Veteran Engagement Implementation Strategies to Prevent Rural Veteran Suicide

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Background. As a psychologist with strong beginner implementation science competencies, Dr. Woodward’s goal is to become an independent investigator and advanced implementation scientist to improve health equity in VA by engaging vulnerable Veterans in implementing healthcare services. In this CDA, she will acquire skills to identify, manualize, pilot, and rigorously evaluate effective methods to engage vulnerable Veterans (those who experience health disparities) throughout the implementation process. Health care disparities persist in VA. In community-based participatory research (CBPR), engaging consumers in research helps vulnerable populations improve health behaviors and outcomes. Thus, implementation researchers could also engage consumers in selecting and tailoring implementation strategies. Implementation strategies are techniques to enhance uptake of an intervention (e.g., quality monitoring, sustainability planning). There is little consumer involvement in this process likely because no formal guidance exists. Dr. Woodward will manualize methods to engage vulnerable Veteran consumers (including families, caregivers, community members) in selecting and tailoring implementation strategies. This manual (called Consumer Voice) will provide concrete guidance on what, when, where, how, and why an implementer might engage consumers in implementing or redesigning healthcare services. Dr. Woodward will pilot this manual in the context of implementing Safety Planning Intervention (SPI) for suicide prevention, focused on rural Veterans, a population particularly vulnerable to suicide. Suicide is VA’s top clinical priority. SPI is an effective intervention that reduces suicidal ideation and behaviors. Dr. Woodward needs training in CBPR, mixed methods in implementation research, and implementation strategy design. Significance/Impact. By adding Veterans’ voices throughout the implementation process, VA can increase access to and quality of healthcare for vulnerable Veterans and improve health equity. Dr. Woodward’s training will ensure her expertise in implementation science and health disparities to meet VA’s needs. Innovation. Consumer Voice is timely given critical needs for innovative implementation science to reduce health disparities and VA’s increasing emphasis on Veteran engagement. Consumer Voice is novel as the first manual to guide a process for consumer engagement throughout implementation; [although it will be piloted on SPI, it will be generalizable to other vulnerable groups and interventions.] Specific Aims. 1) Identify and manualize methods to engage consumers in selecting and tailoring implementation strategies (Consumer Voice). 2) Use Consumer Voice and pilot its acceptability, feasibility, and preliminary effect on implementation and Veteran outcomes. 3) Evaluate SPI sustainment [as a metric of Consumer Voice’s impact.] Methodology. In Aim 1, Dr. Woodward will use a CBPR approach to develop Consumer Voice. During the Aim 2 pilot, Dr. Woodward will implement SPI in two community-based outpatient clinics serving rural Veterans. The comparison site will receive Implementation Facilitation (IF) and the implementation site will receive IF+Consumer Voice. Dr. Woodward will use mixed methods to assess feasibility and acceptability of Consumer Voice. Dr. Woodward will use a pilot hybrid implementation- effectiveness Type 3 design and compare IF to IF+Consumer Voice on: 1) implementation (reach, adoption, fidelity); and 2) Veteran outcomes (depression severity, suicidal ideation, suicidal behavior). In Aim 3, Dr. Woodward will use mixed methods to re-evaluate Aim 2 outcomes at 12-month follow up to assess SPI sustainment. Dr. Woodward will also gather qualitative data from stakeholders to understand what hinders or promotes SPI sustainment and [compare the degree to which consumers were involved in each site’s Sustainability Action Plan]. Next Steps/Implementation. Dr. Woodward will conduct a full evaluation of Consumer Voice on implementation outcomes and suicide disparities between urban and rural Veterans. Full dissemination will include VA cyberseminars and meetings with policy and program partners.