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Health Services Research & Development

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2023 HSR&D/QUERI National Conference Abstract

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4147 — What Barriers Do Suicide Prevention Staff Face When Addressing Veterans’ Adverse Social Determinants of Health?

Lead/Presenter: Gala True,  SC MIRECC and Southeast Louisiana Veterans Healthcare Network
All Authors: True G (SC MIRECC, Southeast Louisiana Veterans Health Care Network, LSU School of Medicine), Antonellis, Christel (Southeast Louisiana Veterans Health Care System Brecht, Tatiana (Birmingham VA Health Care System) Montgomery, Ann Elizabeth (Birmingham VA Health Care System and University of Alabama at Birmingham)

Objectives:
Adverse social determinants of health (SDH) demonstrate strong associations with suicide mortality and morbidity. The Veterans Health Administration (VHA) offers services to address SDH, but little is known about how these programs are integrated with suicide prevention. We assessed barriers that VHA suicide prevention staff encounter when connecting Veterans with services to address select SDH (i.e., housing instability, justice involvement, unemployment).

Methods:
We deployed a questionnaire via REDCap to suicide prevention staff across all VHA facilities. We fielded the survey in January and February 2022, with support from VA’s Office of Mental Health and Suicide Prevention. We sent recruitment emails to 883 eligible suicide prevention staff and received 171 responses, for a response rate of 19.3%. The survey addressed topics including availability and perceived helpfulness of a point of contact (POC) to address select SDH (i.e., housing instability, justice involvement, unemployment) and perceived barriers to connecting Veterans with services to address adverse SDH.

Results:
A majority of respondents reported awareness of a POC within their facility to address Veterans’ housing instability (99.2%), justice involvement (95.9%), and unemployment (91%) and agreed that services to address adverse SDH could reduce Veterans’ suicide risk. Overall, suicide prevention staff said they did not face significant barriers to referring Veterans to SDH-focused services; however, a higher percentage of respondents said they faced challenges when referring Veterans to unemployment and housing services (38% and 35%, respectively) compared with referring to justice involvement services (29%). For suicide prevention staff who did report significant barriers to making referrals to SDH-focused programs, the most frequently cited barriers were lack of time and resources at the program or facility level. In free text responses, suicide prevention staff indicated that Veterans not meeting eligibility criteria for housing or unemployment services was a particular challenge to addressing those adverse SDH.

Implications:
Despite nearly universal awareness of on-site resources to address a Veteran’s adverse SDH and belief that addressing these SDH could reduce suicide risk, one-third of suicide prevention staff reported significant challenges to referring Veterans to services to address adverse SDH. Some of these barriers (e.g., time and resources) may be modifiable at the organizational level, while others (e.g., eligibility criteria) may require change at the policy level.

Impacts:
The results from this survey are being further explored with suicide prevention staff during in-depth interviews with the objective of improving the ability of suicide prevention staff to connect Veterans with services to address adverse SDH and reduce suicide risk.