QUERI – Quality Enhancement Research Initiative

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

Central Arkansas Veterans Healthcare System, Little Rock, AR


Suicide among Veterans is a problem nationally. Suicide rates for Veterans are higher than for the general population, thus suicide prevention is a high priority for the VA. Rural Veterans are at greater risk for suicide; they have higher suicide rates, and firearm deaths are more common in rural suicides. Based on FY2017 data, VISN 16 is the 4th most rural VISN (Veterans Integrated Service Network). Of its 419,374 healthcare users, 41% are classified as residing in rural or highly rural areas. Addressing suicide prevention aligns with the national and VISN priority of implementing best practices for suicide prevention.

In collaboration with VISN 16 Leadership, this project will adapt and implement an evidence-based suicide prevention intervention—Caring Contacts—in a non-mental health setting, the emergency department, to target a wider audience of Veterans (as compared with only those who receive care in the mental health clinic). Rates of self-directed violence in VISN 16 are presented in Figure 1, with higher rates indicated in red. This data is based on reporting by Suicide Prevention Coordinators, so higher numbers also may indicate better reporting.

Figure 1. Rates of self-directed violence per 100,000 enrolled Veterans by VHA submarket in VISN 16, October 2016-Dec 2017

Caring Contacts (CCs) is a simple intervention that involves sending patients at risk of suicide brief, non-demanding expressions of care over a year or more. Studies of CCs have demonstrated significant reductions in suicide deaths, attempts, and ideation at one and two-year follow-up. CCs have been found to be feasible and acceptable with military and Veteran populations and effective with active duty soldiers and Marines.

This initiative proposes the use of qualitative interviews with key stakeholders, an advisory board, and a pilot of CC in the emergency department to develop a CC implementation toolkit for broader dissemination. The initiative will use virtual external facilitation as the implementation strategy. Facilitation is an evidence-based implementation strategy that is especially useful for facilities with demonstrated quality gaps in the selected clinical priority.


The objectives of the VISN PII startup phase are to:

  • Establish an advisory board that includes Veterans, VISN leadership, Suicide Prevention Coordinators, CC experts, as well as representatives from the emergency department, primary care, and mental health;
  • Develop a Caring Contacts (CCs) protocol for the emergency department (i.e., how to identify Veterans that should receive CCs, who will send the CCs, and how they will be sent);
  • Finalize sources of outcome data and how network leadership prefer to access that data, such as VISN-level suicide data from SPAN (Suicide Prevention Applications Network);
  • Conduct a pilot of the CCs protocol at the Central Arkansas Veterans Healthcare System in Little Rock, AR; and
  • Develop and refine a CCs implementation toolkit that will include an implementation guide, leadership briefings, and education materials, and instructions on how to access data for monitoring and feedback, etc.

Expected Impacts

This project will develop a Caring Contacts protocol for the VA emergency department setting and a CCs implementation toolkit. This protocol and toolkit will help other facilities and VISNs implement this suicide prevention intervention.

Principal Investigator: Sara J. Landes, PhD (sara.landes@va.gov); VISN 16 Project Lead: John P. Areno, MD (john.areno@va.gov)

Operations Partner(s): VISN 16/South Central VA Health Care Network Leadership Team, and the Central Arkansas Veterans Healthcare System Emergency Department.