Access to tailored evidence-based treatment for depression and self-injurious thoughts or behaviors among U.S. military veterans who identify as LGBTQ+. Mental and Behavioural Disorders
Conditions
Interventions
Facilities are randomized using constrained randomization to one of two implementation arms: 1) Standard Implementation Package, or 2) Enhanced Implementation Package. The Standard Implementation Pack
Sponsors
Veterans Health Administration
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: Facility (primary participants, unit of randomization) Inclusion Criteria: 1. Availability and willingness of one internal implementation facilitator (devoting up to 3 hours/week for 18 months) 2. Site leadership (Chief of Staff or Associate Chief of Staff for Mental and Behavioral Health Services) is willing to sign an agreement confirming willingness for the internal facilitator, trainers, and facility training, and (if randomized to the Enhanced Condition) willing to interact with study personnel for at least one meeting. 3. In the event that more than 12 facilities apply for inclusion in the study, inclusion will be prioritized by several factors, including number of Mental Health Service full-time employees (to ensure sufficient sample size of clinicians), representativeness across facility complexity classifications, and representativeness across rural/urban locations. Provider Electronic Health Record Cohort Inclusion Criteria (not enrolled): 1. Non-specialty practicing psychotherapist at included study facility 2. Delivered psychotherapy within the measurement period Patient Electronic Health Record Cohort Inclusion (not enrolled): 1. Identified as LGBTQ+ using validated natural language processing algorithm from electronic health record notes from 2019 to present.
Exclusion criteria
Exclusion criteria: Facility-Level Exclusion Criteria (primary participants, unit of randomization): 1. Facility using Cerner as its electronic health record system 2. Internal Facilitator not available 3. Facility leadership unwilling to support implementation Provider Electronic Health Record Cohort Exclusion Criteria (not enrolled): 1. Not a practicing psychotherapist at an included study facility 2. Did not deliver psychotherapy within the measurement period Patient Electronic Health Record Cohort Exclusion (not enrolled): 1. Not identified as LGBTQ+ using validated natural language processing algorithm from electronic health record notes from 2019 to present.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The extent to which an Enhanced Implementation Package improves the adoption and sustainment of the evidence-based psychotherapy (provider-level main outcomes) is measured through the following variables: 1. Primary Adoption Outcome, defined as the rate of practicing psychotherapists delivering at least one session of CBT-PRISM measured using electronic health record data from patients within the healthcare system in the 18-month Implementation Period. 2. Primary Sustainment Outcome, defined as the rate of practicing psychotherapists delivering at least one session of CBT-PRISM measured using electronic health record data from patients within the healthcare system in the 6-month Sustainment Period | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Reach Outcome: Receiving CBT-PRISM, defined as the proportion of LGBTQ+ veterans with electronic health record depression diagnosis receiving at least one session of CBT-PRISM across implementation arms, measured using electronic health record data from patients within the healthcare system during the 18-month Implementation Period and during the 6-month Sustainment Period. 2. Effectiveness Outcome: Documentation of clinically significant improvement in depression symptoms, defined as the proportion of LGBTQ+ veterans with an electronic health record depression diagnosis with a clinically significant decrease in depression symptoms, measured pragmatically using electronic health record data from health system patients. Clinically significant change on health system symptom measurement tools (Patient Health Questionnaire-9; PHQ-9) will be quantified using the Reliable Change Index during the 18-month Implementation Period and 6-month Sustainment Period. 3. Effectiveness Outcome: Likelihood of having documented self-injurious thoughts or behaviors, measured pragmatically using electronic health record data of health care system patients, adjusting for pre-implementation levels of self-injurious thoughts or behaviors. | — |
Countries
United States of America
Contacts
Public ContactHollis Weidenbacher
Outcome results
None listed