Impact of Implementation Facilitation on the REACH VET Clinical Program for Veterans at Risk for Suicide

Sara J Landes; Bridget B Matarazzo; Jeffery A Pitcock; Karen L Drummond; Brandy N Smith; JoAnn E Kirchner; Kaily A Clark; Georgia R Gerard; Molly C Jankovsky; Lisa A Brenner; Mark A Reger; Aaron E Eagan; Rebecca Raciborski; Jacob Painter; James C Townsend; Susan M Jegley; Rajinder Sonia Singh; Jodie A Trafton; John F McCarthy; Ira R Katz

doi:10.1176/appi.ps.20230277

Impact of Implementation Facilitation on the REACH VET Clinical Program for Veterans at Risk for Suicide

Psychiatr Serv. 2024 Mar 6:appips20230277. doi: 10.1176/appi.ps.20230277. Online ahead of print.

Authors

Sara J Landes¹, Bridget B Matarazzo¹, Jeffery A Pitcock¹, Karen L Drummond¹, Brandy N Smith¹, JoAnn E Kirchner¹, Kaily A Clark¹, Georgia R Gerard¹, Molly C Jankovsky¹, Lisa A Brenner¹, Mark A Reger¹, Aaron E Eagan¹, Rebecca Raciborski¹, Jacob Painter¹, James C Townsend¹, Susan M Jegley¹, Rajinder Sonia Singh¹, Jodie A Trafton¹, John F McCarthy¹, Ira R Katz¹

Affiliation

¹ Central Arkansas Veterans Healthcare System, Little Rock (Landes, Pitcock, Drummond, Smith, Kirchner, Raciborski, Painter, Townsend, Jegley, Singh); Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Landes, Drummond, Kirchner, Painter, Singh); Rocky Mountain Mental Illness Research, Education, and Clinical Center, U.S. Department of Veterans Affairs (VA), Aurora, Colorado (Matarazzo, Clark, Gerard, Jankovsky, Brenner); Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora (Matarazzo, Brenner); Veterans Integrated Service Network 19 Clinical Resource Hub, Salt Lake City (Clark); VA Puget Sound Health Care System, Seattle (Reger); VA Office of Mental Health and Suicide Prevention, Washington, D.C. (Eagan, Trafton, McCarthy, Katz).

PMID: 38444365
DOI: 10.1176/appi.ps.20230277

Abstract

Objective: In 2017, the Veterans Health Administration (VHA) implemented a national suicide prevention program, called Recovery Engagement and Coordination for Health-Veterans Enhanced Treatment (REACH VET), that uses a predictive algorithm to identify, attempt to reach, assess, and care for patients at the highest risk for suicide. The authors aimed to evaluate whether facilitation enhanced implementation of REACH VET at VHA facilities not meeting target completion rates.

Methods: In this hybrid effectiveness-implementation type 2 program evaluation, a quasi-experimental pre-post design was used to assess changes in implementation outcome measures evaluated 6 months before and 6 months after onset of facilitation of REACH VET implementation at 23 VHA facilities. Measures included percentages of patients with documented coordinator and provider acknowledgment of receipt, care evaluation, and outreach attempt. Generalized estimating equations were used to compare differences in REACH VET outcome measures before and after facilitation. Qualitative interviews were conducted with personnel and were explored via template analysis.

Results: Time had a significant effect in all outcomes models (p<0.001). An effect of facilitation was significant only for the outcome of attempted outreach. Patients identified by REACH VET had significantly higher odds of having a documented outreach attempt after facilitation of REACH VET implementation, compared with before facilitation. Site personnel felt supported and reported that the external facilitators were helpful and responsive.

Conclusions: Facilitation of REACH VET implementation was associated with an improvement in outreach attempts to veterans identified as being at increased risk for suicide. Outreach is critical for engaging veterans in care.

Keywords: Implementation facilitation; Recovery Engagement and Coordination for Health–Veterans Enhanced Treatment (REACH VET); Suicide and self-destructive behavior; Veterans issues.