Adapting and implementing Caring Contacts in a Department of Veterans Affairs emergency department: a pilot study protocol

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Abstract

Background

Suicide among veterans is a problem nationally, and suicide prevention remains a high priority for the Department of Veterans Affairs (VA). Focusing suicide prevention initiatives in the emergency department setting provides reach to veterans who may not be seen in mental health and targets a critical risk period, transitions in care following discharge. Caring Contacts is a simple and efficacious suicide prevention approach that could be used to target this risk period. The purpose of this study is to (1) adapt Caring Contacts for use in a VA emergency department, (2) conduct a pilot program at a single VA emergency department, and (3) create an implementation toolkit to facilitate spread of Caring Contacts to other VA facilities.

Methods

This project includes planning activities and a pilot at a VA emergency department. Planning activities will include determining available data sources, determining logistics for identifying and sending Caring Contacts, and creating an implementation toolkit. We will conduct qualitative interviews with emergency department staff and other key stakeholders to gather data on what is needed to adapt and implement Caring Contacts in a VA emergency department setting and possible barriers to and facilitators of implementation. An advisory board of key stakeholders in the facility will be created. Qualitative findings from interviews will be presented to the advisory board for discussion, and the board will use these data to inform decision making regarding implementation of the pilot. Once the pilot is underway, the advisory board will convene again to discuss ongoing progress and determine if any changes are needed to the implementation of the Caring Contacts intervention.

Discussion

Findings from the current project will inform future scale-up and spread of this innovation to other VA medical center emergency departments across the network and other networks. The current pilot will adapt Caring Contacts, create an implementation toolkit and implementation guide, evaluate the feasibility of gathering outcome measures, and provide information about what is needed to implement this evidence-based suicide prevention intervention in a VA emergency department.

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Most cited references 42

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Getting evidence into practice: the role and function of facilitation.

Gill Harvey, Alison Loftus-Hills, Jo Rycroft-Malone … (2002)

This paper presents the findings of a concept analysis of facilitation in relation to successful implementation of evidence into practice. In 1998, we presented a conceptual framework that represented the interplay and interdependence of the many factors influencing the uptake of evidence into practice. One of the three elements of the framework was facilitation, alongside the nature of evidence and context. It was proposed that facilitators had a key role in helping individuals and teams understand what they needed to change and how they needed to change it. As part of the on-going development and refinement of the framework, the elements within it have undergone a concept analysis in order to provide theoretical and conceptual clarity. The concept analysis approach was used as a framework to review critically the research literature and seminal texts in order to establish the conceptual clarity and maturity of facilitation in relation to its role in the implementation of evidence-based practice. The concept of facilitation is partially developed and in need of delineation and comparison. Here, the purpose, role and skills and attributes of facilitators are explored in order to try and make distinctions between this role and other change agent roles such as educational outreach workers, academic detailers and opinion leaders. We propose that facilitation can be represented as a set of continua, with the purpose of facilitation ranging from a discrete task-focused activity to a more holistic process of enabling individuals, teams and organizations to change. A number of defining characteristics of facilitation are proposed. However, further research to clarify and evaluate different models of facilitation is required.

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Vital Signs: Trends in State Suicide Rates — United States, 1999–2016 and Circumstances Contributing to Suicide — 27 States, 2015

Deborah M Stone, Thomas Simon, Katherine Fowler … (2018)

Introduction Suicide rates in the United States have risen nearly 30% since 1999, and mental health conditions are one of several factors contributing to suicide. Examining state-level trends in suicide and the multiple circumstances contributing to it can inform comprehensive state suicide prevention planning. Methods Trends in age-adjusted suicide rates among persons aged ≥10 years, by state and sex, across six consecutive 3-year periods (1999–2016), were assessed using data from the National Vital Statistics System for 50 states and the District of Columbia. Data from the National Violent Death Reporting System, covering 27 states in 2015, were used to examine contributing circumstances among decedents with and without known mental health conditions. Results During 1999–2016, suicide rates increased significantly in 44 states, with 25 states experiencing increases >30%. Rates increased significantly among males and females in 34 and 43 states, respectively. Fifty-four percent of decedents in 27 states in 2015 did not have a known mental health condition. Among decedents with available information, several circumstances were significantly more likely among those without known mental health conditions than among those with mental health conditions, including relationship problems/loss (45.1% versus 39.6%), life stressors (50.5% versus 47.2%), and recent/impending crises (32.9% versus 26.0%), but these circumstances were common across groups. Conclusions Suicide rates increased significantly across most states during 1999–2016. Various circumstances contributed to suicides among persons with and without known mental health conditions. Implications for Public Health Practice States can use a comprehensive evidence-based public health approach to prevent suicide risk before it occurs, identify and support persons at risk, prevent reattempts, and help friends and family members in the aftermath of a suicide.

