Development and Testing of a Veteran-Centered Lethal Means Safety Suicide Prevention Intervention

开发和测试以退伍军人为中心的致命手段安全自杀预防干预措施

• 批准号: 10443578
• 负责人: Joseph A Simonetti
• 金额: --
• 依托单位: VA EASTERN COLORADO HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10443578
• 关键词: Accident and Emergency department; Address; Adoption; Affect; Behavior; Behavior Therapy; Behavioral; Behavioral Mechanisms; Caring; Child; Clinical; Clinical Research; Communication; Consensus; Cultural Sensitivity; Development; Devices; Elements; Emergency Care; Emergency Department patient; Ensure; Evaluation; Firearms; Focus Groups; Funding; Future; Goals; Gun injury; Health Services Research; Healthcare; Individual; Intervention; Interview; Knowledge; Mentorship; Methodology; Methods; Modeling; Outpatients; Participant; Perception; Persons; Pharmaceutical Preparations; Pilot Projects; Poisoning; Prevention program; Prevention strategy; Primary Health Care; Process; Protocols documentation; Public Health; Public Health Administration; Qualitative Methods; Recommendation; Research; Research Personnel; Research Priority; Risk; Safety; Sampling; Self Efficacy; Structure; Suicide; Suicide attempt; Suicide prevention; Techniques; Testing; Training; Treatment Efficacy; United States; United States Department of Veterans Affairs; Veterans; Veterans Health Administration; Work; acceptability and feasibility; base; behavior change; care seeking; career; community setting; contextual factors; efficacy testing; evidence base; follow-up; health belief; innovation; intervention refinement; medication safety; motivational enhancement therapy; patient oriented; population health; prevent; preventive intervention; recruit; research and development; screening; staff intervention; suicidal risk; support tools; therapy design; therapy development; willingness

Background: Seventeen Veterans die by suicide on a daily basis, and Veterans often seek care in Emergency Departments (EDs) prior to a suicide attempt. Lethal means safety (LMS) interventions, which aim to reduce access to common methods of suicide such as firearms or toxic medications, are considered important components of suicide prevention programs and are recommended for Veterans with elevated suicide risk. Significance/Impact: The Veterans Health Administration (VHA) considers suicide prevention a clinical and research priority. In 2019, VHA began screening all Veterans seeking ED care for elevated suicide risk. The VA’s National Strategy for Preventing Veteran Suicide highlights “efforts to reduce access to lethal means of suicide among Veterans with identified suicide risk.” However, no LMS intervention has been developed to accompany this initiative and prior LMS interventions have not been developed for US Veterans or VHA settings. The proposed work will address this critical gap in VHA suicide prevention efforts by developing and testing a Veteran-centered, ED-based LMS intervention for multiple methods of suicide. Innovation: Several evidence gaps must be addressed in developing such an intervention. No prior LMS intervention has been shown to be efficacious in promoting medication and firearm safety, and prior interventions have not accounted for the various, person-specific mechanisms by which individuals change behaviors. The proposed intervention will incorporate multiple evidence-informed elements specifically chosen to target different but complimentary behavioral mechanisms highlighted within the Health Belief Model (e.g., self-efficacy) as critical to behavior change. Elements include those that equip staff with evidence-based communication strategies, and provide Veterans with practical, patient-centered support to facilitate LMS behaviors. To ensure that this intervention meets the needs of at-risk ED patients and is sustainable long-term if shown to be efficacious, we will engage Veteran and clinical stakeholders to develop the intervention. Engaging stakeholders in intervention development, an emerging VHA priority, is critical for ensuring feasibility, acceptability, and credibility. As one Veteran remarked during a focus group, “I appreciate you all askin’ us what we’re thinkin’, rather than just sayin’, ya know, here’s what it is and here’s what it’s gonna be.” Specific Aims and Methodology: Aim 1: Identify contextual factors that may inform development of the intervention. I will conduct semi- structured qualitative interviews with up to 30 at-risk Veterans who recently received VHA ED care to identify intrapersonal, interpersonal, and institutional factors that should be considered during intervention refinement and adaptation in Aim 2. Aim 2: Leverage the expertise of a diverse sample of stakeholders to refine intervention elements, adapt them for use among Veterans and within VHA EDs, and develop a final intervention protocol and related materials. Building on prior studies and knowledge gained from Aim 1, I will employ a stakeholder-engaged process to refine, adapt, and finalize the LMS intervention protocol and materials. I will use two evidence-based methods to engage stakeholders and build consensus (Nominal Group Technique, online modified-Delphi process). Aim 3: Pilot the ED-based LMS intervention among 40 Veterans to assess feasibility and acceptability. I will assess feasibility of recruitment, staff fidelity to the intervention, and Veteran engagement, including after ED discharge, and acceptability of the intervention among participants, intervention staff, and ED staff. Next Steps/Implementation: Results from this pilot study will support an IIR application to test the efficacy of this intervention in promoting LMS behaviors among at-risk Veterans. If found to be efficacious, consistent with VHA’s public health approach to suicide prevention and my long-term career goals, my future work will aim to adapt and disseminate the intervention across various VHA (e.g., primary care) and community settings.

