Evaluating the Use of Peer Specialists to Support Suicide Prevention

预防自杀是退伍军人健康管理局（VHA）的首要任务。尽管热情和持续 在过去十年的努力，VHA患者的自杀率仍然显着高于平民和非 VHA使用退伍军人。高风险VHA患者的自杀预防工作侧重于临床（例如，心理健康） 和服务使用（例如，管理）因素。有待检验的是一种针对因素的方法 在社区生活中，这是更好的概念作为康复性质。因为这不仅是精神上的， 身体疾病会增加VHA患者的自杀风险，但也会与他们的自我价值感作斗争， 意义和社区中的社会联系。为了帮助自杀风险高的患者， 建议调整和测试一种名为PREVAIL的有前途的方法，该方法使用“同行专家”（即，退伍军人 受过帮助有类似情况的其他人的培训的精神残疾者）。同行专家不 贬低临床护理的价值，但从事康复任务，建立一个自尊和连通的生活， 一个人的当地社区，提供同情，希望，并建议基于个人的心理健康经验， 复苏PREVAIL是有前途的，但尚未证明临床有效性，需要适应 解决退伍军人和VA医疗保健系统的独特特点。该项目建议使用 干预绘图，一种利用不同利益攸关方的多方法、系统方法， 为准VHA是同行专家的最大雇主，研究表明，他们可以提高 在心理健康、身体健康和康复结果方面的标准临床护理。然而，同行专家 才刚刚开始用于自杀预防工作。本研究的主要目的是：1）使用 干预映射，以确定PREVAIL的哪些组成部分需要调整，以减少自杀意念， 高风险VHA患者，并确定对VHA系统有用的实施策略;以及2）对 适应PREVAIL、康复措施和自杀相关结局的可行性和可接受性， 在严格的前瞻性研究中使用。在由研究人员组成的指导委员会的指导下， 领导层和患者，与不同的VHA工作人员、同行专家和患者进行需求评估访谈 将进行调整，以告知适应情况。根据需求评估的结果和关于 自杀预防、精神康复和以同伴为基础的方法，指导委员会将帮助适应 为准12名患有单相或双相抑郁症的高自杀风险退伍军人将参加为期3个月的“预... 试点”，并提供如何修改修改PREVAIL的反馈。在做出任何必要的 在对干预措施进行修改后，第二组12名患有单极或双极的高自杀风险退伍军人 将招募抑郁症患者参加正式的试点测试，以进一步评估其可行性和可接受性 招聘、保留和评估程序。患者将来自西黑文和纽因顿 康涅狄格州医疗中心。同行专家将来自弗吉尼亚州康涅狄格州的埃雷拉社区护理中心， VHA在心理社会康复方面的领先创新中心之一，也是最大的雇主之一。 同行专家。所有参与者将从康涅狄格州校园接受标准的VHA护理， 参与这项研究。参与者将在基线、干预后和3个月随访时接受评估， 他们的功能障碍和社区融合水平;希望感，生活质量，意义， 目的;自我观点和社会支持。还将在3个月随访时完成病历审查，以评估 涉及自杀行为的医疗保健就诊的变化。如果可接受（> 50%的合格入组 参与者）和可行性（> 70%的参与者完成随访评估）得到证明，这项研究 将导致一种新的以康复为导向的自杀预防干预，以在一个完全随机的 疗效对照试验。

Preventing suicide is a top priority for the Veterans Health Administration (VHA). Despite ardent and sustained efforts over the last decade, the suicide rate for VHA patients remains significantly higher than civilians and non- VHA using Veterans. Suicide prevention efforts for high risk VHA patients focus on clinical (e.g., mental health) and service use (e.g., case management) factors. What has yet to be tested is an approach that targets factors in community living, which are better conceptualized as rehabilitative in nature. For it is not only mental and physical illnesses that heighten suicide risk in VHA patients, but also struggles with their sense of self-worth, meaning, and social connections in the community. To help patients with high risk of suicide, this application proposes to adapt and test a promising approach called PREVAIL, which uses ‘Peer Specialists’ (i.e., Veterans with psychiatric disabilities who have been trained to help others with similar conditions). Peer Specialists do not devalue clinical care but engage in rehabilitative tasks of building a life of self-respect and connectedness in one’s local community by offering empathy, hope, and advice based personal experience of mental health recovery. PREVAIL is promising, but still has not demonstrated clinical effectiveness and requires adaptation to address the unique characteristics of Veterans and the VA health care system. This project proposes to use Intervention Mapping, a multi-method, systematic approach using diverse stakeholders, to adapt and pilot PREVAIL. The VHA is the single, largest employer of Peer Specialists and research shows that they can enhance standard clinical care in mental health, physical health, and rehabilitative outcomes. However, Peer Specialists have only just begun to be deployed in suicide prevention efforts. The primary aims of this study are to: 1) Use Intervention Mapping to identify which components of PREVAIL require adaptation to reduce suicidal ideation in high risk VHA patients and to identify implementation strategies useful for the VHA system; and 2) Pilot test the feasibility and acceptability of the adapted PREVAIL, rehabilitative measures, and suicide-related outcomes for use in a rigorous prospective study. With guidance from a steering committee comprised of researchers, VHA leadership, and patients, needs assessment interviews with diverse VHA staff, Peer Specialists, and patients will be conducted to inform the adaptation. Based on results from the needs assessment and the literature on suicide prevention, psychiatric rehabilitation, and peer-based approaches, the steering committee will help adapt PREVAIL. Twelve high suicide risk Veterans with unipolar or bipolar depression will participate in a 3-month “pre- pilot” and provide feedback on how the adapted PREVAIL may be revised. After making any necessary modifications to the intervention, a second group of 12 high suicide risk Veterans with unipolar or bipolar depression will be recruited to participate in a formal pilot test to further evaluate the feasibility and acceptability of recruitment, retention, and assessment procedures. Patients will be from the West Haven and Newington Connecticut medical centers. The Peer Specialists will be from VA Connecticut’s Errera Community Care Center, one of VHA’s leading centers of innovation in psychosocial rehabilitation and one of the largest employers of Peer Specialists. All participants will receive standard VHA care from the Connecticut campuses while participating in this study. Participants will be assessed at baseline, post-intervention, and 3-month follow-up in their level of functional impairment and community integration; sense of hope, quality of life, meaning, and purpose; and self-views and social support. Chart reviews will also be completed at 3-month follow-up to assess for changes in health care visits involving suicidal behaviors. If acceptability (> 50% enrollment of eligible participants) and feasibility (> 70% of enrollees complete follow-up assessment) are demonstrated, this study will result in a novel rehabilitation-oriented suicide prevention intervention to test in a fully-powered randomized controlled efficacy trial.