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Development and Testing of a Veteran-Centered Lethal Means Safety Suicide Prevention Intervention

开发和测试以退伍军人为中心的致命手段安全自杀预防干预措施

基本信息

批准号：
10689029
负责人：
Joseph A Simonetti
金额：
--
依托单位：
VA EASTERN COLORADO HEALTH CARE SYSTEM
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-07-01 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10689029
关键词：
Accident and Emergency department Address Adoption Affect Behavior Behavior Therapy Behavioral Behavioral Mechanisms Caring Child Clinical Communication Consensus Cultural Sensitivity Development Devices Elements Emergency Care Emergency Department patient Ensure Evaluation Firearms Focus Groups Funding Future Goals Gun injury Health Services Research Healthcare Individual Institution Intervention Interview Knowledge Mentorship Methodology Methods Modeling Outpatients Participant Perception Persons Pharmaceutical Preparations Pilot Projects Poisoning Prevention program Prevention strategy Primary Care Process Protocols documentation Public Health Public Health Administration Qualitative Methods Recommendation Research Research Personnel Research Priority Risk Safety Sampling Self Efficacy Structure Suicide Suicide attempt Suicide prevention Techniques Testing Training Treatment Efficacy United States United States Department of Veterans Affairs Veterans Veterans Health Administration Work acceptability and feasibility behavior change care seeking career community setting contextual factors efficacy testing evidence base follow-up health belief innovation intervention refinement medication safety motivational enhancement therapy patient oriented population health prevent preventive intervention recruit research and development screening staff intervention suicidal risk support tools therapy design therapy development willingness

项目摘要

Background: Seventeen Veterans die by suicide on a daily basis, and Veterans often seek care in Emergency Departments (EDs) prior to a suicide attempt. Lethal means safety (LMS) interventions, which aim to reduce access to common methods of suicide such as firearms or toxic medications, are considered important components of suicide prevention programs and are recommended for Veterans with elevated suicide risk. Significance/Impact: The Veterans Health Administration (VHA) considers suicide prevention a clinical and research priority. In 2019, VHA began screening all Veterans seeking ED care for elevated suicide risk. The VA’s National Strategy for Preventing Veteran Suicide highlights “efforts to reduce access to lethal means of suicide among Veterans with identified suicide risk.” However, no LMS intervention has been developed to accompany this initiative and prior LMS interventions have not been developed for US Veterans or VHA settings. The proposed work will address this critical gap in VHA suicide prevention efforts by developing and testing a Veteran-centered, ED-based LMS intervention for multiple methods of suicide. Innovation: Several evidence gaps must be addressed in developing such an intervention. No prior LMS intervention has been shown to be efficacious in promoting medication and firearm safety, and prior interventions have not accounted for the various, person-specific mechanisms by which individuals change behaviors. The proposed intervention will incorporate multiple evidence-informed elements specifically chosen to target different but complimentary behavioral mechanisms highlighted within the Health Belief Model (e.g., self-efficacy) as critical to behavior change. Elements include those that equip staff with evidence-based communication strategies, and provide Veterans with practical, patient-centered support to facilitate LMS behaviors. To ensure that this intervention meets the needs of at-risk ED patients and is sustainable long-term if shown to be efficacious, we will engage Veteran and clinical stakeholders to develop the intervention. Engaging stakeholders in intervention development, an emerging VHA priority, is critical for ensuring feasibility, acceptability, and credibility. As one Veteran remarked during a focus group, “I appreciate you all askin’ us what we’re thinkin’, rather than just sayin’, ya know, here’s what it is and here’s what it’s gonna be.” Specific Aims and Methodology: Aim 1: Identify contextual factors that may inform development of the intervention. I will conduct semi- structured qualitative interviews with up to 30 at-risk Veterans who recently received VHA ED care to identify intrapersonal, interpersonal, and institutional factors that should be considered during intervention refinement and adaptation in Aim 2. Aim 2: Leverage the expertise of a diverse sample of stakeholders to refine intervention elements, adapt them for use among Veterans and within VHA EDs, and develop a final intervention protocol and related materials. Building on prior studies and knowledge gained from Aim 1, I will employ a stakeholder-engaged process to refine, adapt, and finalize the LMS intervention protocol and materials. I will use two evidence-based methods to engage stakeholders and build consensus (Nominal Group Technique, online modified-Delphi process). Aim 3: Pilot the ED-based LMS intervention among 40 Veterans to assess feasibility and acceptability. I will assess feasibility of recruitment, staff fidelity to the intervention, and Veteran engagement, including after ED discharge, and acceptability of the intervention among participants, intervention staff, and ED staff. Next Steps/Implementation: Results from this pilot study will support an IIR application to test the efficacy of this intervention in promoting LMS behaviors among at-risk Veterans. If found to be efficacious, consistent with VHA’s public health approach to suicide prevention and my long-term career goals, my future work will aim to adapt and disseminate the intervention across various VHA (e.g., primary care) and community settings.

