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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.
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:
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| VAMC's receiving implementation support for REACH VET | This cohort consists of 28 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. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| External facilitation | Other | 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. |
| Measure | Description | Time Frame |
|---|---|---|
| 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. | 6 months after implementation was completed |
| 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 . | 6 month period following implementation |
| 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. | 6 month period following implementation |
| 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. | 6 month period following implementation |
| Measure | Description | Time Frame |
|---|---|---|
| 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). |
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Inclusion Criteria:
Exclusion Criteria:
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The study population will include facilities receiving virtual external facilitation for REACH VET
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| Name | Affiliation | Role |
|---|---|---|
| Sara J. Landes, PhD | Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR | North Little Rock | Arkansas | 72114-1706 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Result | Reger MA, Luxton DD, Tucker R, Comtois KA, Keen AD, Landes SJ, Matarazzo BB, Thompson C. Implementation Methods for the Caring Contacts Suicide Prevention Intervention. Professional Psychology, Research and Practice. 2017 Oct 1; 48(5):369-377. |
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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.
VA Medical Centers in five Veteran Integrated Service Networks were identified by leadership as needing additional support in or der to implement REACH VET.
| ID | Title | Description |
|---|---|---|
| FG000 | VAMC's Receiving Implementation Support for REACH VET | 28 VA Medical Centers were chosen by leadership across seven VISN's for support implementing REACH VET. 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. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
23 VA Medical Centers participating in implementation of REACH VET, Participants were not assigned to study arms
| ID | Title | Description |
|---|---|---|
| BG000 | 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. |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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. | Data not collected at the participant level | Posted | Mean | Standard Deviation | percentage | 6 months after implementation was completed | VAMC | VAMC |
|
All-cause mortality, serious and other adverse events were not monitored or assessed for this implementation evaluation by the study team.
All-cause mortality, serious and other adverse events were not monitored or assessed for this implementation evaluation by the study team.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | VISNs Requesting Implementation Support | This cohort consists of 23 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. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Sara J. Landes | Central Arkansas Veterans Healthcare System | 501-257-3385 | sara.landes@va.gov |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Nov 1, 2018 | Jul 22, 2021 | Prot_000.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Jul 16, 2021 | Jul 22, 2021 | SAP_001.pdf |
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| ID | Term |
|---|---|
| D013405 | Suicide |
| ID | Term |
|---|---|
| D016728 | Self-Injurious Behavior |
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |
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No biospecimens will be collected.
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| 1 month |
| VA Eastern Colorado Health Care System, Denver, CO | Denver | Colorado | 80220 | United States |
| VAMC |
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| VAMC |
| VAMC |
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| Sex: Female, Male | Count of Units | VAMC | VAMC |
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| Race/Ethnicity, Customized | Count of Units | VAMC | VAMC |
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| Coordinator Accepted Pre-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 pre-implementation period. | Mean | Standard Deviation | percent | VAMC |
|
| Provider Assigned Pre-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 pre-implementation period. | Mean | Standard Deviation | percentage | VAMC |
|
| Care Evaluation Performed Pre-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 pre-implementation period. | Mean | Standard Deviation | percentage | VAMC |
|
| Outreach Attempted Pre-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 pre-implementation period. | Mean | Standard Deviation | percent | VAMC |
|
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| 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 . | Data not collected at the participant level | Posted | Mean | Standard Deviation | percent | 6 month period following implementation | VAMC | VAMC |
|
|
|
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| 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. | Data not collected at the participant level | Posted | Mean | Standard Deviation | percent | 6 month period following implementation | VAMC | VAMC |
|
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|
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| 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. | Data not collected at the participant level | Posted | Mean | Standard Deviation | percent | 6 month period following implementation | VAMC | VAMC |
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|
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| 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). | 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. | Posted | Mean | Standard Deviation | score on a scale | 1 month | VAMC | VAMC |
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| 0 |
| 0 |
| 0 |
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| VAMC |
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| Training Needs |
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| Pressure for Change |
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| Staffing |
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| Mission |
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| Cohesion |
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| Autonomy |
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| Communication |
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| Stress |
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| Change |
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| ANOVA |
F (4, 158) = 1.78 |
| .136 |
| Superiority |
| ANOVA | F (4, 158) = 0.39 | .812 | Superiority | Pressure for Change |
| ANOVA | F (4, 158) = 1.10 | .358 | Superiority | Staffing |
| ANOVA | F (4, 158) = 0.48 | .748 | Superiority | Mission |
| Cohesion | ANOVA | F (4, 158) = 0.48 | .748 | Superiority |
| Autonomy | ANOVA | F (4, 158) = 3.88 | .005 | Superiority |
| Communication | ANOVA | F (4, 158) = 1.44 | .224 | Superiority |
| Stress | ANOVA | F (4, 158) = 2.52 | .043 | Superiority |
| Change | ANOVA | F (4, 158) = 2.01 | .096 | Superiority |