on treatment
attendance, hospitalizations, and Emergency Department visits.
 Using a hybrid effectiveness-implementation type 1 design, we will test the effectiveness of ZS in 145
outpatient state licensed (but not state operated) clinics. We will randomly-assign agencies to one of two
conditions: “Basic Implementation” (BI) or “Enhanced Implementation” (EI; enhanced training/consultation, use
of site champions, participatory learning collaboratives). In Aim 1, we will compare the effectiveness of EI and
BI conditions in reducing suicidal behaviors (attempts and deaths), psychiatric hospitalizations, and ED visits.
We will conduct cohort and historical comparison analyses to determine the effectiveness of ZS conditions vs
“treatment-as-usual." In Aim 2, we will use mixed qualitative-quantitative approaches to compare the EI and BI
conditions on implementation and sustainability of the ZS model. We will use the Precede-Proceed framework
to evaluate agency- and provider-level predisposing, enabling, and reinforcing factors affecting implementation
success, as well as rates and quality of ZS components (process/impact evaluation) during implementation,
maintenance, and follow-up periods. This study will be the largest implementation and evaluation of the ZS
approach ever conducted, and will provide crucial insight regarding broader dissemination. Results wi...

## Key facts

- **NIH application ID:** 9972961
- **Project number:** 5R01MH112139-05
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** BARBARA STANLEY
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $732,217
- **Award type:** 5
- **Project period:** 2016-09-15 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9972961

## Citation

> US National Institutes of Health, RePORTER application 9972961, Zero Suicide Implementation and Evaluation in Outpatient Mental Health Clinics (5R01MH112139-05). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9972961. Licensed CC0.

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