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Quality Enhancement Research Initiative

QUERI E-news
December 2021

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Suicide Prevention for Transitioning Servicemembers

The White House recently announced a series of priority goals and executive actions that will drive suicide prevention efforts forward. The new national strategy – “Reducing Military and Veteran Suicide: Advancing a Comprehensive, Cross-Sector, Evidence-Informed Approach” – targets five priority areas including:

  • Improving lethal means safety (i.e., firearms and medications);
  • Enhancing crisis care and facilitating care transitions;
  • Increasing access to and delivery of effective care;
  • Addressing upstream risk and protective factors; and
  • Increasing research coordination, data sharing, and evaluation efforts.

VA’s top clinical priority is preventing suicide among all Veterans, including those who do not seek VA care. Toward this goal, HSR&D and QUERI have supported several initiatives on suicide prevention. Adding to this portfolio, QUERI recently funded Dr. Joseph Geraci and his team to evaluate the impact of a national sponsorship program for transitioning servicemembers on Veteran outcomes, including suicide ideation and behaviors.

Bridging the Gap between Civilians and Veterans

Drs. Joe Geraci and Marianne Goodman are co-Directors of the Transitioning Servicemember/Veteran and Suicide Prevention Center (TASC), which is a joint effort between VISN 2 MIRECC (Mental Illness Research, Education and Clinical Centers) and the VISN 17 Center of Excellence for Research on Returning War Veterans. The TASC’s mission is to lead research, evaluation, and educational efforts focused on the successful transition of Servicemembers to their civilian lives, thus enabling them to find their next “mission” and reduce their risk for suicide. This mission is important as suicide rates among Veterans are highest during their transition to civilian life.

Dedicated to addressing Veteran mental health and suicide rates, Dr. Geraci believes bridging the gap between civilians and Veterans is a crucial first step. Within the TASC, he leads two national VA efforts: Veteran Cultural Competence Training and the evaluation of the Transitioning Servicemember/Veteran Sponsorship Initiative (TSM/V-SI). The Veteran Cultural Competence program is a day-long immersive experience in which VA and non-VA professionals gain a new perspective on what it is like to be a Veteran – and the emotions they may experience in day-to-day life. The TSM/V-SI provides volunteer and certified (1-on-1) sponsors who help transitioning Servicemembers secure housing, find jobs, pursue educational opportunities, and access mental health support, while also assisting their families.

I am dedicated to this work because it directly supports my former Servicemembers and many others. I have seen the amazing feats they can accomplish on the battlefield and want them all to accomplish their next mission in civilian life. –Dr. Geraci

Joe Geraci, PhD, LMHC, is a retired Lieutenant Colonel (Infantry) in the US Army. As an Infantry officer, he was deployed in Afghanistan and served as a senior leader on the frontlines with the 2nd Ranger Battalion, 173rd Airborne Brigade, and 10th Mountain Division, which gives him a unique perspective as a Veteran, VA clinician, and researcher. Marianne Goodman, MD, is a clinical research physician at the James J Peters VA Medical Center (JJPVA) and is Director of the JJPVA Suicide Prevention Research and Care Center, VISN 2 MIRECC.

Importance of the Transitioning Servicemember/Veteran Sponsorship Initiative (TSM/V-SI)

Recently, Dr. Geraci partnered with QUERI and Erin Finley, PhD, MPH, part of HSR&D’s Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), to evaluate the TSM/V-SI. This is critical because according to the Department of Defense’s 2020 Annual Suicide Report, more Servicemembers were lost to suicide than to combat in Afghanistan and Iraq, with 580 dying by suicide in 2020 alone. Also, Servicemembers at higher risk of suicide are younger than 35 years of age. In addtion, the 2020 DoD Inspector General’s report found that 53% (4,415 of 8,328 per month) of all active duty Servicemembers and their families who were identified as needing mental healthcare did not receive that care, and the Military Health System did not know why.

A period of significant risk for young Veterans is in the three-year period after exiting the military. The TSM/V-SI seeks to intervene with young Veterans by:

  • Engaging transitioning Servicemembers prior to their exit from the military;
  • Connecting them to certified and volunteer sponsors (1-on-1) in their post-military hometowns; and
  • Enrolling them in needed VA and community services.

The TSM/V-SI will be executed using a stepped-wedge design (from 2021 to 2024), which relies on sequential roll-out to participating cities over time, while using other cities as controls until they begin implementation.

The TSM/V-SI is based on results identified in a randomized control trial with transitioned Servicemembers who received certified and volunteer sponsors. The results showed a moderate treatment effect for suicide risk factors (e.g., reintegration difficulties and social support).

In the military, all Servicemembers have leaders to help them through challenges and transitions. There is no such universal support when they enter civilian life, thus contributing to the deadly gap between military and civilian life. –Dr. Geraci

Evaluating the ETS Sponsorship Program

The QUERI evaluation of the TSM/V-SI seeks to determine the effectivness of the initative by measuring reintegration difficulties, social support, psychological distress, suicidal ideation and behaviors, and the use of both VA and non-VA healthcare. Investigators also will examine the feasibility of implementing the TSM/V-SI in six cities in Texas. Servicemembers who transition to cities without the TSM/V-SI will experience their transition from military to civilian life as usual (i.e., services available from the U.S. Army Soldier for Life-Transition Assistance Program). After cities have implemented the TSM/V-SI, transitioning Servicemembers will have access to the TSM/V-SI in their city and connections to community services.

The sponsorship initiative strives to create a seamless transition for all Servicemembers to civilian life by providing them a community-based intervention that is directly aligned with military culture. –Dr. Geraci

Listen to more about suicide prevention from the perspective of a Veteran and VA clinician-researcher in our conversation with Dr. Geraci at HSR&D Investigator Insights Podcasts.

To become a sponsor and assist a transitioning Servicemember moving to your area who desires to work in your career field, please sign up. For more information about this QUERI project or TASC, please contact Dr. Geraci at .

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