» Table of Contents

Implementing Caring Contacts for Suicide Prevention in Non-Mental Health Settings

Takeaway: QUERI investigators are implementing Caring Contacts in VA emergency departments and urgent care centers in 28 facilities across 9 VISNs. This will improve suicide prevention for Veterans during a high-risk period.

Suicide rates for Veterans are higher than for the general population, thus suicide prevention is a high priority for VA. Transitions in care, such as discharge from an emergency department (ED), are critical time periods for suicide prevention as the majority of deaths by suicide occur within 30 days after discharge from the hospital or ED. Healthcare providers need something effective to improve care during this transition.

The Implementing Caring Contacts for Suicide Prevention in Non-Mental Health Settings QUERI Partnered Implementation Initiative (PII) is implementing and evaluating an evidence-based suicide prevention intervention—Caring Contacts—in VA EDs and urgent care centers. Caring Contacts (CC) is an intervention that involves sending patients who are suicidal brief, non-demanding expressions of care and concern over the course of a year. Studies of CCs have demonstrated significant reductions in suicide deaths, attempts, and ideation.

With previous QUERI funding, the Caring Contacts research team adapted CC for Veterans and the ED setting, developed an implementation process and tools, and piloted implementation at the Central Arkansas Veterans Healthcare System in Little Rock, AR. See Figure 1 for one of 11 cards sent during the year after screening positive for suicide risk in the ED. Messages are printed on flat cards and sent in light blue envelopes.

In the first year, 375 Veterans received Caring Contacts from the ED at the Central Arkansas Veterans Healthcare System. Veterans who received Caring Contacts reported positive views of the intervention. One Veteran stated, “I appreciate them sending the cards out though to check on me because, you know, I have several suicide attempts. That made me feel good, that hey, I’m being thought about.” Another Veteran said, “It was nice to get something […] I’m an older person and a lot of people in my family have passed on and I’ve lost some close friends and stuff so…your support circle starts to shrink.”

The current funded project is focused on spreading implementation of Caring Contacts to 28 facilities across 9 VISNs using implementation facilitation, an evidence-based implementation strategy. As of August 2020, seven facilities have started receiving external facilitation. Due to the COVID-19 pandemic, facilitation is being provided virtually.

The goals of this project are to:

• Spread Caring Contacts across all VA medical centers in VISN 16 and selected sites in VISNs 5, 6, 10, 12, 17, 19, 22, 23.
• Evaluate clinical and implementation outcomes associated with Caring Contacts spread (e.g., service utilization, suicide related behavior, and number of Veterans reached).
• Conduct a budget impact analysis that documents cost of implementation and cost outcomes of Caring Contacts in the emergency department.
• Evaluate the role of geographic context in clinical and implementation outcome patterns.

The research team includes Traci Abraham, Mary Bollinger, Kate Comtois, Nyssa Curtis, Susan Jegley, Barbara Johnson, Donald Jones, Bo Kim, Sara Landes (Principal Investigator), Robert Lew, Bridget Matarazzo, Krissi Morris, Jacob Painter, Jeff Pitcock, Mark Reger, Brandy Smith, Jeff Smith, Kelly Stolzmann, and Jennifer Van Tiem. The facilitator team includes Princess Ackland, Kathy Dollar, Susan Jegley, JoAnn Kirchner, Kathy Marchant, Clinta Ché Reed, Dustin Rhodes, Sonia Singh, Kristen Wing, and Jack Woods.

Co-led by VISN leaders and VA implementation experts, QUERI VISN PIIs focus on the deployment of effective practices that support healthcare priorities selected by VISN leadership. This QUERN VISN PII was developed in partnership with VISN 16 leadership including Drs. Skye McDougall, John Areno, and Irving Kuo.

For more information, please contact Sara J. Landes, PhD, at sara.landes@va.gov.