Caring Cards to and from Veterans: Feasibility and Acceptability of a Peer Approach toSuicide Prevention and Recovery

RR&D的小型项目康复研究奖（SPiRE）。有很强 需要制定，评估和实施旨在减少退伍军人自杀的可翻译干预措施。爱心 用于自杀预防的触点（即，精神科住院病人获医护人员发信支持 stays）是一种有经验支持的低成本方法，可有效降低自杀风险和住院率 再入院，并已研究和应用于退伍军人/VA设置。同伴支持（即，生活在 心理健康经验）是另一个经验支持的方法。同行的 参与精神卫生保健可以改善患者的社会功能和社区融合， 减少自我羞辱和功能障碍。该提案描述了关怀卡（CC）干预措施， which哪一个is a novel新integration集成of caring关怀contacts接触and peers同行.在CC，门诊退伍军人与生活的心理健康 经验（同行）创建充满活力和鼓舞人心的卡片，然后发送给其他退伍军人挣扎， 心理健康问题。通过设计，CC增加了参与者之间的社会联系，以减少自杀 风险，这与社会脱节密切相关。事实上，有两种基于证据的社会风险 自杀因素：挫败感（TB;感觉自己不属于）和感知 负担（PB;感觉自己的存在是别人的负担）。CC结合了两种关怀 联系人和同行通过增加社会联系，专门针对结核病和结核病的减少。本研究 目的是建立CC的可行性和可接受性。我们最初的质量改进项目提供了 为CC的可行性和可接受性提供强有力的初步证据。目前的建议是一个单一的- 研究中心，为期2年的试点试验，采用开放试验，前/后研究设计。我们建议招募门诊病人 具有高自杀风险历史的退伍军人组成我们的CC组，并担任制卡者（CM）。我们 将招募目前自杀风险高的门诊退伍军人成为我们的卡收件人（CR）。的 主要结果（目标1）是确定CC的可行性和可接受性。目标2将检查CC的能力， 降低CM和CR的主要结局（TB和PB）。目标3将初步评估CC的能力， 增加社会联系，以及降低自杀风险（即，自杀意念及行为）的个案 和CR。CM将在一年的时间里每周举行一次会议，每次为期六个月; CR将收到一份 共六张卡，每月一张。每月的会议小组也将是CM和CR的可选场地， 面对面地见面基线和随访评估将在开始时和治疗后1个月完成 CM的最后一组，或CR的最后一张卡后一个月。这个项目建立在我们的初步数据上 这表明资深CM对CC组感兴趣并认为参与CC组非常有意义， 经验丰富的CR喜欢收到卡片，希望收到更多，并将其描述为鼓舞人心的， 赋予力量这个项目是创新的，利用同龄人来促进自杀预防和社会 通过专门针对结核病和肺结核，在有自杀风险的退伍军人中进行康复。它的独特之处还在于， 同时针对两个人群（有自杀史的门诊退伍军人和目前有自杀史的退伍军人） 风险），这是以前没有检查过的传统护理接触。这项研究直接 国家预防自杀优先研究议程。这项研究直接支持 RR&D的使命，并与VA的2018-2028年预防退伍军人自杀的国家战略保持一致。我们 预计这些数据将为处于风险中的退伍军人提供自杀预防和社会恢复的最佳实践 自杀

This proposal responds to RR&D's Small Projects in Rehabilitation Research Award (SPiRE). There is a strong need to develop, evaluate, and implement translatable interventions aimed at reducing Veteran suicide. Caring contacts for suicide prevention (i.e., staff send supportive letters to patients following psychiatric inpatient stays) is an empirically supported, low-cost method for meaningfully reducing suicide risk and hospitalization readmissions and, has been studied and applied in Veterans/VA settings. Peer support (i.e., persons with lived mental health experience) in mental health recovery is another empirically supported approach. Peers' involvement in mental healthcare improves patients' social functioning and community integration, as well as reduces self-stigma and functional impairment. This proposal describes the Caring Cards (CC) intervention, which is a novel integration of caring contacts and peers. In CC, outpatient Veterans with lived mental health experience (peers) create hope-filled and inspiring cards that are then sent to other Veterans struggling with mental health concerns. By design, CC increases social connectedness among participants to reduce suicide risk, which is strongly associated with social disconnectedness. Indeed, there are two evidence-based social risk factors of suicide: thwarted belongingness (TB; feeling like one does not belong) and perceived burdensomeness (PB; feeling as though one's existence is a burden on others). CC combines both caring contacts and peers to specifically target reductions in TB and PB by increasing social connectedness. This study aims to establish the feasibility and acceptability of CC. Our initial quality improvement project provided strong preliminary evidence for the feasibility and acceptability of the CC. The current proposal is for a single- site, 2-year pilot trial that employs an open-trial, pre/post research design. We propose to recruit outpatient Veterans with a history of high suicide risk to make up our CC group and serve as the card-makers (CMs). We will recruit outpatient Veterans who are currently at high-risk for suicide to be our card-recipients (CRs). The primary outcome (Aim 1) is to establish feasibility and acceptability of CC. Aim 2 will examine CC's ability to reduce our primary outcomes (TB and PB) among CMs and CRs. Aim 3 will preliminary evaluate CC's ability to increase social connectedness, as well as reduce suicide risk (i.e., suicidal ideation and behavior) among CMs and CRs. CMs will meet in weekly groups, each for six months, over the course of one year; CRs will receive a total of six cards, one per month. Monthly meetup groups will also be an optional venue for CMs and CRs to meet each other in-person. Baseline and follow-up assessments will be completed at start and one month after final group for CMs, or one month after the final card for CRs. This project builds on our preliminary data which indicate that Veteran CMs are interested in and find participating in CC groups highly meaningful, and Veteran CRs enjoy receiving the cards, want to receive more, and describe them as inspirational and empowering. This project is innovative in its utilization of peers to facilitate suicide prevention and social recovery among Veterans at risk for suicide by specifically targeting TB and PB. It is also unique in that it simultaneously targets two populations (outpatient Veterans with a history of, and those with current suicide risk), which have not previously been examined with traditional caring contacts. This research directly responds to the National Prioritized Research Agenda for Suicide Prevention. This study directly supports RR&D's mission and is aligned with VA's 2018-2028 National Strategy for Preventing Veteran Suicide. We expect that these data will inform best practices in suicide prevention and social recovery for Veterans at risk for suicide.