Suicide
Conditions
Keywords
Suicide, Prevention, Implementation, Facilitation
Brief summary
The VA's Office of Mental Health and Suicide Prevention implemented an new program to increase suicide prevention outreach for Veterans at highest risk for suicide. Using a statistical model, REACH VET, short for Recovery Engagement and Coordination for Health - Veterans Enhanced Treatment, uses information from Veterans' health records to identify those who are at a higher risk for suicide, hospitalization, illness, or other negative outcomes. Once a Veteran is identified, his or her VA mental health or primary care provider reaches out to check on the Veteran's well-being and review their treatment plan to determine if enhanced care is needed. The goal of the current study was to evaluate the implementation of this program. The objectives of this evaluation were to evaluate how well this program is put into place using an implementation strategy called virtual external facilitation, and to collect data about the cost of the program and the strategy.
Detailed description
The VA's Office of Mental Health and Suicide Prevention is implemented an innovative new program to increase suicide prevention outreach and target Veterans at highest risk for suicide. Using a new predictive model, REACH VET, short for Recovery Engagement and Coordination for Health - Veterans Enhanced Treatment, analyzes existing data from Veterans' health records to identify those who are at a statistically elevated risk for suicide, hospitalization, illness, or other adverse outcomes. Once a Veteran is identified, their VA mental health or primary care provider reaches out to check on the Veteran's well-being and review their condition(s) and treatment plans to determine if enhanced care is needed. The goal of the proposed study is to evaluate the implementation of REACH VET. The objectives of this evaluation are to: 1. evaluate the implementation of REACH VET using virtual external facilitation, and 2. collect preliminary data about the cost and cost offsets. The current evaluation will examine the impact of a virtual external facilitation strategy on the implementation of REACH VET in 28 medical facilities across 7 Veteran Integrated Service Networks (VISNs) in a stepped wedge design. Primary implementation outcomes include metrics of REACH VET implementation: coordinator assignment, provider assignment, care evaluation, and attempted outreach. Qualitative interviews will be conducted with implementation facilitators, Suicide Prevention Coordinator(s), clinical leadership, and providers to identify barriers and facilitators to implementation of REACH VET and the experience of facilitation. Secondary data will be collected on the cost of the intervention and the cost of implementation strategy.
Interventions
Facilitation is an evidence-based implementation strategy to support sites that have difficulty implementing innovative programs. Facilitation is a multi-faceted process of interactive problem solving and support that occurs in the context of a recognized need for improvement and a supportive interpersonal relationship (Powell et al., 2015). Facilitation has been used nationally across VA to implement a number of different clinical interventions. The current project will examine this minimally intensive version of implementation facilitation, virtual external facilitation.
Sponsors
VA Office of Research and Development
Study design
Observational model
ECOLOGIC_OR_COMMUNITY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* VA employee at a facility receiving virtual external facilitation * Involved in REACH VET implementation
Exclusion criteria
* Not a VA employee * Not employed at a facility receiving virtual external facilitation * Not involved in REACH VET implementation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Coordinator Assigned Post-Implementation | 6 months after implementation was completed | The average percentage of eligible Veterans across all 23 participating sites having a coordinator assigned within 2 weeks of the monthly REACH VET report being released during the 6 month post-implementation period. |
| Provider Assigned Post-Implementation | 6 month period following implementation | The average percentage of eligible Veterans across all 23 participating sites having a provider assigned within 2 weeks of the monthly REACH VET report being released during the 6 month post-implementation period . |
| Care Evaluation Performed Post-Implementation | 6 month period following implementation | The average percentage of eligible Veterans across all 23 participating sites receiving a care evaluation within 2 weeks of the monthly REACH VET report being released during the 6 month post-implementation period. |
| Attempted Outreach Post-Implementation | 6 month period following implementation | The average percentage of eligible Veterans across all 23 participating sites where outreach was attempted within 2 weeks of the monthly REACH VET report being released during the 6 month post-implementation period. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Organizational Readiness for Change Survey | 1 month | Eligible staff at participating VA facilities were solicited to complete a modified version of the Texas Christian University Organizational Readiness for Change - Staff (TCU ORC-S). We abbreviated the original instrument to 62 items and modified text for contextual relevance. Responses were collected from 22 sites across five Veteran Integrated Service Networks (VISN). The responses were scored on ten scales: Program Needs (10 - 50 higher is preferred), Training Needs (10 - 50 higher is preferred), Pressure for Change (10 - 50 higher is preferred), Staffing (10 - 50 higher is preferred), Mission (10 - 50 higher is preferred), Cohesion (10 - 50 higher is preferred), Autonomy (10 - 50 higher is preferred), Communication (10 - 50 higher is preferred), Stress (10 - 50 lower is preferred) and Change (10 - 50 lower is preferred). |
Countries
United States
Participant flow
Recruitment details
VA Medical Centers in five Veteran Integrated Service Networks were identified by leadership as needing additional support in or der to implement REACH VET.
