Patient and Provider Outcomes of E-Learning Training in Collaborative Assessment and Management of Suicidality (CAMS)

Suicide prevention among military Veterans has become a national priority; yet, there is a gap in suicide-specific intervention training for mental health students and professionals. The need for training in this area has become even more acute with the recent hiring by the Veterans Health Affairs (VHA) of thousands of clinicians to address the mental health needs of Veterans from all war eras. Since e-learning (online) education is more effective than traditional in-person (face-to-face) education for adult learners when methods, such as blended learning, are used, this mode of delivery may more easily meet the training and continuing education needs of busy medical professionals who may find it easier to fit online education into their daily schedules.

A well developed in-person training approach known as the Collaborative Assessment and Management of Suicidality (or CAMS) has been recommended in systematic reviews as an effective tool for assessing and managing suicidality, as well as decreasing providers' fears, improving their attitudes, increasing their knowledge, confidence, and competence, and dispelling myths. The overall aims of this project were to develop an e-learning alternative for the CAMS program, determine its effectiveness relative to in-person CAMS training, and assess factors that may relate to adoption and implementation of CAMS in general and specifically through e-learning and in-person modalities.

Study Overview

• Status: Completed
• Conditions: Suicide
• Intervention / Treatment: Behavioral: CAMS

Detailed Description

There were four specific aims:

1. Refine a Collaborative Assessment and Management of Suicidality (or CAMS) e-learning course that covers the same material and meets the same learning objectives of CAMS in-person training.

2. Test the effectiveness of the CAMS e-learning modality compared to the CAMS in-person modality and a concurrent non-intervention control in terms of provider evaluation and behavior.

   HO: Providers in each of the two CAMS arms will demonstrate higher levels of content mastery and confidence in acquired skills than providers in the no CAMS arm.

   H2: In the 12 months post-training, suicidal patients of providers in each of the two CAMS arms will receive higher rates of CAMS guideline concordant treatment, compared with providers in the no CAMS arm.

3. Test the effectiveness of the CAMS e-Learning delivery compared to the CAMS in-person delivery and a concurrent non-intervention control in terms of patient outcomes.

   H3, 4, 5: In the 12 months post-training, suicidal patients of CAMS e-learning providers and CAMS in-person providers will be similar for health services use patterns, duration of high risk episodes, and number of high risk episodes per patient.

   H6: In the 12 months post training, suicidal patients of providers in the no CAMS arm will have higher rates of emergency room use and inpatient mental health admissions, have a longer average duration of high risk episodes, and have more high risk episodes per patient.

4. Assess factors that facilitate or inhibit adoption of CAMS through e-Learning or In-person.

Of the 309 providers who met eligibility criteria, 230 consented and 212 completed the baseline assessments and were randomized. A total of 261 patients met eligibility criteria and information was abstracted on them.

We developed the CAMS-e, conducted a pilot, revised the e-CAMS, delivered the training in the first site, and again revised it. There is little difference in satisfaction ratings between the two types of training deliveries on the VA Evaluation of Training. Findings show that there were some modest immediate improvements due to the two training conditions; however, the effects were only sustainable at three months for one question related to hospitalization beliefs.

To date, the project has had the following impacts:

1. success in obtaining 6.5 continuing education units (CEUs) for the e-learning version
2. invitations to place e-CAMS on the Department of Defense learning platforms
3. VA Central Office has purchased a license to use the Suicide Status Form (SSF) as a clinical tool and template in the computerized electronic patient record system throughout the national VA. The template is in the developmental process.
4. Efforts are underway to move the CAMS e-learning on to the VA Training Management System (TMS) which will facilitate system wide dissemination and has the potential to increase adoption in VAMC's or by providers.

