Clinical Confidence in Risk Assessments of Suicidal Clients: An Intervention Study.

This paper reports on factors associated with clinician confidence in the assessment of suicide risk and the ability of an educational intervention aimed at improving decision-making in experienced clinicians to influence clinical confidence. Two aspects of clinical confidence were considered: (1) outcome-based confidence regarding the ultimate decision whether or not the client required hospitalization due to suicide risk; and (2) process-based confidence regarding clinician performance during an interview. The intervention combined: risk assessment interviews with simulated clients; classroom-based education on decision-making science; practice-based self-monitoring with the aid of wearable technology; and classroom-based group and individual opportunities to engage in discussions regarding clinical decision-making. Results revealed that while there was wide variability in clinician decisions regarding hospitalization, participants were equally confident in their suicide risk assessment process and clinical performance regardless of the final decision. Confidence in clinical decision-making was negatively associated with psychological stress and physiological stress, as well as emotional exhaustion on the Maslach Burnout Inventory (MBI) and positively associated with the personal achievement scale of the MBI. Confidence in clinical performance was negatively associated with psychological stress and both emotional exhaustion and depersonalization on the MBI. Confidence in clinical decision-making did not significantly increase following the educational intervention, however, there were some modest increases in confidence in clinical performance that approached statistical significance. These findings raise new questions regarding clinical confidence, separating different aspects of clinical confidence and investigating further the association between clinical confidence and client outcomes in social work. [ABSTRACT FROM AUTHOR]