14: Home Visit - MIRECC / CoE
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MIRECC / CoE

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14: Home Visit

Risk Management and Treatment » Post-acute Care
14: Home Visit

We suggest offering a home visit to support reengagement in outpatient care among patients not presenting for outpatient care following hospitalization for a suicide attempt.

Strength:

Weak for

Category:

ReviewedAmended

Grades and Definitions

Strong for
or "We recommend offering this option …"
Weak for
or "We suggest offering this option …"
No recommendation
or "There is insufficient evidence …"
Weak against
or "We suggest not offering this option …"
Strong against
or "We recommend against offering this option …"

Categories and Definitions

Evidence Reviewed* Recommendation Category* Definition*
Reviewed New-added New recommendation following review of the evidence
New-replaced Recommendation from previous CPG that has been carried over to the updated CPG that has been changed following review of the evidence
Not changed Recommendation from previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed but the recommendation is not changed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed based on review of the evidence
Not reviewed Not changed Recommendation from previous CPG that has been carried forward to the updated CPG, but for which the evidence has not been reviewed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has not been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed because it was deemed out of scope for the updated CPG
*Adapted from the NICE guideline manual (2012): The guidelines manual. London: National Institute for Health and Care Excellence;2012. and Martinez Garcia L, McFarlane E, Barnes S, Sanabria AJ, Alonso-Coello P, Alderson P. Updated recommendations: An assessment of NICE clinical guidelines. Implement Sci. 2014;9:72.

Recommendation Resources

Research has shown that discharge from inpatient care is a strong risk factor for suicide. Lack of treatment engagement following hospital discharge is also a risk factor for suicide. Conducting a home visit following hospitalization for a suicide attempt is an evidence-based intervention to increase outpatient treatment engagement.

Manuals

VA developed, evaluated, and implemented the Home-Based Mental Health Evaluation (HOME) Program to support Veterans transitioning from inpatient to outpatient care.

Home-Based Mental Health Evaluation (HOME) Program
Click/Tap for smaller image HOME Program graphic (transcript provided below)
Overview of the HOME Program
HOME
Home-based Mental Health Evaluation
  1. Enrollment while on the inpatient unit
  2. Telephone follow-up within one day of discharge
  3. Home visit during first week post-discharge
  4. Ongoing telephone follow-up until engaged in care
Each post-discharge contact includes:
Click/Tap for smaller image Visual abstract of Efficacy of the Home-Based Mental Health Evaluation (HOME) Prgram for Engaging Patients in Care After Hospitalization (transcript provided below)
Efficacy of the Home-Based Mental Health Evaluation (HOME) Prgram for Engaging Patients in Care After Hospitalization (Matarazzo, et al 2019, Rocky Mountain MIRECC)
Efficacy of the Home-Based Mental Health Evaluation (HOME) Prgram for Engaging Patients in Care After Hospitalization (Matarazzo, et al 2019, Rocky Mountain MIRECC)

(n=302 patients admitted to inpatient psyciatric unit)

Background:
  • Suicide risk is increased post-psyc hospitalization
  • Lack of treatment engagement posthospitalization is associated with suicide
Current Study:

Home Program

  • Phone- and home-based contacts
  • Safety planning
  • Problem solving (barriers to care)
  • Suicide risk assessment

vs. Enhanced care as usual

Results:

HOME participants

  • 1.33x more likely to engage in Treatment
  • Engaged in treatment more quickly
  • Attended 55% more individual appointments
  • Attended 68% more group appointments
  1. Suicide risk assessment
  2. Review and update of Safety Plan
  3. Appointment reminders
  4. Identify and problem-solve around barriers to care

Veterans who participated in the HOME Program were more likely to engage in care, engaged in care more quickly, and attended more individual outpatient appointments in the 90 days post-discharge (Matarazzo et al., 2019).

If you are interested in the HOME Program Manual or training, please email srmconsult@va.gov.
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Webinars

This section includes links to recommended webinars about the home visits recommendation and home visit interventions.

CPG Webinar Home Visits as a Suicide Prevention Strategy Presented by Dr. Bridget Matarazzo
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Articles

This section includes links to recommended articles about home visit interventions.

Brancu, M., Cleary, B., Cunningham, K.C., Anderson, S.R., Gerard, G.R., Fernandez, P.E., Matarazzo, B.B (2020). Implementing a Home-based Suicide Prevention Program with Rural Veterans. Journal of Rural Mental Health, 44(3): 146-155. https://doi.org/10.1037/rmh0000138
Matarazzo, B. B., Farro, S. A., Billera, M., Forster, J. E., Kemp, J. E., & Brenner, L. A. (2017). Connecting Veterans at Risk for Suicide to Care Through the HOME Program. Suicide & life-threatening behavior, 47(6), 709-717. https://doi.org/10.1111/sltb.12334
Matarazzo, B. B., Forster, J. E., Hostetter, T. A., Billera, M., Adler, G., Ganzini, L. K., Oslin, D. W., & Brenner, L. A. (2019). Efficacy of the Home-Based Mental Health Evaluation (HOME) Program for Engaging Patients in Care After Hospitalization.. Psychiatric services (Washington, D.C.), 70(12), 1094-1100. https://doi.org/10.1176/appi.ps.201900002
Matarazzo, B. B., Gerard, G. R., Jankovsky, M. C., Oslin, D. W., & Brenner, L. A. (2021). Feasibility and Acceptability of the HOME Program for Veterans Recently Discharged from a Psychiatric Hospitalization. Administration and policy in mental health, 10.1007/s10488-021-01109-7. Advance online publication. https://doi.org/10.1007/s10488-021-01109-7
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