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RRP 12-460 – HSR&D Study

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RRP 12-460
Variation in Implementation of the Partners in Care (PIC) Program
Angie Waliski PhD
Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR
No. Little Rock, AR
Funding Period: April 2013 - March 2015

BACKGROUND/RATIONALE:
Gatekeeper training for suicide prevention is an evidence-based universal intervention that has been used extensively by VA; primarily through the Office of Mental Health Services (OMHS)-sponsored Operation S.A.V.E. program. Research shows that gatekeeper training for suicide prevention increases knowledge of risk factors for suicide and increased referral for those exhibiting suicidal warning signs among clinical and non-clinical staff from Vet Centers and VA Medical Centers. In other studies using behavioral observation methodology, findings reveal that gatekeeper training increases perceived ability to question individuals exhibiting signs of distress and to persuade them to accept a targeted referral during a videotaped role play with standardized patients.

Yet, access to those with this knowledge within the community can be challenging. One program with potential to overcome this barrier is "Partners in Care" (PIC). PIC began as an initiative of the Maryland National Guard (NG) Joint Force Headquarters Chaplain's office and has been identified by the NG Bureau as a best practice. Working through NG State/Joint Forces Chaplains (NG Chaplains), this program provides training to faith-based organizations on the processes and procedures for accessing and making referrals to supportive services and resources. In 2012, PIC was implemented in 5 states including AZ, MO, OR, VA and MN. VA partnered with State NG, SAMHSA, and the National Action Alliance for Suicide Prevention's Military/Veteran Task Force to include evidence-based suicide prevention gatekeeper training (i.e., Operation S.A.V.E.) as one component of PIC.

OBJECTIVE(S):
This project sought to 1) document PIC implementation and the use of evidence-based Operation S.A.V.E. skills to identify sources of variability in implementation within different states and sites; 2) identify features of highly effective PIC program implementation including the use of Operation S.A.V.E. skills; and 3) to describe suicide prevention activities conducted by NG Chaplains and community partners following the VA supported suicide prevention training program, Operation S.A.V.E., given at the PIC training Summits in the 5 pilot states.

METHODS:
This study used a mixed quantitative and qualitative methods design to characterize multiple stakeholders' perspectives of the evidence, context, and facilitation needs related to PIC program implementation. There were two sources of study data. The first was data collected as part of standard program evaluation practices and includes (1) Pre-Post training evaluations conducted the day of the PIC Summit and (2) Summit Planning Interviews with NG Chaplains documenting the training team development, recruitment strategies, topics included in the trainings and opinions of the support provided by project partners. The second data source consisted of semi-structured surveys of training attendees at 3, 6 and 18 months post-Summit. It also included key informant interviews of NG Chaplains at 2 weeks, 3 months, and 6 months post-Summit.

FINDINGS/RESULTS:
Aim 1: Of the 205 attendees who completed the post-Summit survey, 127 (62%) indicated interest in follow-up contact and 63% indicated they would be somewhat likely or very likely to implement PIC following the Summit training. Arizona Summit did not include a pre and post survey, therefore follow-up data from attendees is not included in these results. Although 127 attendees provided their contact information for follow-up interviews on the Post-Summit surveys, only 46 of the 127 (36%) agreed to participate in the 3 month follow up, 29 (23%) participated at 6 months, and 14 of the 127 (11%) participated for the 18 month key informant interviews. At 3 and 6 months 48% of remaining respondents (n=22 and 14, respectively) reported implementing PIC; at 18 months 79% (n=11) of the remaining 14 respondents reported implementing PIC. This may indicate loss to follow-up (as indicated by a decrease in willingness to participate at 18 months) signifies those congregations were no longer participating in PIC and conversely, those that were willing to participate in follow-up interviews at 18 months were those that had become invested in the PIC program.

Aim 2: NG Chaplains' prior connections with faith-based organizations in the regions they served and with existing coalitions provided the infrastructure and additional personnel needed to successfully implement the program. In some instances, the PIC program was embedded in programs that had been previously launched to address suicide prevention. A second strength was the flexibility of the PIC program to address a variety of client needs. Once the NG Chaplains determined that there were available and appropriate services, the referral process became easy in matching client needs with the services and resources. The NG Chaplains noted there was always willingness for PIC congregations to distribute tangible goods and services. Examples of goods and services distributed included: clothing, money, gas cards, mentoring, or assistance with child care. NG Chaplains perceived that the type of services or referrals needed could also be defined as prevention and assistance in dealing with ongoing life stressors.

Aim 3: During our evaluation of the suicide prevention activities conducted by the NG Chaplains and community partners we realized that neither the NG Chaplains nor community partners kept records of suicide ideators, attempters, or completers. They did, however report that they noticed an overall decline in suicide attempts but an increase in ideations. When asked, the NG Chaplains and community partners attributed the increase in ideations to the training they received during the training summit in identifying a person in crisis.

IMPACT:
Clergy are being utilized to encourage military service members and Veterans to seek help for suicide ideations. PIC incorporates Operation S.A.V.E. with a multi-layered approach that utilizes community stakeholders to provide support services for Veterans and their families. Results collected from this study will inform the National dissemination of the PIC program.

PUBLICATIONS:

Journal Articles

  1. Waliski A, Townsend J, Matthieu MM, Edlund CN, Castro MI, Kirchner JE. Training Rural Community Leaders in Suicide Prevention: Operation S.A.V.E. Outcomes. Journal of Military and Government Counseling. 2017 May 1; 5(2):87-102.
  2. Waliski A, Matthieu MM, Townsend J, Castro MI, Kirchner JE. Engaging faith based organizations to assist service members and Veterans: An evaluation of Partners in Care. Journal of Military and Government Counseling. 2017 Jan 1; 5(1):20-37.
  3. Waliski A, Matthieu MM, Townsend J, Castro MI, Kirchner JE. Training as a Recruitment Strategy for Building Military and Community Partnerships with Faith-Based Organizations: The Partners in Care Program. Journal of Military and Government Counseling. 2016 Jan 1; 4(1):2-11.
Conference Presentations

  1. Waliski A, Matthieu M, Townsend J, Kirchner JE. Facilitation strategies used to pilot the implementation of the partners in care program in five states. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 8; San Diego, CA.
  2. Waliski A, Whittle P. Enlisting faith-based organizations to assist in suicide prevention among Veterans and military service members. Paper presented at: American Counseling Association Annual Conference; 2014 Mar 29; Honolulu, HI.
  3. Kemp J, Zeller E, Waliski A, Thompson C. Partners in Care: Training Rural Clergy to Support Veterans and National Guard Members. Paper presented at: American Association of Suicidology Annual Conference; 2013 Apr 26; Austin, TX.


DRA: Mental, Cognitive and Behavioral Disorders
DRE: Prevention
Keywords: QUERI Implementation
MeSH Terms: none