James O E Pittman1,2,3, Laurie Lindamer4,5,6, Niloofar Afari4,5,6, Colin Depp4,5,6, Miguel Villodas7, Alison Hamilton8, Bo Kim9,10, Maria K Mor11,12, Erin Almklov4,5, John Gault4,5, Borsika Rabin4,13,14. 1. VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA. james.pittman@va.gov. 2. VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA. james.pittman@va.gov. 3. Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA. james.pittman@va.gov. 4. VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA. 5. VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, USA. 6. Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA. 7. San Diego State University, 5500 Campanile Dr, San Diego, CA, USA. 8. VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, USA. 9. HSR&D Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, USA. 10. Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, USA. 11. VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. 12. VA Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. 13. UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA. 14. UC San Diego Dissemination and Implementation Science Center, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, USA.
Abstract
BACKGROUND: Post-9/11 veterans who enroll in VA health care frequently present with suicidal ideation and/or recent suicidal behavior. Most of these veterans are not screened on their day of enrollment and their risk goes undetected. Screening for suicide risk, and associated mental health factors, can lead to early detection and referral to effective treatment, thereby decreasing suicide risk. eScreening is an innovative Gold Standard Practice with evidence to support its effectiveness and implementation potential in transition and care management (TCM) programs. We will evaluate the impact of eScreening to improve the rate and speed of suicide risk screening and referral to mental health care compared to current screening methods used by transition care managers. We will also evaluate the impact of an innovative, multicomponent implementation strategy (MCIS) on the reach, adoption, implementation, and sustained use of eScreening. METHODS: This is an eight-site 4-year, stepped-wedge, mixed-method, hybrid type-II implementation trial comparing eScreening to screening as usual while also evaluating the potential impact of the MCIS focusing on external facilitation and Lean/SixSigma rapid process improvement workshops in TCM. The aims will address: 1) whether using eScreening compared to oral and/or paper-based methods in TCM programs is associated with improved rates and speed of PTSD, depression, alcohol, and suicide screening & evaluation, and increased referral to mental health treatment; 2) whether and to what degree our MCIS is feasible, acceptable, and has the potential to impact adoption, implementation, and maintenance of eScreening; and 3) how contextual factors influence the implementation of eScreening between high- and low-eScreening adopting sites. We will use a mixed methods approach guided by the RE-AIM outcomes of the Practical Robust Implementation and Sustainability Model (PRISM). Data to address Aim 1 will be collected via medical record query while data for Aims 2 and 3 will be collected from TCM staff questionnaires and qualitative interviews. DISCUSSION: The results of this study will help identify best practices for screening in suicide prevention for Post-9/11 veterans enrolling in VA health care and will provide information on how best to implement technology-based screening into real-world clinical care programs. TRIAL REGISTRATION: ClinicalTrials.gov : NCT04506164; date registered: August 20, 2020; retrospectively registered.
BACKGROUND: Post-9/11 veterans who enroll in VA health care frequently present with suicidal ideation and/or recent suicidal behavior. Most of these veterans are not screened on their day of enrollment and their risk goes undetected. Screening for suicide risk, and associated mental health factors, can lead to early detection and referral to effective treatment, thereby decreasing suicide risk. eScreening is an innovative Gold Standard Practice with evidence to support its effectiveness and implementation potential in transition and care management (TCM) programs. We will evaluate the impact of eScreening to improve the rate and speed of suicide risk screening and referral to mental health care compared to current screening methods used by transition care managers. We will also evaluate the impact of an innovative, multicomponent implementation strategy (MCIS) on the reach, adoption, implementation, and sustained use of eScreening. METHODS: This is an eight-site 4-year, stepped-wedge, mixed-method, hybrid type-II implementation trial comparing eScreening to screening as usual while also evaluating the potential impact of the MCIS focusing on external facilitation and Lean/SixSigma rapid process improvement workshops in TCM. The aims will address: 1) whether using eScreening compared to oral and/or paper-based methods in TCM programs is associated with improved rates and speed of PTSD, depression, alcohol, and suicide screening & evaluation, and increased referral to mental health treatment; 2) whether and to what degree our MCIS is feasible, acceptable, and has the potential to impact adoption, implementation, and maintenance of eScreening; and 3) how contextual factors influence the implementation of eScreening between high- and low-eScreening adopting sites. We will use a mixed methods approach guided by the RE-AIM outcomes of the Practical Robust Implementation and Sustainability Model (PRISM). Data to address Aim 1 will be collected via medical record query while data for Aims 2 and 3 will be collected from TCM staff questionnaires and qualitative interviews. DISCUSSION: The results of this study will help identify best practices for screening in suicide prevention for Post-9/11 veterans enrolling in VA health care and will provide information on how best to implement technology-based screening into real-world clinical care programs. TRIAL REGISTRATION: ClinicalTrials.gov : NCT04506164; date registered: August 20, 2020; retrospectively registered.
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