Development of the Veterans Crisis Line Caring Letters Suicide Prevention Intervention

Area of Science:

• Public Health
• Mental Health Interventions
• Implementation Science

Background:

• The Veterans Crisis Line (VCL) serves veterans at high risk of suicide.
• Post-acute care suicide prevention requires effective interventions.
• The Caring Letters intervention aims to provide ongoing support and demonstrate care to at-risk veterans.

Purpose of the Study:

• To describe the design, implementation, and evaluation plan for the VCL Caring Letters intervention.
• To assess the effectiveness of Caring Letters on clinical outcomes and VHA utilization.
• To identify facilitators and barriers to implementing the Caring Letters campaign.

Main Methods:

• An effectiveness-implementation hybrid type 1 trial using the RE-AIM framework.
• Linking VCL contact data with national administrative VHA data.
• Qualitative formative evaluation using semi-structured interviews.

Main Results:

• Over 100,000 veterans received Caring Letters in the first 12 months (over 500,000 letters mailed).
• A formative evaluation revealed positive veteran perspectives on the intervention.
• The intervention is being evaluated for its impact on clinical outcomes and VHA utilization.

Conclusions:

• Collaborative program design and evaluation with stakeholder engagement yield rigorous and feasible plans.
• The Caring Letters intervention shows promise for supporting veterans.
• Findings will inform VHA and VCL care strategies.