Translation of a Crisis Line Facilitation (MVCL) for Suicide Prevention using Crisis Line Facilitation

Summary

In 2016, 45,000 U.S. individuals died by suicide, twice as many as died by homicide. Military personnel are disproportionately affected, especially in the National Guard (NG) where suicide rates (27.6/100,000) are the highest of all the Armed Forces and twice those of similar-aged individuals in the U.S. population. The proposed translation project will conduct a Hybrid Type I Effectiveness-Implementation Trial testing group-based Crisis Line Facilitation (CLF) vs. passive implementation (PI) to enhance NG Crisis Line Facilitation (MVCL) use. In Phase 1, we will conduct a cluster RCT, enrolling 300 Michigan soldiers from 12 NG units during drill weekends, with units randomized to receive either group-based CLF or PI (i.e., handouts). In Phase 2, qualitative data on barriers and facilitators to MVCL use and CLF implementation in the NG will be collected from key stakeholders, NG leadership, and NG service members. Based on these data and using the translation framework Enhanced-Replicating Effective Programs (E-REP), we will develop a customized implementation toolkit (i.e., program components, training materials, fidelity and process evaluation tools, technical support) and examine implementation (enhanced by an external facilitator), including evaluating RE-AIM outcomes.

Abstract

Aim 1: Compare Crisis Line Facilitation (CLF) vs. Passive Implementation (PI) on primary (Military Veterans Crisis Line [MVCL] use; Mental Health Service Utilization) and secondary (behavioral intention; MVCL attitudes; perceived norms; self-efficacy; peer outreach) outcomes at 6-months. Exploratory analyses will also examine suicidal thoughts, plans, and attempts.

Aim 2: Examine qualitative data from key stakeholders to understand facilitators and barriers to implementation, customize an implementation toolkit for the NG, and examine preliminary implementation using RE-AIM (Reach; Effectiveness; Adoption; Implementation; Maintenance) outcomes over 3 months.

This study is highly significant as it: (1) addresses suicide, a critical U.S. public health problem and a key NCIPC Director’s Research Priority Area; (2) tests a scalable translational strategy to increase uptake of an existing best-practice suicide prevention resource (i.e., Crisis Lines); and, (3) addresses the elevated suicide risk among the NG population, 47% of whom have served on active duty and/or qualify as veterans23 and 46% of whom reside in rural settings with limited access to mental health services. This study is innovative as it is the first to test the effects of a group-based, universal prevention strategy (i.e., CLF) with a peer outreach approach (i.e., framing as delivery to help peer soldiers/family) to increase crisis line use among the NG to encourage help-seeking during periods of elevated risk. Findings will have key implications for the translation of effective universal suicide prevention approaches to engage NG personnel in seeking help for themselves and/or their peer soldiers and will create an implementation toolkit adaptable to other settings and populations.