Additional impacts may be evident with regard to improved care once we complete analysis of the patient outcomes and provider adherence data. We have also considered a short manuscript on economic analysis

• Study Type: Interventional
• Enrollment (Actual): 212
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Alabama
    • Birmingham, Alabama, United States, 35233
      • VA Medical Center, Birmingham, AL
    • Tuscaloosa, Alabama, United States, 35404
      • VA Medical Center, Tuscaloosa
  • Georgia
    • Decatur, Georgia, United States, 30033
      • Atlanta VA Medical and Rehab Center, Decatur, GA
  • South Carolina
    • Charleston, South Carolina, United States, 29401-5799
      • Ralph H. Johnson VA Medical Center, Charleston, SC
    • Columbia, South Carolina, United States, 29209
      • Wm. Jennings Bryan Dorn VA Medical Center, Columbia SC

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 22 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Mental health providers, psychiatrist, social workers, psychologist, advanced practice nurses and case managers

Exclusion Criteria:

• Previous CAMS Training

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention 1: in person CAMS; In person Collaborative Assessment and Management of Suicidality (CAMS) training for providers	Behavioral: CAMS; Collaborative assessment management in suicidality
Experimental: Intervention 2: e-learning CAMS; Online Collaborative Assessment and Management of Suicidality (CAMS) training for providers	Behavioral: CAMS; Collaborative assessment management in suicidality
No Intervention: Control: no training; Control Group: no training

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Provider Self-efficacy and Beliefs About Suicidality	Assessed beliefs and confidence in managing suicidal individuals. Using a 5-point Likert scale, there were 11 items that addressed the following: competence, reactions, beliefs, motivations, and CAMS as it relates to their practice. Scores ranged from 11-55 with questions were phrased so higher scores indicated more positive views.	post-training

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Satisfaction With Training	Evaluation included 20 standard items assessing providers satisfaction with training, including items similar to other published satisfaction surveys. Survey items were rated using a five-point Likert scale indicating the degree to which respondents agreed or disagreed. Questions were always phrased positively so that agree or strongly agree is equivalent to a positive response.	post-training

Collaborators and Investigators

• Sponsor: US Department of Veterans Affairs
• Collaborators: Medical University of South Carolina; Washington Psychological Center
• Investigators: Principal Investigator: Kathryn M. Magruder, PhD MPH BA, Ralph H. Johnson VA Medical Center, Charleston, SC

Publications and helpful links

General Publications

• Pearson GS, Evans LK, Hines-Martin VP, Yearwood EL, York JA, Kane CF. Promoting the mental health of families. Nurs Outlook. 2014 May-Jun;62(3):225-7. doi: 10.1016/j.outlook.2014.04.003. No abstract available.
• Puntil C, York J, Limandri B, Greene P, Arauz E, Hobbs D. Competency-based training for PMH nurse generalists: inpatient intervention and prevention of suicide. J Am Psychiatr Nurses Assoc. 2013 Jul-Aug;19(4):205-10. doi: 10.1177/1078390313496275.
• Marshall E, York J, Magruder K, Yeager D, Knapp R, De Santis ML, Burriss L, Mauldin M, Sulkowski S, Pope C, Jobes DA. Implementation of online suicide-specific training for VA providers. Acad Psychiatry. 2014 Oct;38(5):566-74. doi: 10.1007/s40596-014-0039-5. Epub 2014 Feb 22.
• York JA, Lamis DA, Pope CA, Egede LE. Veteran-specific suicide prevention. Psychiatr Q. 2013 Jun;84(2):219-38. doi: 10.1007/s11126-012-9241-3.

Study record dates

Study Major Dates

• Study Start: July 1, 2010
• Primary Completion (Actual): July 1, 2013
• Study Completion (Actual): December 1, 2013

Study Registration Dates

• First Submitted: May 19, 2009
• First Submitted That Met QC Criteria: May 20, 2009
• First Posted (Estimate): May 21, 2009

Study Record Updates

• Last Update Posted (Estimate): April 24, 2015
• Last Update Submitted That Met QC Criteria: April 6, 2015
• Last Verified: October 1, 2014

More Information

Terms related to this study

• Keywords: suicide; management; assessment; health services; Provider Training
• Additional Relevant MeSH Terms: Behavioral Symptoms; Self-Injurious Behavior; Suicide
• Other Study ID Numbers: EDU 08-424; 19016 (Other Identifier: MUSC IRB)