novel approaches for high-risk suicidal veterans · it is a prevention tool, developed...

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NOVEL APPROACHES FOR HIGH-RISK SUICIDAL VETERANS MARIANNE GOODMAN, M.D. K. NIDHI KAPIL-PAIR, PH.D. SARAH SULLIVAN, M.S., MHC-LP ANGELA P. SPEARS, B.S. RACHEL E. HARRIS, M.A. James J. Peters VA Medical Center, Bronx, NY Mental Illness Research, Education and Clinical Center Suicide Prevention and Treatment Research Program

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Page 1: NOVEL APPROACHES FOR HIGH-RISK SUICIDAL VETERANS · It is a prevention tool, developed collaboratively by patient and clinician (Stanley & Brown, 2008). ... tolerance and emotion

NOVEL APPROACHES

FOR HIGH-RISK

SUICIDAL

VETERANS

MARIANNE GOODMAN, M.D.

K. NIDHI KAPIL-PAIR, PH.D.

SARAH SULLIVAN, M.S., MHC-LP

ANGELA P. SPEARS, B.S.

RACHEL E. HARRIS, M.A.

James J. Peters VA Medical Center, Bronx, NY

Mental Illness Research, Education and Clinical Center

Suicide Prevention and Treatment Research Program

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To address critical gaps in suicide treatment,

our clinical research group has developed

three novel interventions:

1. PLF - Project Life Force

2. SAFER - Safe Actions for Families to

Encourage Recovery

3. Using TELEHEALTH to improve outcomes

in Veterans at risk for suicide.

NOVEL INTERVENTIONS

Page 3: NOVEL APPROACHES FOR HIGH-RISK SUICIDAL VETERANS · It is a prevention tool, developed collaboratively by patient and clinician (Stanley & Brown, 2008). ... tolerance and emotion

Question: Of all living US citizens, what percentage

are Veterans?

?

Map of total US population and distribution

BACKGROUND: Q & A

Page 4: NOVEL APPROACHES FOR HIGH-RISK SUICIDAL VETERANS · It is a prevention tool, developed collaboratively by patient and clinician (Stanley & Brown, 2008). ... tolerance and emotion

Answer: Of all living US citizens, 7.3 percent have

served in the military at some point in their lives

(SAMSHA).

92.7%

7.3%

% Veterans in the United States

Civilians Veterans

Map of total US population and distribution

Q & A

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Question: How many Veterans live in NY state?

?

Map of total US population and distribution

Q & A

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Answer: 806,827 Veterans are currently living in NY

state.

806,827

20,392,192

# OF VETERANS IN NEW YORK STATE

NY VeteransVeterans living in other states

Map of total US population and distribution

Q & A

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Question: How many Veterans kill themselves

every day?

Q & A

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Answer: 20

Q & AOnly 6 of the 20

Veterans who die

by suicide each day

receive services at

the VA

93 Civilians, also die by

suicide each day

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This is in spite of enhanced suicide prevention resources.

Suicide prevention is the #1 clinical priority in the VA.

Veterans account for 18% of

all suicide deaths in US

adults.

THE PROBLEM: VETERAN SUICIDE

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SUICIDE SAFETY PLAN (SSP)

The Suicide Safety Plan (SSP) is a

written, prioritized list of coping

strategies and resources for

reducing suicide risk.

It is a prevention tool, developed

collaboratively by patient and

clinician (Stanley & Brown, 2008).

In 2008, the VA mandated that

clinicians oversee the construction of

an individualized SSP for every

patient who is identified at “high risk”

for suicide.

The patient takes the SSP home for

his/her use at the onset of (or during)

a suicidal crises.

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(Stanley & Brown, 2008)

1. Warning signs

2. Internal coping strategies

3. People and social settings that provide distraction

4. People whom I can ask for help

5. Professionals or agencies I can contact during a crisis

6. Making the environment safe

BREAKDOWN OF SSP

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VA USE OF THE SSP

• There are currently no recommended guidelines or

mechanisms for refinement of the SSP beyond its initial

development.

