2023 HSR&D/QUERI National Conference

1073 — Evidence-basis for Veteran Sponsorship Initiative and Way Ahead: Supporting High Risk Transitioning Servicemembers and Veterans

Lead/Presenter: Joseph Geraci,  VA Transitioning Servicemember/Veteran & Suicide Prevention Center
All Authors: Geraci JC (VA Transitioning Servicemember/Veteran And Suicide Prevention Center), Finley EP (Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles; UT Health San Antonio), Frankfurt SB (VISN 17 Center of Excellence on Research for Returning War Veterans; Central Texas Veterans Healthcare System), Vanneman ME (Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System; University of Utah School of Medicine), Kamdar N (Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center) Seim RW (VISN 17 Center of Excellence on Research for Returning War Veterans) Goodman M (Transitioning Servicemember and Suicide Prevention Center, VISN 2 MIRECC/VISN 17 COE)

The United States’ youngest Veterans are experiencing a suicide epidemic. Suicide rates for Veterans aged 18 to 34 nearly doubled between 2001 and 2019. These elevations may be due to the fact that the risk for suicide almost triples during the first year after military service with 200,000 servicemembers exiting the service each year. The period between discharge and reintegration to civilian life is therefore referred to as a “deadly gap” characterized by a relative gap in support. As a result, the Commander John Scott Hannon Veterans Mental Health Care Improvement Act required the VA to draft a strategic plan to expand the healthcare coverage for servicemembers during their transition to civilian life. This is of critical importance as only 26% of servicemembers utilize VA services after the military and most Veterans who die by suicide do not seek VA services. To aid in addressing the suicide risk, as well as meet Hannon Act requirements, the Veteran Sponsorship Initiative (VSI) connects servicemembers to VA certified, volunteer and community-based peer sponsors and enrollment in VA care.

The presenters will provide a chronological overview of the methods used in studies to determine the evidence-basis for the VSI, consisting of a 3-arm randomized controlled trial (n = 200; 2014-2018), a single-arm, prospective cohort feasibility study with enrollment starting on military installations (n = 431; 2020-2022), a stepped wedge design, randomized Hybrid Type 2 effectiveness-implementation trial with a rollout to six cities in Texas as part of a QUERI Partnered Evaluation Initiative with VISN 17 (n = 630; 2021-2024) and a proposed (awaiting review committee results) Hybrid Type 2 effectiveness-implementation trial as part of a QUERI Partnered Implementation Initiative-Start up that identifies servicemembers as high-risk through the use of predictive analytics modeling and then provides augmented services to these servicemembers as they move to VISNs 2, 4, 17, 19 and 20 (n = 500 total; n = 75 high risk Servicemembers; 2022-2023).

The randomized controlled trial highlighted that community-based interventions are significantly enhanced through the addition of certified sponsors, especially related to reducing reintegration difficulties and improving connectedness. The feasibility study showed that participants had higher VA enrollment/primary care utilization, lower rates of depression and suicide risk compared to non-VSI participants approximately 10 months post-discharge. The study also showed that it is feasible to recruit servicemembers representative of military demographics 6-months pre-discharge, data collection procedures were feasible and the VSI was acceptable to servicemembers. The presenters will be able to provide interim results from the QUERI PEI and PII-Startup (if awarded).

The VSI is the first initiative focused on mitigating suicide risk for servicemembers by providing them an intervention pre-discharge and then evaluating them post-discharge. Results attest to the effectiveness, feasibility and potential value of VSI continuing to expand to assist the maximum number of servicemembers.

Continued evaluation of the VSI will have important implications for national implementation of interventions to address the epidemic of servicemember suicide and meet requirements outlined within the Hannon Act. Aligned with the Evidence-Based Policymaking Act, VSI is the first large-scale implementation of an evidence-based practice that supports servicemembers during the “deadly gap” of transition from military service to civilian life.