Veteran Engagement Implementation Strategies to Prevent Rural Veteran Suicide

背景资料。作为一名具有很强的初级实施科学能力的心理学家，伍德沃德博士的 目标是成为独立的调查者和先进的实施科学家，以改善健康公平 通过让易受伤害的退伍军人参与实施医疗服务，在退伍军人中发挥作用。在这个CDA中，她将获得技能 识别、操作、试验和严格评估有效的方法，以吸引易受伤害的退伍军人(那些 在整个实施过程中都存在健康差距)。医疗保健差距持续存在 弗吉尼亚州在基于社区的参与性研究(CBPR)中，让消费者参与研究有助于弱势群体 人口改善健康行为和结果。因此，实施研究人员也可以参与 消费者在选择和定制实施策略方面的作用。实施策略是实现以下目标的技术 加强对干预措施的理解(例如，质量监测、可持续性规划)。几乎没有消费者 参与这一进程可能是因为没有正式的指导意见。伍德沃德博士将把方法手册化为 让脆弱的资深消费者(包括家庭、照顾者、社区成员)参与选择和 调整实施战略。本手册(名为《消费者之声》)将在以下方面提供具体指导 实施者可以在什么、何时、何地、如何以及为什么让消费者参与实现或重新设计 医疗保健服务。伍德沃德博士将在实施安全规划的背景下试用这本手册 预防自杀的干预(SPI)，重点针对农村退伍军人，这是一个特别容易受到 自杀。自杀是退伍军人管理局临床上的首要任务。SPI是一种有效的干预措施，可以减少自杀意念和 行为。伍德沃德博士需要在CBPR方面进行培训，在实施研究中采用混合方法，以及 实施策略设计。重要性/影响力。通过将退伍军人的声音添加到整个 在实施过程中，退伍军人管理局可以增加弱势退伍军人获得医疗保健的机会和医疗保健的质量 提高健康公平。伍德沃德博士的培训将确保她在实施科学和健康方面的专业知识 差距，以满足退伍军人管理局的需求。创新。消费者之声及时满足创新的关键需求 实施科学，以减少健康差距和退伍军人越来越重视退伍军人参与。 消费者之声是第一本指导消费者参与过程的新奇手册 实施；[虽然它将在SPI上试行，但它将推广到其他弱势群体和 干预措施。]明确的目标。1)确定方法并将其付诸实施，让消费者参与选择和 定制实施战略(消费者之声)。2)使用消费者之声并试行其可接受性； 可行性，以及对实施和经验成果的初步影响。3)评价特殊利益攸关方的维持[作为 消费者之声影响的衡量标准。]方法论。在目标1中，伍德沃德博士将使用CBPR方法来 发展消费者之声。在Aim 2试点期间，伍德沃德博士将在两个社区实施SPI 为农村退伍军人服务的门诊。比较现场将获得执行促进(IF)和 实施现场将收到IF+消费者之声。伍德沃德博士将使用混合方法评估 消费者声音的可行性和可接受性。伍德沃德博士将使用一种试验性混合实施- 效率类型3设计并比较IF与IF+消费者的声音：1)实施(覆盖、采用、 忠诚度)；以及2)退伍军人结局(抑郁严重程度、自杀意念、自杀行为)。在《目标3》中，Dr。 伍德沃德将使用混合方法在12个月的随访中重新评估目标2的结果，以评估SPI 维持性。伍德沃德博士还将从利益相关者那里收集定性数据，以了解什么阻碍或 促进SPI的持续和[比较消费者参与每个网站的程度 可持续发展行动计划]。后续步骤/实施。伍德沃德博士将对 消费者对实施结果和城乡退伍军人自杀差距的看法。饱满 传播将包括退伍军人管理局网络研讨会和与政策和方案合作伙伴的会议。

Background. As a psychologist with strong beginner implementation science competencies, Dr. Woodward’s goal is to become an independent investigator and advanced implementation scientist to improve health equity in VA by engaging vulnerable Veterans in implementing healthcare services. In this CDA, she will acquire skills to identify, manualize, pilot, and rigorously evaluate effective methods to engage vulnerable Veterans (those who experience health disparities) throughout the implementation process. Health care disparities persist in VA. In community-based participatory research (CBPR), engaging consumers in research helps vulnerable populations improve health behaviors and outcomes. Thus, implementation researchers could also engage consumers in selecting and tailoring implementation strategies. Implementation strategies are techniques to enhance uptake of an intervention (e.g., quality monitoring, sustainability planning). There is little consumer involvement in this process likely because no formal guidance exists. Dr. Woodward will manualize methods to engage vulnerable Veteran consumers (including families, caregivers, community members) in selecting and tailoring implementation strategies. This manual (called Consumer Voice) will provide concrete guidance on what, when, where, how, and why an implementer might engage consumers in implementing or redesigning healthcare services. Dr. Woodward will pilot this manual in the context of implementing Safety Planning Intervention (SPI) for suicide prevention, focused on rural Veterans, a population particularly vulnerable to suicide. Suicide is VA’s top clinical priority. SPI is an effective intervention that reduces suicidal ideation and behaviors. Dr. Woodward needs training in CBPR, mixed methods in implementation research, and implementation strategy design. Significance/Impact. By adding Veterans’ voices throughout the implementation process, VA can increase access to and quality of healthcare for vulnerable Veterans and improve health equity. Dr. Woodward’s training will ensure her expertise in implementation science and health disparities to meet VA’s needs. Innovation. Consumer Voice is timely given critical needs for innovative implementation science to reduce health disparities and VA’s increasing emphasis on Veteran engagement. Consumer Voice is novel as the first manual to guide a process for consumer engagement throughout implementation; [although it will be piloted on SPI, it will be generalizable to other vulnerable groups and interventions.] Specific Aims. 1) Identify and manualize methods to engage consumers in selecting and tailoring implementation strategies (Consumer Voice). 2) Use Consumer Voice and pilot its acceptability, feasibility, and preliminary effect on implementation and Veteran outcomes. 3) Evaluate SPI sustainment [as a metric of Consumer Voice’s impact.] Methodology. In Aim 1, Dr. Woodward will use a CBPR approach to develop Consumer Voice. During the Aim 2 pilot, Dr. Woodward will implement SPI in two community-based outpatient clinics serving rural Veterans. The comparison site will receive Implementation Facilitation (IF) and the implementation site will receive IF+Consumer Voice. Dr. Woodward will use mixed methods to assess feasibility and acceptability of Consumer Voice. Dr. Woodward will use a pilot hybrid implementation- effectiveness Type 3 design and compare IF to IF+Consumer Voice on: 1) implementation (reach, adoption, fidelity); and 2) Veteran outcomes (depression severity, suicidal ideation, suicidal behavior). In Aim 3, Dr. Woodward will use mixed methods to re-evaluate Aim 2 outcomes at 12-month follow up to assess SPI sustainment. Dr. Woodward will also gather qualitative data from stakeholders to understand what hinders or promotes SPI sustainment and [compare the degree to which consumers were involved in each site’s Sustainability Action Plan]. Next Steps/Implementation. Dr. Woodward will conduct a full evaluation of Consumer Voice on implementation outcomes and suicide disparities between urban and rural Veterans. Full dissemination will include VA cyberseminars and meetings with policy and program partners.