Pre-assignment details
This study focuses on the implementation of an innovative new program to increase suicide prevention within VHA. Twenty-eight (28) VHA medical facilities were identified by leadership from seven Veteran Integrated Service Networks (VISN) for implementation based upon need for additional support in standing up the program. All outcomes were reported at the facility level. No patients were enrolled in this study and no outcomes are reported at the patient level.
Participants by arm
| Arm | Count |
|---|---|
| VISNs Requesting Implementation Support This cohort consists of VA Medical Centers (VAMC's) needing additional implementation support to fully implement REACH VET as identified by Veteran Integrated Service Network (VISN) leadership, and that agreed to participate.
External facilitation: Facilitation is an evidence-based implementation strategy to support sites that have difficulty implementing innovative programs. Facilitation is a multi-faceted process of interactive problem solving and support that occurs in the context of a recognized need for improvement and a supportive interpersonal relationship (Powell et al., 2015). Facilitation has been used nationally across VA to implement a number of different clinical interventions. The current project will examine this minimally intensive version of implementation facilitation, virtual external facilitation. | 0 |
| VISNs Requesting Implementation Support This cohort consists of VA Medical Centers (VAMC's) needing additional implementation support to fully implement REACH VET as identified by Veteran Integrated Service Network (VISN) leadership, and that agreed to participate.
External facilitation: Facilitation is an evidence-based implementation strategy to support sites that have difficulty implementing innovative programs. Facilitation is a multi-faceted process of interactive problem solving and support that occurs in the context of a recognized need for improvement and a supportive interpersonal relationship (Powell et al., 2015). Facilitation has been used nationally across VA to implement a number of different clinical interventions. The current project will examine this minimally intensive version of implementation facilitation, virtual external facilitation. | 23 |
| Total | 23 |
Baseline characteristics
| Characteristic | VISNs Requesting Implementation Support |
|---|---|
| Age, Continuous | NA VAMC |
| Care Evaluation Performed Pre-Implementation | 63.4 percentage STANDARD_DEVIATION 23.9 |
| Coordinator Accepted Pre-Implementation | 88.5 percent STANDARD_DEVIATION 16.7 |
| Outreach Attempted Pre-Implementation | 56.2 percent STANDARD_DEVIATION 77 |
| Provider Assigned Pre-Implementation | 68.1 percentage STANDARD_DEVIATION 25.5 |
| Race/Ethnicity, Customized Units | NA VAMC |
| Sex: Female, Male Female | NA VAMC |
| Sex: Female, Male Male | NA VAMC |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 0 |
| other Total, other adverse events | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 |
Outcome results
Primary
Attempted Outreach Post-Implementation
The average percentage of eligible Veterans across all 23 participating sites where outreach was attempted within 2 weeks of the monthly REACH VET report being released during the 6 month post-implementation period.
Time frame: 6 month period following implementation
Population: Data not collected at the participant level
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| VISNs Requesting Implementation Support | Attempted Outreach Post-Implementation | 77.0 percent | Standard Deviation 20.6 |
Comparison: Odds Ratio of eligible Veterans where outreach was attempted during the 6 month period following implementation compared to eligible Veterans where outreach was attempted in the 6 month period prior to implementation.p-value: 0.01195% CI: [1.08, 1.76]Regression, Logistic
Primary
Care Evaluation Performed Post-Implementation
The average percentage of eligible Veterans across all 23 participating sites receiving a care evaluation within 2 weeks of the monthly REACH VET report being released during the 6 month post-implementation period.
Time frame: 6 month period following implementation
Population: Data not collected at the participant level
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| VISNs Requesting Implementation Support | Care Evaluation Performed Post-Implementation | 83.6 percent | Standard Deviation 18.9 |
Comparison: Odds Ratio of eligible Veterans receiving a care evaluation during the 6 month period following implementation compared to eligible Veterans receiving a care evaluation in the 6 month period prior to implementation.p-value: 0.19995% CI: [0.9, 1.7]Regression, Logistic
Primary
Coordinator Assigned Post-Implementation
The average percentage of eligible Veterans across all 23 participating sites having a coordinator assigned within 2 weeks of the monthly REACH VET report being released during the 6 month post-implementation period.
