Clinician Ratings of Acceptability, Appropriateness, Feasibility and Usability of a Suicide Risk Flag Implemented in Behavioral Health Clinics

Risk models that leverage data collected in electronic health records and insurance claims to estimate risk of suicide attempt are an innovation in suicide prevention. Published studies of their effectiveness and implementation are rare and few report clinicians’ perceptions of this technology. This study measured clinician ratings of acceptance, appropriateness, feasibility, usefulness, usability, and organizational readiness—both prior to intervention start and 6 months following use—among 298 respondents practicing in behavioral health clinics in three large health systems. Clinician ratings were neutral at pre-implementation with mean scores of 3.5 for acceptability, 3.6 for appropriateness, 3.7 for feasibility (scale 1-5, higher scores more favorable), 4.1 for usefulness (scale 1-7), and 57.0 for usability (scale 0-100). Readiness for change was also moderate (40.7, scale 0-60). At post-implementation, usability increased slightly but perceived usefulness declined; there were no significant changes in other measures. While a suicide risk model was not considered unacceptable, inappropriate, or infeasible, it was also not considered especially useful. If an ongoing effectiveness trial does not show superiority of the model over usual care in terms of suicide risk reduction, clinicians may be unlikely to endorse its use.