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务人员的自杀率比其他服务高63% 在离职后的第一年，这一比率特别高。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， 在离职后的一年内向过渡服务人员提供自杀预防资源。在 作为回应，VA的中央办公室自杀预防计划（SPP）计划实施一封关怀信， 为每年过渡的所有245，000名服务人员开展活动。在关怀信干预中，一系列 的信息被发送给个人，传达他们没有被遗忘，人们关心 关心他们，关心他们的幸福。这些消息还可以提醒您可以获得帮助。 多项随机临床试验支持《关怀信》对减少自杀和自杀的疗效 尝试率。联合委员会最近推广了关怀信。过渡运动 然而，由于没有固定的退伍军人服务提供者，服役人员面临着一些独特的挑战 作为签字人。因此，我们建议SPP和拟议的 评估小组审查了“关怀信”在这一新人口中的使用情况。具体而言，评价将 测试两种模式：（1）一种修改后的方法，以关心信件，其中信件是从VA提供者发送的， 退伍军人不知道，和（2）一个文化敏感的同行为基础的方法，以关怀信中，信 都是最近转业的军人发送的，性别和兵役分支相匹配。的 活动还将随机分配服务成员到一个标准的邮件时间表（一年8条消息）或 高频率调度（一年14条消息）。在目标1中，我们将评估关怀信对 临床结局和VA临床利用率。在目标2中，我们将研究两种不同的 关怀信签署人和两个不同的邮寄时间表对干预的临床有效性。 目标3将审查实施关怀信运动的促进者和障碍。在目标4中，我们 从VA的角度对实施进行预算影响分析。这将是迄今为止 它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.