Context, Timing and Individualized Care: A Realist Evaluation of Safety Planning for Individuals Living with Suicide-Related Thoughts and Behaviours, Their Families and Friends and Service Providers
Bibliographic record
Abstract
Background/Objectives: This research aimed to identify and investigate how context facilitates or hinders safety planning interventions (SPIs) intended to manage suicidal ideation (SI) and behaviour (SB) from the perspective of service users, friends, family members, service providers and other key informants. Additionally, this research aimed to identify underlying mechanisms influencing the effective and acceptable management of SI and SB across these groups. Methods: A realist evaluation framework (i.e., Context + Mechanism = Outcome; CMO) was used to inform the qualitative study design, which explores whether SPIs are perceived as effective (i.e., outcome) and examines the underlying mechanism(s) and specific contexts involved. A total of 28 service users, 11 family members or friends and 15 key informants, including service providers and other stakeholders, participated in semi-structured interviews. A total of 18 frontline service providers also participated in three focus groups. These interviews and focus groups were analyzed to develop a shared model capturing the mechanisms and contexts influencing effective SPI implementation. Data was collected between September 2019 and December 2021. Results: The model consists of three pillars: (1) understanding the importance of context, timing and relationships in safety planning, (2) identifying perceived barriers and facilitators to safety planning as described by service users, family members and service providers, (3) bridging the gap between evidence and experience in implementing safety planning interventions. Conclusions: While SPIs are evidence-based interventions, contextual factors and perceived barriers and facilitators can impact implementation and outcomes in mental health care settings. Understanding these factors can help to explain differences in outcomes within and across patient populations and care settings, and addressing perceived challenges can improve implementation and experiences for service users, family members and service providers.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.031 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".