Partnered Implementation Evaluation of a National Sponsorship Program for Transitioning Service Members

退伍军人事务部提案中的问题正在解决。美国目前正在经历一场全国性的流行病 仍在国防部服役的最年轻服役人员自杀(国防部，2019年)和 那些已经从军队过渡出去的人。例如，18岁退伍军人的自杀率- 34岁，自杀死亡人数增加了一倍多，从2006年的每10万人中约有22人自杀，增加到每10万人中有45人自杀 2016年为100,000人(弗吉尼亚州，2018年；弗吉尼亚州2019年)。对于这些年轻的退伍军人来说，似乎有一段时间是非常危险的 在他们离开军队后的第一年，最近的估计表明增加了近 在此期间占50%(Kang等人，2015；沈，Cunha和Williams，2016)。由于这些令人不安的趋势， 在过去的两年里，已经发布了两项行政命令，呼吁联邦组织更紧密地合作 与当地、非营利组织和学术界组织合作，实施预防自杀的公共卫生方法。 预防自杀仍然是退伍军人管理局的首要任务，从公共健康的角度来看， 最近发布的预防自杀国家战略(退伍军人事务部，2018年)。在这 战略，退伍军人管理局承认，它必须接触到军人(SMS)和退伍军人 在经历严重危机之前建立社区(退伍军人事务部，2018年)。同样，VISN 17也做出了重要的 承诺服务期满(ETS)赞助计划，以便在 他们正在退伍。对最近的一项随机对照试验进行了初步分析。 9/11退伍军人得到了ETS赞助商的支持，结果显示 对减少过渡压力源和改善社会支持的适度治疗效果(Geraci，2018)。 目标。我们提出了一种混合类型2有效性-实施试验来评估ETS的扩展 从2020财年到2023年在德克萨斯州的六个城市的赞助。目标1将决定 ETS赞助计划，如过渡压力源、社会支持、心理测量 痛苦、自杀意念和行为，以及退伍军人管理局/非退伍军人管理局服务利用情况。目标2将决定 在德克萨斯州六个城市实施ETS赞助计划的可行性和潜在效用。发短信说 过渡到没有既定ETS赞助计划的城市将经历从军事 恢复正常的平民生活(即，美国陆军士兵提供的服务-生活过渡援助 计划)。在城市实施ETS赞助计划后，过渡短信将可以访问 ETS在他们所在城市的赞助商，并热情地移交给社区服务。 方法：研究方法。我们将使用阶梯式楔形设计，同时使用其他城市作为控件，直到它们开始 实施。此设计将允许我们将实施支持扩展到最大数量的城市 加强形成性评估(定期与关键合作伙伴进行反思和SM访谈)。步行者 楔形设计还使我们能够有效地利用站点内和站点间可用的所有数据 比较。对于现场比较，城市将在计划评估中充当自己的控制点 比较实施前和实施后的城市。这一比较考察了城市从 控制到干预状态。现场间比较评估了一个城市与所有城市的干预期 所有城市的其他干预和控制期。对所有过渡阶段的SMS测量感兴趣的结果 在给定的干预时间段内，在每个城市。我们在城市层面随机进行，并将使用个人 SMS作为初步量化结果衡量的观察单位。将有六个城市参加 计划评估，三个开始日期或步骤中的每一个分配两个城市。分层模型将 在城市内嵌套管理体系，分析实施前和实施后的结果 实施情况评估。分层随机效应模型考察了组内和组间的变化 跨越时间和条件。

Problem in VA Proposal is Addressing. The United States is currently experiencing a national epidemic of suicide for its youngest Service Members (SMs) still serving in the Department of Defense (DOD, 2019) and those that have already transitioned out of the military. For example, the rate of suicide for Veterans aged 18- 34 years old having more than doubled from approximately 22 suicide deaths per 100,000 in 2006 to 45 per 100,000 in 2016 (VA, 2018; VA 2019). It appears that a period of significant risk for these young Veterans is during their first year after separating from the military with recent estimates suggesting an increase of nearly 50% during this period (Kang et al., 2015; Shen, Cunha, & Williams, 2016). As a result of the troubling trends, two executive orders have been issued within the last two years calling for federal organizations to work closer with local, nonprofit and academia organizations to implement a public health approach to suicide prevention. Preventing suicide remains a top priority for the VA with similar sentiments of a public health perspective to suicide prevention being recently published National Strategy for Preventing Suicide (VA, 2018). In this strategy, the VA acknowledged that it must reach out to Servicemembers (SMs) and Veterans in the community before they experience an acute crisis (VA, 2018). Similarly, VISN 17 made a significant commitment to the Expiration Term of Service (ETS) Sponsorship program in order to engage SMs prior to them exiting the military. Preliminary analysis was conducted for a recent randomized control trial with post- 9/11 Veterans in New York City that received the support from ETS Sponsors with the results showing a moderate treatment effect for both reduced transition stressors and improved social support (Geraci, 2018). Aims. We propose a Hybrid Type 2 effectiveness-implementation trial to evaluate the expansion of ETS Sponsorship across six cities from FY 2020 to 2023 in Texas. Aim #1 will determine the effectiveness of the ETS sponsorship program, as evidenced by measures of transition stressors, social support, psychological distress, suicidal ideation and behaviors, and VA/non-VA service utilization. Aim #2 will determine the feasibility and potential utility of implementing the ETS Sponsorship program to six cities in Texas. SMs that transition to cities without an established ETS Sponsorship program will experience their transition from military to civilian life as usual (i.e., services available from the U.S. Army Soldier for Life-Transition Assistance Program). After cities have implemented the ETS Sponsorship program, transitioning SMs will have access to an ETS Sponsor in their city and warm handoffs to community services. Methods. We will use a stepped wedge design while using other cities as controls until they begin implementation. This design will allow us to extend implementation support to the maximal number of cities and enhance the formative evaluation (periodic reflections with key partners and SM interviews). The stepped wedge design also enables us to make efficient use of all data available for within-site and between-site comparisons. For the within-site comparison, cities will act as their own controls in a program evaluation that compares cities pre- versus post- implementation. The comparison examines cities as they cross-over from control to intervention states. The between-site comparison evaluates the intervention period for a city vs. all other intervention and control periods for all cities. Outcomes of interest are measured for all transitioning SMs at each city within the given intervention time period. We randomized at the city level and will use individual SMs as the unit of observation for primary quantitative outcome measures. Six cities will participate in the program evaluation, with two cities allocated to each of the three start dates or steps. Hierarchical models will be run in which SMs are nested within city analyzing the results of the pre-implementation and post- implementation assessments. Hierarchical random effects models examine within- and between-group change across time and by condition.