Time frame: 6 months after implementation was completed
Population: Data not collected at the participant level
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| VISNs Requesting Implementation Support | Coordinator Assigned Post-Implementation | 97.6 percentage | Standard Deviation 1 |
Comparison: Odds Ratio of eligible Veterans being assigned a coordinator during the 6 month period following implementation compared to eligible Veterans being assigned a coordinator in the 6 month period prior to implementation.p-value: 0.30295% CI: [0.73, 2.82]Regression, Logistic
Primary
Provider Assigned Post-Implementation
The average percentage of eligible Veterans across all 23 participating sites having a provider assigned within 2 weeks of the monthly REACH VET report being released during the 6 month post-implementation period .
Time frame: 6 month period following implementation
Population: Data not collected at the participant level
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| VISNs Requesting Implementation Support | Provider Assigned Post-Implementation | 87.2 percent | Standard Deviation 17.3 |
Comparison: Odds Ratio of eligible Veterans being assigned a provider during the 6 month period following implementation compared to eligible Veterans being assigned a provider in the 6 month period prior to implementation.p-value: 0.22695% CI: [0.86, 1.93]Regression, Logistic
Secondary
Organizational Readiness for Change Survey
Eligible staff at participating VA facilities were solicited to complete a modified version of the Texas Christian University Organizational Readiness for Change - Staff (TCU ORC-S). We abbreviated the original instrument to 62 items and modified text for contextual relevance. Responses were collected from 22 sites across five Veteran Integrated Service Networks (VISN). The responses were scored on ten scales: Program Needs (10 - 50 higher is preferred), Training Needs (10 - 50 higher is preferred), Pressure for Change (10 - 50 higher is preferred), Staffing (10 - 50 higher is preferred), Mission (10 - 50 higher is preferred), Cohesion (10 - 50 higher is preferred), Autonomy (10 - 50 higher is preferred), Communication (10 - 50 higher is preferred), Stress (10 - 50 lower is preferred) and Change (10 - 50 lower is preferred).
Time frame: 1 month
Population: Eligible staff from all participating facilities were solicited to complete the modified Texas Christian University Organizational Readiness for Change for Staff (TCU ORC-S). Eligible staff were not considered enrolled but did contribute to this assessment.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| VISNs Requesting Implementation Support | Organizational Readiness for Change Survey | Pressure for Change | 29.91 score on a scale | Standard Deviation 5.04 |
| VISNs Requesting Implementation Support | Organizational Readiness for Change Survey | Change | 31.30 score on a scale | Standard Deviation 5.74 |
| VISNs Requesting Implementation Support | Organizational Readiness for Change Survey | Staffing | 29.86 score on a scale | Standard Deviation 6.61 |
| VISNs Requesting Implementation Support | Organizational Readiness for Change Survey | Stress | 33.19 score on a scale | Standard Deviation 8.14 |
| VISNs Requesting Implementation Support | Organizational Readiness for Change Survey | Communication | 31.74 score on a scale | Standard Deviation 7.27 |
| VISNs Requesting Implementation Support | Organizational Readiness for Change Survey | Training Needs | 21.90 score on a scale | Standard Deviation 5.25 |
| VISNs Requesting Implementation Support | Organizational Readiness for Change Survey | Program Needs | 25.77 score on a scale | Standard Deviation 7.78 |
| VISNs Requesting Implementation Support | Organizational Readiness for Change Survey | Autonomy | 34.78 score on a scale | Standard Deviation 5.71 |
| VISNs Requesting Implementation Support | Organizational Readiness for Change Survey | Cohesion | 31.67 score on a scale | Standard Deviation 10.3 |
| VISNs Requesting Implementation Support | Organizational Readiness for Change Survey | Mission | 33.46 score on a scale | Standard Deviation 6.94 |
| VISN B | Organizational Readiness for Change Survey | Training Needs | 25.94 score on a scale | Standard Deviation 8.49 |
| VISN B | Organizational Readiness for Change Survey | Program Needs | 31.74 score on a scale | Standard Deviation 7.27 |
| VISN B | Organizational Readiness for Change Survey | Pressure for Change | 30.56 score on a scale | Standard Deviation 6.16 |
| VISN B | Organizational Readiness for Change Survey | Staffing | 28.23 score on a scale | Standard Deviation 6.64 |
