— Self-Directed Violence Classification System (SDVCS): Implementation Strategies, Barriers and Facilitators

Brenner LA, VA VISN 19 MIRECC; Betthauser LM, VA VISN 19 MIRECC; Bulman BE, VA VISN 19 MIRECC; Breshears RE, WellStar Health System; Silverman MM, VA VISN 19 MIRECC; Huggins J, VA VISN 19 MIRECC; Harwood JE, University of Colorado Anschutz Medical Campus; Albright K, University of Colorado Anschutz Medical Campus; Nagamoto HT, Department of Veterans Affairs, Eastern Colorado Health Care System;

Objectives:
Suicide is a significant major health concern, and increased suicide rates have been documented within the military and Veteran population. The Blue Ribbon Work Group on Suicide Prevention provided recommendations for improving Veterans Affairs (VA) suicide prevention, research and education programs. The VA VISN 19 MIRECC responded to this charge by collaborating with the Centers for Disease Control to generate a standardized nomenclature, the Self-Directed Violence Classification System (SDVCS), which was recently adopted by the Department of Veterans Affairs. The VA VISN 19 MIRECC conducted a QUERI funded pilot project using implementation science research strategies to identify facilitators and barriers regarding the uptake of the SDVCS in two VA medical centers (VAMCs).

Methods:
Implementation science strategies included formative and summative evaluations, and internal and external facilitation. Study procedures included initial focus groups with Mental Health (MH) leadership, formalized trainings for MH leadership and MH clinicians, follow-up focus groups and quality improvement (QI) surveys at 1- and 6-months post-training, and a review of participating clinicians' chart notes to evaluate term usage.

Results:
Feedback from the initial QI survey suggested that the SDVCS was generally acceptable. Focus group qualitative data indicated clinicians' overall satisfaction with the SDVCS training; however, participants across both VAMCs noted increased training is warranted. Clinicians also expressed concerns regarding the new terminology, describing it as a “complete paradigm shift”. Clinicians expressed that demonstration of the nomenclature as related to improved care of patients is essential to implementation. Specific feedback regarding the SDVCS worksheet and Clinical Tool (CT) yielded mixed levels of acceptance. Overall, increased functionality and intuitive use of the nomenclature were strong recommendations noted by a majority of the participants.

Implications:
Initial implementation efforts suggest that the SDVCS and CT are acceptable and useful to mental health providers, though clinicians suggested recommendations and improvements for increased adoption of the system.

Impacts:
Preliminary data found challenges and recommendations associated with implementing the SDVCS. Implementation science strategies and results associated with implementation of the SDVCS will be covered in this presentation. Data suggest that additional efforts will be required to facilitate widespread implementation.