Veteran Engagement Implementation Strategies to Prevent Rural Veteran Suicide

防止农村退伍军人自杀的退伍军人参与实施策略

• 批准号: 10535422
• 负责人: Eva Woodward
• 金额: --
• 依托单位: CENTRAL ARKANSAS VETERANS HLTHCARE SYS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10535422
• 关键词: Address; Adoption; Ambulatory Care Facilities; Area; Award; Caregivers; Clinic; Clinical; Clinics and Hospitals; Communities; Competence; Consumer Participation; Data; Development; Ensure; Evaluation; Family; Family Caregiver; Feedback; Feeling suicidal; Future; General Population; Goals; Health behavior outcomes; Healthcare; Healthcare Systems; Human Resources; Impact evaluation; Infrastructure; Intervention; Interview; K-Series Research Career Programs; Knowledge; Low income; Manuals; Mental Depression; Methodology; Methods; Monitor; Outcome; Patients; Policies; Population; Process; Provider; Psychologist; Reduce health disparities; Reporting; Research; Research Methodology; Research Personnel; Risk; Rural; Rural Population; Safety; Scientist; Severities; Site; Standardization; Suicide; Suicide prevention; Techniques; Testing; Time; Training; United States Department of Veterans Affairs; Update; Variant; Veterans; Voice; Vulnerable Populations; Work; acceptability and feasibility; base; behavioral health; career; clinical practice; community based participatory research; design; effective intervention; effective therapy; effectiveness implementation study; evidence base; experience; follow-up; group intervention; health care disparity; health care quality; health care service; health disparity; health equity; implementation facilitation; implementation intervention; implementation outcomes; implementation process; implementation research; implementation science; implementation strategy; implementation study; improved; improved outcome; innovation; meetings; member; novel; prevent; process evaluation; programs; racial minority; research study; skills; suicidal behavior; suicidal risk; uptake

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.

背景。作为具有强大开始实施科学能力的心理学家，伍德沃德博士的 目标是成为一名独立的研究者和高级实施科学家，以提高健康公平 在弗吉尼亚州，通过让弱势退伍军人参与实施医疗服务。在这个CDA中，她将获得技能 识别，手动化，试点和严格评估有效的方法来吸引脆弱的退伍军人（这些方法 谁在整个实施过程中都经历健康差异）。医疗保健差异持续存在 VA。在基于社区的参与研究（CBPR）中，吸引消费者参与研究有助于脆弱 人群改善了健康行为和结果。这是实施研究人员也可以参与 消费者选择和调整实施策略。实施策略是技术的技术 增强干预措施的吸收（例如，质量监测，可持续性计划）。消费者很少 参与此过程可能是因为不存在正式指导。伍德沃德博士将手动方法将 让脆弱的退伍军人消费者（包括家庭，照顾者，社区成员）参与选择和 调整实施策略。本手册（称为消费者声音）将为 什么，何时，何地，如何以及为什么实施者可能会吸引消费者实施或重新设计 医疗服务。伍德沃德博士将在实施安全计划的背景下试用本手册 干预（SPI）预防自杀，专注于粗糙的退伍军人，这是一个特别容易受到伤害的人口 自杀。自杀是VA的最高临床优先事项。 SPI是一种有效的干预措施，可降低自杀想法和 行为。伍德沃德博士需要在CBPR中进行培训，实施研究的混合方法以及 实施策略设计。意义/影响。通过在整个过程中添加退伍军人的声音 实施过程，VA可以增加弱势退伍军人的医疗保健和医疗保健质量 改善健康公平。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 满足VA需求的差异。创新。消费者的声音及时满足创新的关键需求 实施科学，以减少健康分布和VA对退伍军人参与的重视。 消费者声音是新颖的，是第一个指导整个消费者参与过程的手册 执行; [尽管它将在SPI上进行试验，但它将推广到其他弱势群体，以及 干预措施。]具体目的。 1）识别和手动化方法，以吸引消费者选择和 调整实施策略（消费者语音）。 2）使用消费者语音并驾驶其可接受性， 可行性以及对实施和退伍军人结果的初步影响。 3）评估SPI维持[ 消费者语音影响的指标。]方法论。在AIM 1中，伍德沃德博士将使用CBPR方法 发展消费者的声音。在AIM 2飞行员期间，伍德沃德博士将在两个基于社区的SPI中实施SPI 为农村退伍军人提供服务的门诊诊所。比较站点将获得实施促进（如果）和 如果+消费者语音将接收实现网站。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飞行员混合实施 - 有效性3型设计，并比较IF+消费者的语音：1）实现（接收，采用， 和2）老将的结果（抑郁严重程度，自杀构想，自杀行为）。在AIM 3中，博士 伍德沃德（Woodward 维持。伍德沃德博士还将收集利益相关者的定性数据，以了解什么阻碍或 促进SPI维持和[比较消费者参与每个网站的程度 可持续性行动计划]。下一步/实现。伍德沃德博士将对 消费者对城市和农村退伍军人之间的实施成果和自杀分布的声音。满的 传播将包括VA网络网络以及与政策和计划合作伙伴的会议。