REACH VET Implementation Program Evaluation (REACH VET)

Risk Stratified Enhancements to Clinical Care: Targeting Care for Patients Identified Through Predictive Modeling as Being at High Risk for Suicide, With the Office of Mental Health Operations

The VA's Office of Mental Health and Suicide Prevention implemented an new program to increase suicide prevention outreach for Veterans at highest risk for suicide. Using a statistical model, REACH VET, short for Recovery Engagement and Coordination for Health - Veterans Enhanced Treatment, uses information from Veterans' health records to identify those who are at a higher risk for suicide, hospitalization, illness, or other negative outcomes. Once a Veteran is identified, his or her VA mental health or primary care provider reaches out to check on the Veteran's well-being and review their treatment plan to determine if enhanced care is needed. The goal of the current study was to evaluate the implementation of this program. The objectives of this evaluation were to evaluate how well this program is put into place using an implementation strategy called virtual external facilitation, and to collect data about the cost of the program and the strategy.

Study Overview

• Status: Completed
• Conditions: Suicide
• Intervention / Treatment: Other: External facilitation

Detailed Description

The VA's Office of Mental Health and Suicide Prevention is implemented an innovative new program to increase suicide prevention outreach and target Veterans at highest risk for suicide. Using a new predictive model, REACH VET, short for Recovery Engagement and Coordination for Health - Veterans Enhanced Treatment, analyzes existing data from Veterans' health records to identify those who are at a statistically elevated risk for suicide, hospitalization, illness, or other adverse outcomes. Once a Veteran is identified, their VA mental health or primary care provider reaches out to check on the Veteran's well-being and review their condition(s) and treatment plans to determine if enhanced care is needed.

The goal of the proposed study is to evaluate the implementation of REACH VET. The objectives of this evaluation are to:

1. evaluate the implementation of REACH VET using virtual external facilitation, and
2. collect preliminary data about the cost and cost offsets.

The current evaluation will examine the impact of a virtual external facilitation strategy on the implementation of REACH VET in 28 medical facilities across 7 Veteran Integrated Service Networks (VISNs) in a stepped wedge design. Primary implementation outcomes include metrics of REACH VET implementation: coordinator assignment, provider assignment, care evaluation, and attempted outreach. Qualitative interviews will be conducted with implementation facilitators, Suicide Prevention Coordinator(s), clinical leadership, and providers to identify barriers and facilitators to implementation of REACH VET and the experience of facilitation. Secondary data will be collected on the cost of the intervention and the cost of implementation strategy.

• Study Type: Observational
• Enrollment (Actual): 28

Contacts and Locations

Study Locations

• United States
  • Arkansas
    • North Little Rock, Arkansas, United States, 72114-1706
      • Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR
  • Colorado
    • Denver, Colorado, United States, 80220
      • VA Eastern Colorado Health Care System, Denver, CO

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

The study population will include facilities receiving virtual external facilitation for REACH VET

Description

Inclusion Criteria:

• VA employee at a facility receiving virtual external facilitation
• Involved in REACH VET implementation

Exclusion Criteria:

• Not a VA employee
• Not employed at a facility receiving virtual external facilitation
• Not involved in REACH VET implementation

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

VAMC's receiving implementation support for REACH VET; This cohort consists of 28 VA Medical Centers (VAMC's) needing additional implementation support to fully implement REACH VET as identified by Veteran Integrated Service Network (VISN) leadership, and that agreed to participate.

Other: External facilitation; Facilitation is an evidence-based implementation strategy to support sites that have difficulty implementing innovative programs. Facilitation is a multi-faceted "process of interactive problem solving and support that occurs in the context of a recognized need for improvement and a supportive interpersonal relationship (Powell et al., 2015)." Facilitation has been used nationally across VA to implement a number of different clinical interventions. The current project will examine this minimally intensive version of implementation facilitation, virtual external facilitation.; Other Names: Virtual external facilitation, facilitation, implementation facilitation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Coordinator Assigned Post-Implementation	The average percentage of eligible Veterans across all 23 participating sites having a coordinator assigned within 2 weeks of the monthly REACH VET report being released during the 6 month post-implementation period.	6 months after implementation was completed
Provider Assigned Post-Implementation	The average percentage of eligible Veterans across all 23 participating sites having a provider assigned within 2 weeks of the monthly REACH VET report being released during the 6 month post-implementation period .	6 month period following implementation
Care Evaluation Performed Post-Implementation	The average percentage of eligible Veterans across all 23 participating sites receiving a care evaluation within 2 weeks of the monthly REACH VET report being released during the 6 month post-implementation period.	6 month period following implementation
Attempted Outreach Post-Implementation	The average percentage of eligible Veterans across all 23 participating sites where outreach was attempted within 2 weeks of the monthly REACH VET report being released during the 6 month post-implementation period.	6 month period following implementation

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Organizational Readiness for Change Survey	Eligible staff at participating VA facilities were solicited to complete a modified version of the Texas Christian University Organizational Readiness for Change - Staff (TCU ORC-S). We abbreviated the original instrument to 62 items and modified text for contextual relevance. Responses were collected from 22 sites across five Veteran Integrated Service Networks (VISN). The responses were scored on ten scales: Program Needs (10 - 50 higher is preferred), Training Needs (10 - 50 higher is preferred), Pressure for Change (10 - 50 higher is preferred), Staffing (10 - 50 higher is preferred), Mission (10 - 50 higher is preferred), Cohesion (10 - 50 higher is preferred), Autonomy (10 - 50 higher is preferred), Communication (10 - 50 higher is preferred), Stress (10 - 50 lower is preferred) and Change (10 - 50 lower is preferred).	1 month

Collaborators and Investigators

• Sponsor: VA Office of Research and Development
• Investigators: Principal Investigator: Sara J. Landes, PhD, Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR

Publications and helpful links

General Publications

• Reger MA, Luxton DD, Tucker R, Comtois KA, Keen AD, Landes SJ, Matarazzo BB, Thompson C. Implementation Methods for the Caring Contacts Suicide Prevention Intervention. Professional Psychology, Research and Practice. 2017 Oct 1; 48(5):369-377.

Study record dates

Study Major Dates

• Study Start (Actual): September 18, 2017
• Primary Completion (Actual): March 13, 2020
• Study Completion (Actual): December 31, 2020

Study Registration Dates

• First Submitted: September 6, 2017
• First Submitted That Met QC Criteria: September 11, 2017
• First Posted (Actual): September 12, 2017

Study Record Updates

• Last Update Posted (Estimated): January 25, 2024
• Last Update Submitted That Met QC Criteria: May 10, 2023
• Last Verified: May 1, 2023

More Information

Terms related to this study

• Keywords: Implementation; Prevention; Suicide; Facilitation
• Additional Relevant MeSH Terms: Behavioral Symptoms; Self-Injurious Behavior; Suicide
• Other Study ID Numbers: SDR 16-195

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No