Randomized Evaluation of a Caring Letters Suicide Prevention Campaign for Service Members Transitioning to Civilian Life

摘要 过渡到平民生活的服役人员的自杀率比其他服役人员高63% 会员，在离职后第一年的费率特别高。因此，总统 发布了一项行政命令，要求退伍军人事务部(VA)制定一项计划， 在退役后一年向过渡服役人员提供自杀预防资源。在……里面 作为回应，退伍军人事务部中央办公室自杀预防计划(SPP)计划实施一封关爱信件 为所有245,000名每年过渡的服役人员开展活动。在爱心书信干预中，一系列 的信息被发送给个人，以传达他们没有被遗忘，人们关心的信息 并关心他们的福祉。这些消息还提醒人们，帮助是可用的。 多项随机临床试验支持关爱书信减少自杀和自杀的有效性 尝试比率。联合委员会最近宣传了关爱书信。转型的运动 然而，服务成员面临着一些独特的挑战，因为没有现有的VA提供商提供服务 作为签字人。因此，我们建议在SPP和拟议的 评估小组检查爱心信件在这一新人群中的使用情况。具体地说，评估将 测试两种模型：(1)一种改进的关怀信件方法，其中信件由退伍军人管理局发送 退伍军人不知道，以及(2)以文化敏感的同龄人为基础的关怀信件的方法 是从最近变性的服役人员那里寄来的，性和兵役部门是匹配的。这个 活动还将随机安排服务成员按照标准的邮寄计划(一年8条消息)或 高频时间表(一年14条消息)。在目标1，我们将评估爱心信件对以下方面的影响 临床结果和VA临床利用率。在目标2中，我们将检查这两种不同的 关爱信件签署人和两种不同的邮寄时间表关于干预的临床效果。 目标3将审查促进者和实施关爱书信运动的障碍。在目标4中，我们将 从退伍军人事务部的角度对实施进行预算影响分析。这将是最大的一次评估 这将为领导层提供直接和可操作的数据， 评估这一重大预防运动的影响。

ABSTRACT Service members transitioning to civilian life have suicide rates that are 63% higher than other service members, and rates are especially high in the first year after separation from service. Therefore, the President issued an Executive Order that requires the Department of Veteran Affairs (VA) to develop a plan to provide, suicide prevention resources to transitioning service members in the year following separation from service. In response, VA’s Central Office Suicide Prevention Program (SPP) plans to implement a Caring Letters campaign for all 245,000 service members who transition each year. In the Caring Letters intervention, a series of messages are sent to individuals to communicate that they are not forgotten, and that people care about them and are concerned for their well-being. The messages also serve as a reminder that help is available. Multiple randomized clinical trials support the efficacy of Caring Letters for reducing suicide and suicide attempt rates. The Joint Commission has recently promoted Caring Letters. The campaign for transitioning service members faces some unique challenges, however, since there is no established VA provider to serve as the signatory. Therefore, we propose a partnered program evaluation between SPP and the proposed evaluation team to examine the use of Caring Letters in this new population. Specifically, the evaluation will test two models: (1) A modified approach to Caring Letters in which letters are sent from a VA provider the Veteran does not know, and (2) a culturally-sensitive peer-based approach to Caring Letters in which letters are sent from recently transitioned service members matched on sex and military service branch. The campaign will also randomize service members to a standard mailing schedule (8 messages in a year) or a high frequency schedule (14 messages in a year). In Aim 1, we will evaluate the effects of Caring Letters on clinical outcomes and VA clinical utilization rates. In Aim 2, we will examine the effects of the two different Caring Letter signatories and two different mailing schedules on the clinical effectiveness of the intervention. Aim 3 will examine facilitators and barriers to implementing the Caring Letters campaign. In Aim 4, we will conduct budget impact analyses of implementation from the VA perspective. This will be the largest evaluation of a Caring Letters intervention ever conducted, and it will provide direct and actionable data to leadership to evaluate the impacts of this major prevention campaign.