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Role of "external facilitation" in implementation of research findings: a qualitative evaluation of facilitation experiences in the Veterans Health Administration

Cheryl B Stetler, Marcia Legro, Joanne Rycroft-Malone … (2006)

Background Facilitation has been identified in the literature as a potentially key component of successful implementation. It has not, however, either been well-defined or well-studied. Significant questions remain about the operational definition of facilitation and about the relationship of facilitation to other interventions, especially to other change agent roles when used in multi-faceted implementation projects. Researchers who are part of the Quality Enhancement Research Initiative (QUERI) are actively exploring various approaches and processes, including facilitation, to enable implementation of best practices in the Veterans Health Administration health care system – the largest integrated healthcare system in the United States. This paper describes a systematic, retrospective evaluation of implementation-related facilitation experiences within QUERI, a quality improvement program developed by the US Department of Veterans Affairs. Methods A post-hoc evaluation was conducted through a series of semi-structured interviews to examine the concept of facilitation across several multi-site QUERI implementation studies. The interview process is based on a technique developed in the field of education, which systematically enhances learning through experience by stimulating recall and reflection regarding past complex activities. An iterative content analysis approach relative to a set of conceptually-based interview questions was used for data analysis. Findings Findings suggest that facilitation, within an implementation study initiated by a central change agency, is a deliberate and valued process of interactive problem solving and support that occurs in the context of a recognized need for improvement and a supportive interpersonal relationship. Facilitation was described primarily as a distinct role with a number of potentially crucial behaviors and activities. Data further suggest that external facilitators were likely to use or integrate other implementation interventions, while performing this problem-solving and supportive role. Preliminary Conclusions This evaluation provides evidence to suggest that facilitation could be considered a distinct implementation intervention, just as audit and feedback, educational outreach, or similar methods are considered to be discrete interventions. As such, facilitation should be well-defined and explicitly evaluated for its perceived usefulness within multi-intervention implementation projects. Additionally, researchers should better define the specific contribution of facilitation to the success of implementation in different types of projects, different types of sites, and with evidence and innovations of varying levels of strength and complexity.

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Author and article information

Contributors

Sara J. Landes:

ORCID: http://orcid.org/0000-0001-8515-2465

sara.landes@va.gov

JoAnn E. Kirchner: joann.kirchner@va.gov

John P. Areno: john.areno@va.gov

Mark A. Reger: mark.reger@va.gov

Traci H. Abraham: traci.abraham@va.gov

Jeffery A. Pitcock: jeffery.pitcock@va.gov

Mary J. Bollinger: mary.bollinger2@va.gov

Katherine Anne Comtois: kcomtois@uw.edu

Journal

Journal ID (nlm-ta): Pilot Feasibility Stud

Journal ID (iso-abbrev): Pilot Feasibility Stud

Title: Pilot and Feasibility Studies

Publisher: BioMed Central (London )

ISSN (Electronic): 2055-5784

Publication date (Electronic): 10 October 2019

Publication date PMC-release: 10 October 2019

Publication date Collection: 2019

Volume: 5

Electronic Location Identifier: 115

Affiliations

[1 ]ISNI 0000 0004 0419 1545, GRID grid.413916.8, QUERI for Team-Based Behavioral Healthcare, , Central Arkansas Veterans Healthcare System, ; North Little Rock, AR USA

[2 ]South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas VA Health Care System, North Little Rock, AR USA

[3 ]ISNI 0000 0004 4687 1637, GRID grid.241054.6, Department of Psychiatry, , University of Arkansas for Medical Sciences, ; Little Rock, AR USA

[4 ]ISNI 0000 0004 0420 9231, GRID grid.484305.e, South Central VA Health Care Network, ; Ridgeland, MS USA

[5 ]ISNI 0000 0004 0420 6540, GRID grid.413919.7, VA Puget Sound Health Care System, ; Tacoma, WA USA

[6 ]ISNI 0000 0004 0419 1545, GRID grid.413916.8, Center for Mental Healthcare & Outcomes Research (CeMHOR), , Central Arkansas Veterans Healthcare System, ; North Little Rock, AR USA

[7 ]ISNI 0000000122986657, GRID grid.34477.33, University of Washington School of Medicine, ; Seattle, WA USA

Author information

Sara J. Landes http://orcid.org/0000-0001-8515-2465

Article

Publisher ID: 503

DOI: 10.1186/s40814-019-0503-9

PMC ID: 6785900

PubMed ID: 31624637

SO-VID: a06a904a-05e9-4e88-a319-f7d7ba774491

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 28 March 2019

Date accepted : 20 September 2019

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100007181, Quality Enhancement Research Initiative;

Award ID: PII 18-195

Award Recipient : Sara J. Landes

Custom metadata

Keywords: suicide prevention,implementation,emergency department,caring contacts,veterans

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Keywords: suicide prevention, implementation, emergency department, caring contacts, veterans

Adapting and implementing Caring Contacts in a Department of Veterans Affairs emergency department: a pilot study protocol

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Most cited references 42

Getting evidence into practice: the role and function of facilitation.

Vital Signs: Trends in State Suicide Rates — United States, 1999–2016 and Circumstances Contributing to Suicide — 27 States, 2015

Role of "external facilitation" in implementation of research findings: a qualitative evaluation of facilitation experiences in the Veterans Health Administration

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