Implementing Caring Contacts for Suicide Prevention in Non-Mental Health Settings

退伍军人的自杀率高于一般人群和自杀预防 仍然是VA全国和VISN的高度优先事项。这是一个特别关键的问题， 农村退伍军人自杀风险更大;他们有更高的自杀率和枪支 农村地区的自杀率更高。接触没有心理健康诊断的退伍军人 和/或不从事精神卫生保健的人，我们建议实施一项证据- 基于自杀预防干预，关怀接触，在非精神卫生环境， 急诊科关怀联系人（CC）是一种简单的干预措施， 自杀病人简短的，非要求的关怀和关心的表达超过一年或更长时间。 CC的研究表明，自杀死亡，企图和 1年和2年随访时的构思。CC已被发现是可行的和可接受的， 军队和退伍军人，并与现役士兵和海军陆战队的帮助。审查 对CC的研究表明，“重复的后续接触似乎可以减少自杀行为。” CC也被认为具有成本效益。这一举措建议利用外部便利， 在VISN 16和VISN 5、6、12内的站点实施CC的实施策略， 17、19、22和23。值得注意的是，参与的VISN包括五个最农村的VISN中的三个 (23、16和19）。便利化是一种基于证据的实施战略， 适用于在选定的临床优先级中存在已证明的质量差距的机构。的 这一举措的预期影响是减少急诊和住院人数， 心理健康和健康接触以及门诊心理健康和健康的增加 有自杀危险的退伍军人。我们将评估CC和 实施.为了评估投资回报，我们将使用服务利用率数据来估计 服务费用。提供者和退伍军人的观点将通过关键线人来衡量 采访

Suicide rates for Veterans are higher than for the general population and suicide prevention remains a high priority for the VA nationally and for VISNs. This is a particularly critical issue for rural Veterans who are at greater risk for suicide; they have higher suicide rates and firearm deaths are more common in rural suicides. To reach Veterans without mental health diagnoses and/or who are not engaged in mental health care, we are proposing to implement an evidence- based suicide prevention intervention, Caring Contacts, in a non-mental health setting, the emergency department. Caring Contacts (CC) is a simple intervention that involves sending suicidal patients brief, non-demanding expressions of care and concern over a year or more. Studies of CC have demonstrated significant reductions in suicide deaths, attempts, and ideation at one and two-year follow-up. CC have been found to be feasible and acceptable with military and Veteran populations and helpful with active duty Soldiers and Marines. A review of studies on CC determined that “repeated follow-up contacts appear to reduce suicidal behavior.” CC was found to be cost-effective as well. This initiative proposes use of external facilitation as the implementation strategy to implement CC across VISN 16 and sites within VISNs 5, 6, 12, 17, 19, 22, and 23. Of note, the participating VISNs include three of the five most rural VISNs (23, 16, and 19). Facilitation is an evidence-based implementation strategy that is especially useful for facilities with demonstrated quality gaps in the selected clinical priority. The anticipated impacts of this initiative are a decrease in the number of emergency and inpatient mental health and health encounters and an increase in outpatient mental health and health encounters for Veterans at risk of suicide. We will assess the costs of CC and of implementation. To assess return on investment, we will use service utilization data to estimate cost of services. Provider and Veteran perspectives will be measured through key informant interviews.