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15: WHO BIC

Risk Management and Treatment » Post-acute Care
15: WHO BIC

We suggest offering the World Health Organization Brief Intervention and Contact (WHO BIC) treatment modality following presentation to the emergency department for suicide attempt, in addition to standard care.

Strength:

Weak for

Category:

ReviewedNew-added

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

WHO BIC is an evidence-based intervention to prevent suicide via brief contacts during the high-risk time following an emergency department (ED) visit for a suicide attempt. The goals are to enhance treatment engagement, build self-efficacy and increase social support.

Training Resources

This section includes WHO BIC training resources.

The WHO BIC Program Content
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(Acknowledgement: Dr. Natalie Riblet)
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The WHO BIC Program Content
WHO BIC Program Goals
  • Enhance engagement
  • Build self-efficacy
  • Motivational Interviewing
  • Increase social supporting
Brief Educational Intervention
  • 1 hour; prior to discharge
  • Education on suicide risk
  • MI and Self-efficacy
Program Logistics
  • WHO BIC Provider is a person with clinical training (e.g.nurse, psychologist, psychiatrist)
  • In-person or phone
9 Follow-up Contacts
  • 9 follow-up contacts in first 18 months after discharge
  • MI and Self-efficacy
  • Professional Support
  • The WHO BIC intervention starts with an individual educational session as close to the time of ED discharge as possible. Afterwards, nine follow up contacts are conducted over eighteen months.
  • Sessions can be offered in person or by telephone by a variety of professionally trained mental health providers (psychiatrist, psychologist, nurse, social worker).

Learn more at: World Health Organization Brief Intervention Contact (Supre-miss protocol)

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Webinars

This section includes training information about WHO BIC.

CPG Webinar WHO-BIC as a Strategy to Prevent Suicide Presented by Dr. Natalie Riblet
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Books

This section includes links to recommended books about the WHO BIC intervention.

Wasserman et. al. (2021). Oxford Textbook of Suicidology and Suicide Prevention 2nd Edition. Oxford University Press. (See Chapter 42)
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Articles

This section includes links to recommended articles about applying the WHO BIC intervention to Veterans.

Riblet, N. B., Shiner, B., Schnurr, P., Bruce, M. L., Wasserman, D., Cornelius, S., Scott, R., & Watts, B. V. (2019). A Pilot Study of an Intervention to Prevent Suicide After Psychiatric Hospitalization. The Journal of nervous and mental disease, 207(12). 1031-1038. https://doi.org/10.1097/NMD.0000000000001061
Riblet, N., Shiner, B., Scott, R., Bruce, M. L., Wasserman, D., & Watts, B. V. (2019). Exploring Psychiatric Inpatients' Beliefs About the Role of Post-discharge Follow-up Care in Suicide Prevention. Military medicine, 184(1-2). e91-e100. https://doi.org/10.1093/milmed/usy129
Riblet, N. B., Stevens, S. P., Watts, B. V., Gui, J., Forehand, J., Cornelius, S., Powell, R., Lewicki, K., Wasserman, D., & Shiner, B. (2021). A Pilot Randomized Trial of a Brief Intervention to Prevent Suicide After Inpatient Psychiatric Discharge. Psychiatric services (Washington, D.C.), appips202000537. Advance online publication. https://doi.org/10.1176/appi.ps.202000537
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