User-centered Design and Evaluation of a Virtual Human Patient to Improve Safety Planning Skills

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PROJECT SUMMARY Despite unprecedented suicide prevention efforts undertaken in the last decade, suicide rates among veterans and military service members remain elevated relative to the pre-9/11 era, highlighting the need for improved development and implementation of scientifically supported interventions for this at-risk population. This project will develop an online, interactive Virtual Standardized Patient (VSP) to train providers within the Department of Veterans Affairs (VA) to administer the brief suicide Safety Planning Intervention (SPI). Research has demonstrated the SPI to be an acceptable, feasible, and effective intervention for veterans at elevated risk of suicide. However, training to conduct the SPI has been limited and no currently available training provides the opportunity for behavioral rehearsal and interactive practice in an online format available at the convenience of the provider. The current proposal will develop a VSP using best practices in user-centered design to create a standardized training tool to assist providers in developing clinical skills to more effectively implement the SPI. The project will include a two-phase study. Phase I will include a formative evaluation to inform the design of the VSP with SPI specific content and will involve iterative revisions based on user- centered design feedback from VA healthcare providers (N = 10). Once the final version of the VSP is completed, it will be evaluated in a mixed methods pilot study with 30 VA healthcare providers to examine changes in provider SPI clinical skills, knowledge, confidence, and self-efficacy (phase II). This evaluation of the VSP will encourage future research and dissemination of this novel training tool, if effective. The resulting VSP will be cost-effective and highly scalable, and will require only a desktop computer with Internet access to run. The VSP will be developed to target training for a wide range of providers, not just those in mental health. Similarly, the technology will be developed such that it could be disseminated to providers who work with veteran and non-veteran patients outside of the VA. This training tool will be useful for providers initially learning the SPI, as well as those who wish to refresh their skills. Our proposal brings together two teams (VA Puget Sound and the USC Institute for Creative Technologies) with a history of high impact mental health technology development. These teams have unique, and complementary, expertise in order to successfully execute this proposal. Results have the potential to make a substantial impact on the VA healthcare system and its at-risk patients. Next steps will include a fully powered randomized controlled trial to examine the efficacy of the developed VSP on provider behaviors (clinical skills) and patient outcomes, followed by dissemination of the VSP to other VA and non-VA sites, if efficacious.