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Implementing eScreening for suicide prevention in VA post-9/11 transition programs using a stepped-wedge,

James O E Pittman1,2,3, Laurie Lindamer4,5,6, Niloofar Afari4,5,6

  • 1VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, USA. james.pittman@va.gov.

Implementation Science Communications
|April 30, 2021
PubMed
Summary

Implementing eScreening for Post-9/11 veterans improves suicide risk detection and referral rates. This study evaluates eScreening and a multicomponent implementation strategy for better mental health care access.

Keywords:
FacilitationImplementationPRISMRE-AIMSuicideVeteranseScreening

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Area of Science:

  • Implementation Science
  • Health Services Research
  • Mental Health Screening

Background:

  • Post-9/11 veterans accessing VA healthcare often exhibit suicidal ideation or behavior.
  • Current screening methods frequently fail to detect suicide risk upon enrollment.
  • Early detection and treatment referral are crucial for decreasing suicide risk.

Purpose of the Study:

  • To evaluate the impact of eScreening on the rate and speed of suicide risk screening and referral compared to usual care.
  • To assess the effectiveness of a multicomponent implementation strategy (MCIS) on eScreening adoption and sustainability.
  • To explore contextual factors influencing eScreening implementation across different sites.

Main Methods:

  • An eight-site, 4-year, stepped-wedge, mixed-method, hybrid type-II implementation trial.
  • Comparison of eScreening versus usual screening methods in transition and care management (TCM) programs.
  • Mixed methods approach using medical record data, staff questionnaires, and qualitative interviews, guided by RE-AIM and PRISM frameworks.

Main Results:

  • eScreening is expected to improve rates and speed of screening for PTSD, depression, alcohol use, and suicide.
  • Increased referral rates to mental health treatment are anticipated with eScreening implementation.
  • The MCIS is being evaluated for its feasibility, acceptability, and impact on eScreening adoption and maintenance.

Conclusions:

  • Study findings will identify best practices for suicide prevention screening in Post-9/11 veterans.
  • Results will inform the optimal implementation of technology-based screening in clinical settings.
  • This research aims to enhance the integration of effective suicide risk screening into VA healthcare.