背景：每天有 17 名退伍军人自杀身亡，退伍军人经常在紧急情况下寻求护理 部门 (ED) 在自杀未遂之前进行致命意味着安全 (LMS) 干预，旨在减少自杀企图。 获得常见的自杀方法（例如枪支或有毒药物）被认为很重要 自杀预防计划的组成部分，建议自杀风险较高的退伍军人使用。 意义/影响：退伍军人健康管理局 (VHA) 认为预防自杀是一项临床和 2019 年，VHA 开始对所有因自杀风险升高而寻求急诊治疗的退伍军人进行筛查。 退伍军人管理局预防退伍军人自杀的国家战略强调“努力减少获得致命手段的机会” 然而，目前尚未开发出 LMS 干预措施来预防有自杀风险的退伍军人的自杀。” 伴随这一举措，之前的 LMS 干预措施尚未针对美国退伍军人或 VHA 制定 拟议的工作将通过制定和解决 VHA 自杀预防工作中的这一关键差距。 测试以退伍军人为中心、基于 ED 的 LMS 干预措施以治疗多种自杀方法。 创新：在制定此类干预措施时必须解决一些证据差距。没有事先的 LMS。 干预已被证明可以有效促进药物和枪支安全，并且事先 干预措施没有考虑到个人改变的各种具体机制 拟议的干预措施将纳入专门选择的多种有证据依据的元素。 针对健康信念模型中强调的不同但互补的行为机制（例如， 自我效能）对于行为改变至关重要，其中包括为员工提供基于证据的要素。 沟通策略，并为退伍军人提供实用的、以患者为中心的支持，以促进 LMS 确保这种干预措施满足高危 ED 患者的需求并且是长期可持续的。 如果被证明有效，我们将让退伍军人和临床利益相关者参与制定干预措施。 让利益相关者参与干预开发（VHA 的一个新兴优先事项）对于确保可行性至关重要， 正如一位退伍军人在焦点小组中所说的那样，“我很感谢你们都向我们询问。 我们在想什么，而不仅仅是说，你知道，这就是它是什么，这就是它将会是什么。” 具体目标和方法： 目标 1：确定可能有助于制定干预措施的背景因素。 对最近接受 VHA 急诊室护理的多达 30 名高危退伍军人进行结构化定性访谈，以确定 在干预细化过程中应考虑的个人内部、人际和制度因素 和目标 2 中的适应。 目标 2：利用不同利益相关者样本的专业知识来完善干预要素并加以调整 供退伍军人和 VHA 急诊室使用，并制定最终干预方案和相关材料。 基于之前的研究和从目标 1 中获得的知识，我将采用利益相关者参与的流程来 我将使用两种基于证据的方法来完善、调整和最终确定 LMS 干预方案和材料。 吸引利益相关者并建立共识（名义小组技术，在线修改德尔菲流程）。 目标 3：在 40 名退伍军人中试点基于 ED 的 LMS 干预措施，以评估可行性和可接受性。 评估招聘的可行性、工作人员对干预措施的忠诚度以及退伍军人的参与度，包括急诊室之后 出院情况，以及参与者、干预工作人员和急诊室工作人员对干预的接受程度。 后续步骤/实施：该试点研究的结果将支持 IIR 应用程序来测试其功效 如果发现这种干预措施有效，则可以促进高危退伍军人的 LMS 行为。 VHA 预防自杀的公共卫生方法和我的长期职业目标，我未来的工作目标是 在各种 VHA（例如初级保健）和社区环境中调整和传播干预措施。