Implementing eScreening for suicide prevention in VA post-9/11 transition programs using a stepped-wedge, mixed-method, hybrid type-II implementation trial: a study protocol

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

Feasibility and acceptability of caring contacts texts for suicide prevention among veterans recently separated from military service.

“…The FIM and AIM are four-item questionnaires each using a 5-point Likert-type scale. Total scores on each range from 4 to 20, with higher scores indicating greater feasibility and acceptability and scores above 12 (i.e., mean score) indicating the intervention was, overall, feasible or acceptable (Adrian et al, 2022; Pittman et al, 2021). These measures have demonstrated acceptable test–retest reliability and good structural validity (Weiner et al, 2017).…”

Older adults using social support to improve self-care (OASIS): Adaptation, implementation and feasibility of peer support for older adults with T2D in appalachia: A feasibility study protocol

“…At the second meeting, we will present de-identified results from the survey and then engage in subsequent brainstorming/goal setting to determine best approaches, including possible midcourse EBI adaptations, to improve data collection for RE-AIM dimensions deemed most in need of increased attention. To meet the third goal, we will use a PRISM-based survey [ 39 ] and the same interview guide used at project start-up to give context to determinants of midcourse progress (including any identified adaptations).…”

Time–motion analysis of external facilitation for implementing the Collaborative Chronic Care Model in general mental health clinics: Use of an interval-based data collection approach

“…Time–motion methodology is beginning to be more widely used for implementation science. Especially as economic evaluation of implementation is receiving increased attention within the field (since implementation cost can influence whether and how to implement an evidence-based intervention) ( Eisman et al, 2020 ; Yoon, 2020 ), time–motion methodology is being embraced as an approach for collecting and analyzing data that inform implementation cost ( Matthieu et al, 2020 ; Lamper et al, 2020 ; Pittman et al, 2021 ). Notably, Ritchie et al (2020b) conducted a by-week time–motion study of implementation facilitation activities for the EFs, internal facilitators, and participating staff across all levels of the health care systems in which implementation of integrated mental health services within primary care settings was being carried out.…”