Suicide Prevention
Conditions
Keywords
suicide, firearm, primary care, lethal means safety, motivational interviewing, self-injurious behavior
Brief summary
Suicide prevention remains a significant priority and nearly three-quarters of Veteran suicides result from firearm injury. Since access to lethal means of self-harm increases the risk of injury, the VA/DoD Clinical Practice Guidelines recommend that Veterans with elevated suicide risk receive lethal means safety (LMS) counseling to reduce access to lethal means, including firearms. However, no LMS counseling interventions have been tested within VA. Thus, the aim of this study is to conduct a pilot randomized controlled trial to evaluate the feasibility and acceptability of a tailored LMS counseling intervention compared to an active control condition.
Detailed description
This is a pilot randomized controlled trial of up to 50 Veterans to assess the feasibility and acceptability of a LMS intervention and testing procedures.
Interventions
BEHAVIORALRAMP
Participants randomized to the intervention condition will receive a brief, motivational interviewing-based intervention called RAMP (Raise the subject, Assess current storage, Motivate change, and Plan next steps) in the context of their clinical care. RAMP incorporates evidence-informed intervention components to facilitate secure firearm storage
BEHAVIORALActive control
The control condition will entail a 5-minute review of a pamphlet on suicide prevention with the PCMHI clinician. This pamphlet is produced by the Veteran's Crisis Line and is widely available on the OSP suicide prevention website as a VHA resource. This condition will control for time and attention, subject matter, mode of delivery, and setting.
Sponsors
VA Office of Research and Development
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Masking description
The research assistant (outcomes assessor) will be blinded to study condition.
Intervention model description
This pilot randomized controlled trial includes two arms: the experimental arm will have trained PCMHI clinicians deliver a brief motivational interviewing-based intervention to facilitate secure firearm storage; the control arm will have PCMHI clinicians review a suicide prevention pamphlet.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
For Veterans: * Has access to a firearm * Referred to PCMHI care For clinicians (delivering intervention): * deliver care in PCMHI * trained in RAMP and study procedures
Exclusion criteria
For Veterans: * Unable to consent due to cognitive impairment, severity of illness (including psychiatric symptoms), intoxication with drugs and/or alcohol * Unreliable telephone access * Inability to read English or communicate in spoken and written English For clinicians (delivering intervention): \- Did not participate in training
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Screening | through study completion, approximately 2 years | Investigators will assess the number of new PCMHI patients seen in PCMHI and the number who were approached about potential study participation per month |
| Recruitment | through study completion, approximately 2 years | Investigators will track the number of eligible Veterans who enrolled in the study per month |
| Retention | approximately 30 days | Investigators will calculate the number of Veterans who received RAMP who were willing to complete immediate and one-month follow up assessments. |
| Assessment of behavioral outcomes | approximately 30 days | Investigators will assess the percentage of participants who completed behavioral outcome measures within the time allotted at each timepoint |
| Veteran acceptability - Theoretical Framework of Acceptability | At immediate follow up, within approximately 2 weeks of intervention | Investigators will assess Veteran acceptability using the eight Likert-style items from the Theoretical Framework of Acceptability questionnaire, which assess seven component constructs of acceptability including Veteran's experience of the lethal means safety intervention. Each item has 5 answer options (1-5) on a Likert Scale. Score range is 8 to 40, with a higher score indicating more higher reported acceptability. |
| Veteran acceptability - Experience and Satisfaction with intervention | At immediate follow up, within approximately 2 weeks of intervention | Investigators will conduct qualitative evaluation of the participant's experience and satisfaction receiving the intervention. |
| Clinician acceptability - Theoretical Framework of Acceptability | at 50% enrollment (approximately 1 year) and 100% enrollment (approximately 2 years) | Investigators will invite clinicians to respond to the eight-item Theoretical Framework of Acceptability questionnaire eliciting clinician acceptability of the lethal means safety intervention. Each item has 5 answer options (1-5) on a Likert Scale. Score range is 8 to 40, with a higher score indicating more higher reported acceptability. |
| Clinician acceptability - Negative impact | at 50% enrollment (approximately 1 year) and 100% enrollment (approximately 2 years) | Investigators will assess to what extent PCMHI clinicians agree that study recruitment negatively impacted clinical care, using Likert-type items where '1' indicates strongly disagree and '5' indicates strongly agree. For those responding \>3 (don't know), an open-ended question will elicit detailed information (e.g., interfered with delivery of clinical care, led to Veteran frustration). |
Countries
United States
Contacts
Primary ContactFrances Aunon, PhD MS
Backup ContactSteve Martino, PhD
Outcome results
None listed