| VISN B | Organizational Readiness for Change Survey | Mission | 31.38 score on a scale | Standard Deviation 6.96 |
| VISN B | Organizational Readiness for Change Survey | Cohesion | 32.36 score on a scale | Standard Deviation 8 |
| VISN B | Organizational Readiness for Change Survey | Autonomy | 32.47 score on a scale | Standard Deviation 5.75 |
| VISN B | Organizational Readiness for Change Survey | Communication | 28.18 score on a scale | Standard Deviation 6.87 |
| VISN B | Organizational Readiness for Change Survey | Stress | 34.63 score on a scale | Standard Deviation 6.93 |
| VISN B | Organizational Readiness for Change Survey | Change | 29.52 score on a scale | Standard Deviation 6.3 |
| VISN C | Organizational Readiness for Change Survey | Cohesion | 35.24 score on a scale | Standard Deviation 8.58 |
| VISN C | Organizational Readiness for Change Survey | Stress | 30.71 score on a scale | Standard Deviation 11.79 |
| VISN C | Organizational Readiness for Change Survey | Pressure for Change | 30.00 score on a scale | Standard Deviation 6.8 |
| VISN C | Organizational Readiness for Change Survey | Staffing | 30.00 score on a scale | Standard Deviation 6.08 |
| VISN C | Organizational Readiness for Change Survey | Training Needs | 30.00 score on a scale | Standard Deviation 13.84 |
| VISN C | Organizational Readiness for Change Survey | Mission | 32.29 score on a scale | Standard Deviation 10.09 |
| VISN C | Organizational Readiness for Change Survey | Autonomy | 32.00 score on a scale | Standard Deviation 7.83 |
| VISN C | Organizational Readiness for Change Survey | Program Needs | 32.86 score on a scale | Standard Deviation 11.47 |
| VISN C | Organizational Readiness for Change Survey | Change | 29.71 score on a scale | Standard Deviation 11.97 |
| VISN C | Organizational Readiness for Change Survey | Communication | 29.86 score on a scale | Standard Deviation 6.99 |
| VISN D | Organizational Readiness for Change Survey | Training Needs | 25.93 score on a scale | Standard Deviation 7.33 |
| VISN D | Organizational Readiness for Change Survey | Change | 32.72 score on a scale | Standard Deviation 5.82 |
| VISN D | Organizational Readiness for Change Survey | Program Needs | 28.96 score on a scale | Standard Deviation 7.55 |
| VISN D | Organizational Readiness for Change Survey | Pressure for Change | 29.29 score on a scale | Standard Deviation 6.03 |
| VISN D | Organizational Readiness for Change Survey | Cohesion | 33.75 score on a scale | Standard Deviation 7.56 |
| VISN D | Organizational Readiness for Change Survey | Communication | 30.80 score on a scale | Standard Deviation 7.27 |
| VISN D | Organizational Readiness for Change Survey | Stress | 31.31 score on a scale | Standard Deviation 8.11 |
| VISN D | Organizational Readiness for Change Survey | Autonomy | 35.98 score on a scale | Standard Deviation 4.8 |
| VISN D | Organizational Readiness for Change Survey | Staffing | 31.15 score on a scale | Standard Deviation 6.37 |
| VISN D | Organizational Readiness for Change Survey | Mission | 33.27 score on a scale | Standard Deviation 6.48 |
| VISN E | Organizational Readiness for Change Survey | Staffing | 26.67 score on a scale | Standard Deviation 4.84 |
| VISN E | Organizational Readiness for Change Survey | Stress | 36.97 score on a scale | Standard Deviation 8.32 |
| VISN E | Organizational Readiness for Change Survey | Mission | 30.21 score on a scale | Standard Deviation 7.45 |
| VISN E | Organizational Readiness for Change Survey | Cohesion | 33.32 score on a scale | Standard Deviation 8.49 |
| VISN E | Organizational Readiness for Change Survey | Change | 31.47 score on a scale | Standard Deviation 4.63 |
| VISN E | Organizational Readiness for Change Survey | Autonomy | 32.24 score on a scale | Standard Deviation 5.22 |
| VISN E | Organizational Readiness for Change Survey | Program Needs | 27.17 score on a scale | Standard Deviation 10.29 |
| VISN E | Organizational Readiness for Change Survey | Communication | 30.32 score on a scale | Standard Deviation 7.16 |
| VISN E | Organizational Readiness for Change Survey | Pressure for Change | 28.87 score on a scale | Standard Deviation 8.74 |
| VISN E | Organizational Readiness for Change Survey | Training Needs | 24.78 score on a scale | Standard Deviation 9.64 |
Comparison: Program Needsp-value: 0.018ANOVA
Comparison: Training Needsp-value: 0.136ANOVA
p-value: 0.812ANOVA
p-value: 0.358ANOVA
p-value: 0.748ANOVA
Comparison: Cohesionp-value: 0.748ANOVA
Comparison: Autonomyp-value: 0.005ANOVA
Comparison: Communicationp-value: 0.224ANOVA
Comparison: Stressp-value: 0.043ANOVA
Comparison: Changep-value: 0.096ANOVA