背景资料：每天有17名退伍军人自杀身亡，退伍军人经常在紧急情况下寻求治疗部门(EDs)在自杀未遂之前。致命意味着安全(LMS)干预，旨在减少获得枪械或有毒药物等常见自杀方法被认为是重要的是自杀预防计划的组成部分，建议自杀风险较高的退伍军人使用。意义/影响：退伍军人健康管理局(VHA)认为自杀预防是一种临床和研究优先。2019年，VHA开始对所有寻求急诊护理的退伍军人进行自杀风险较高的筛查。这个弗吉尼亚州防止退伍军人自杀的国家战略突出表明，为减少获得致命手段的努力已确定有自杀风险的退伍军人中的自杀。然而，LMS干预还没有发展到伴随这一计划，之前的LMS干预措施尚未针对美国退伍军人或VHA制定设置。拟议的工作将解决VHA自杀预防工作中的这一关键差距，方法是制定和实施测试以退伍军人为中心、以ED为基础的LMS干预措施对多种自杀方法的影响。创新：在制定这样的干预措施时，必须解决几个证据差距。没有之前的LMS 干预措施已被证明在促进药物和枪支安全方面是有效的，而且在干预措施没有考虑到个人改变的各种特定于个人的机制行为。拟议的干预将纳入多个具体选择的证据知情要素以健康信念模型中突出显示的不同但互补的行为机制为目标(例如，自我效能感)对行为改变至关重要。要素包括那些为员工配备循证证据的要素沟通策略，并为退伍军人提供实用的、以患者为中心的支持，以促进LMS 行为。确保这一干预措施符合高危ED患者的需求，并具有长期可持续性如果被证明是有效的，我们将聘请资深人士和临床利益相关者来开发干预措施。让利益攸关方参与干预发展，这是一项新的VHA优先事项，对于确保可行性至关重要，可接受性和可信度。正如一位退伍军人在一个焦点小组中所说的那样，“我很感谢你们所有人的邀请我们想的是，而不是只是说，你知道，这就是它，这就是它将会是什么。具体目标和方法：目标1：确定可能影响干预进展的背景因素。我将进行半- 对最多30名最近接受VHA ED护理的高危退伍军人进行结构化定性访谈，以确定在干预改进过程中应考虑的个人、人际和制度因素和目标2中的适应。目标2：利用不同利益攸关方样本的专业知识来完善干预要素，调整它们供退伍军人和VHA急诊室使用，并制定最终干预方案和相关材料。基于先前的研究和从目标1获得的知识，我将采用利益相关者参与的过程来完善、调整和最终确定LMS干预方案和材料。我将使用两种基于证据的方法与利益相关者接触并建立共识(名义小组技术，在线修改-德尔福流程)。目的3：在40名退伍军人中试行基于ED的LMS干预，以评估其可行性和可接受性。这就做评估招聘的可行性、员工对干预的忠诚度和退伍军人参与度，包括教育后出院情况，以及参与者、干预人员和教育部门工作人员对干预措施的接受程度。下一步/实施：这项试点研究的结果将支持IIR应用程序，以测试这种在高危退伍军人中促进LMS行为的干预。如果发现是有效的，与 VHA预防自杀的公共卫生方法和我的长期职业目标，我未来的工作将致力于在各种VHA(如初级保健)和社区环境中调整和传播干预措施。