Suicide Prevention for Justice Involved Managed Care Subscribers

The goal of this clinical trial is to test the effects of two suicide prevention interventions for individuals released from jail. The main questions it aims to answer are: Does the use of Caring Contacts improve subscriber engagement with healthcare services while reducing suicide-related outcomes? and Will providing training and resources to behavioral health providers improve re-engagement with healthcare services for patients recently released from jail? Participants will include (1) subscribers of a managed care organization (MCO) and (2) behavioral health providers within the MCO system. Interventions include sending subscribers Caring Contacts letters for 6-months following jail release and providing resources and training to behavioral health providers to target healthcare re-engagement and suicide prevention.

Caring Contact letters will be mailed to a randomly selected group of managed care subscribers over a 6-month period following jail release.

Behavioral health providers (n=120) will be trained in evidence-based suicide prevention screening and intervention practices, in addition to receiving weekly reports with information on clients who have been released from jail to encourage outreach efforts for re-engagement with the healthcare system.

Caring Contacts involves sending individuals at risk for suicide brief, non- demanding messages of care.

Behavioral health providers will receive training in reaching out to and re- engaging patients who pass through the justice system, as well as training in suicide risk assessment (the Columbia Suicide Severity Rating Scale; C-SSRS) and response (the Safety Planning Intervention; SPI).

A suicide attempt is defined as "engaging in a potentially self-injurious behavior, associated with at least some intent to die as a result of the act." We will assess total number of subsequent attempts using the already-developed Mental Health Research Network (MHRN) algorithm for extracting suicide attempt information from claims data

We will extract number of outpatient behavioral health (i.e., mental health or substance use) visits during the 12 months prior to and 6 months following jail release from claims data.

Caring Contact messages will list the CMS phone number (which is answered by the Care Management Team, who are trained to assess and connect callers to the appropriate services) as a way to reach out. Care Source will track calls to this line by subscribers in all study conditions.

Data on inpatient and emergency department mental health visits will be extracted from claims data using MHRN algorithms.

Inclusion Criteria: 18+ years old Behavioral health (BH) providers/staff employed at a CareSource BH agency Exclusion Criteria: None