Adapting Caring Contacts for Veterans in a Department of Veterans Affairs Emergency Department: Results From a Type 2 Hybrid Effectiveness-Implementation Pilot Study.

Sara J Landes,Susan M Jegley,John P Areno,Jacob Painter,Nyssa D Curtis,Traci H Abraham,Donald E Jones,Bridget B Matarazzo,Katherine Anne Comtois,Jeffery A Pitcock,Sacha A Mcbain,Joann E Kirchner,Mark A Reger,R Sonia Singh,Jack A Woods,Mary J Bollinger

doi:10.3389/fpsyt.2021.746805

Abstract

Transitions in care, such as discharge from an emergency department (ED), are periods of increased risk for suicide and effective interventions that target these periods are needed. Caring Contacts is an evidence-based suicide prevention intervention that targets transitions, yet it has not been widely implemented. This pilot study adapted Caring Contacts for a Department of Veterans Affairs (VA) ED setting and population, created an implementation toolkit, and piloted implementation and evaluation of effectiveness. To inform adaptation, qualitative interviews were conducted with stakeholders. Data were used by an advisory board comprised of stakeholders, experts, and veterans to make adaptations and develop an implementation planning guide to delineate steps needed to implement. Key decisions about how to adapt Caring Contacts included recipients, author, content, and the schedule for sending. Pilot implementation occurred at one VA ED. Caring Contacts involved sending patients at risk of suicide brief, non-demanding expressions of care. Program evaluation of the pilot used a type 2 hybrid effectiveness-implementation design to both pilot an implementation strategy and evaluate effectiveness of Caring Contacts. Evaluation included qualitative interviews with veteran patients during implementation. VA electronic health records were used to evaluate VA service utilization in the 6-month periods immediately before and after veterans were delivered their first Caring Contact. Hundred and seventy-five veterans were mailed Caring Contacts and the facility continued adoption after the pilot. Participants were positive about the intervention and reported feeling cared about and connected to VA as a result of receiving Caring Contacts. This project developed an implementation planning process that successfully implemented Caring Contacts at one site. This can be used to further implement Caring Contacts at additional VA or community EDs.

Highlights

Suicide is a growing public health problem, especially for military veterans
The planning phase allowed for collection of key stakeholder feedback about the intervention and its fit with the setting and veterans
Use of an advisory board with key stakeholders and CC experts allowed for adaptation of CC to the setting and recipient while keeping aligned with what is known about CC via research and capitalizing on existing resources and national initiatives

Summary

Introduction

Suicide rates have increased for veterans and non-veterans, rates for veterans are 1.5 times higher after adjusting for age and gender [1, 2]. Suicide prevention remains a top priority for the Department of Veteran Affairs (VA) [3]. Transitions in care are critical periods of suicide risk [4]. Most deaths by suicide take place within 30 days of discharge from the hospital or emergency department (ED), with most occurring within a week [5,6,7]. In a large meta-analysis of 100 studies, the suicide rate 3 months post discharge was ∼100 times the global suicide rate [8]. National suicide prevention initiatives have focused on transitions in care to improve suicide prevention [9,10,11,12,13]

Methods

Results

Conclusion