• There are no recommended guidelines for involving family

members or friends in the implementation of, or use of, the

SSP.

To address these critical gaps, our clinical research group has

developed two novel interventions:

SAFER - Safe Actions for Families to Encourage Recovery

PLF – Project Life Force

Please Note: These interventions are adjunctive to standard

outpatient mental health care at the James J. Peters VA Medical

Center.

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PROJECT LIFE FORCE

PLFKeeping High-Risk Veterans Alive Through a

Group Safety Planning Intervention

Funding : VA SPiRE RR&D

VA MERIT, CSRD

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RCT:

6-month

DBT vs. TAU

in 93 high-risk

suicidal Veterans:

Negative study:

Both groups

improved in all

outcome

measures

ORIGINS OF PLF- DBT NEGATIVE RCT

DIALECTICAL BEHAVIOR THERAPY (DBT) TRIAL IN SUICIDAL VETERANS (GOODMAN ET. AL, 2016)

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PERSONAL ANECDOTE WITH SUICIDAL VETERAN

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Findings notable for:

Wide range of use (none to several times daily)

Importance of clinician collaboration

Barriers/obstacles to use

Problems/obstacles:

Lack of social network

Social withdrawal/depression

Avoidant style of coping

Burden too great to carry out plan alone

Facilitators of use of the plan:

Sharing of plan with significant others

Mobile formats of the plan

Individualized plans

20 Veterans interviewed after SSP construction and 1 month later

QUALITATIVE STUDY OF SUICIDE SAFETY PLAN

(SSP) USE (KAYMAN ET AL., 2015)

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Findings notable for:

Wide range of use (none to several times daily)

Importance of clinician collaboration

Barriers/obstacles to use

Problems/obstacles:

Lack of social network

Social withdrawal/depression

Avoidant style of coping

Burden too great to carry out plan alone

Facilitators of use of the plan:

Sharing of plan with significant others

Mobile formats of the plan

Individualized plans

20 Veterans interviewed after SSP construction and 1 month later

PLF aims to address these concerns

PLF incorporates:

1) Teaching of distress

tolerance and emotion

regulation skills applied to

individual steps of the SSP,

2) Introduces use of a mobile

SSP Application,

3) Helps Veterans identify

individuals they can call for

help, and practice asking for

help,

4) Aims to develop detailed,

personalized and meaningful

SSPs,

5) Delivered in a group

context offering support.

QUALITATIVE STUDY OF SUICIDE SAFETY PLAN

(SSP) USE (KAYMAN ET AL., 2015)

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PROJECT LIFE FORCE

PROJECT LIFE FORCE (PLF) is a manualized, 90-minute

group therapy for 10 sessions, lasting 3 months.

• Combines psychoeducation and emotion regulation skills with suicide

safety planning development and implementation.

Group Psychotherapy

Emotion Regulation Skills

Psychoeducation

Suicide Safety Planning

Technologic integration

THE SOLUTION:

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PLF Session 2:

Emotion

Recognition

SkillsPLF Session 3:

Distress Tolerance

Skills

PLF Session 4-5:

Interpersonal

Communication

Skills with

Family PLF Session 6:

Interpersonal

Communication

Skills with Clinical

TeamPLF Session 1:

Crisis

Prevention

Services

PLF Session 7:

Means Restriction

GROUP SUICIDE SAFETY PLANNING & SKILLS

INTERVENTION

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1) PLF=manualized, weekly 90-minute

group treatment lasting 10 weeks.

2) Each session of PLF corresponds to

a step of the safety plan and teaches

skills to maximize the use of that

particular step of the plan.

3) PLF is augmented with education

pertaining to suicide risk, means

restriction and suicide prevention mobile

applications.

4) A manual with 84 pages of session

handouts has been developed & tested.

5) Designed to meet VA mandated

monitoring and permit immediate

access.

6) Capitalizes on group support & is

cost effective.

Project Life Force Session Outline

Session Focus Skill Covered

1

Introduction, psychoeducation about

suicide, SSP step #5 - crisis

numbers, meet local SPC

Crisis Management Skills

Urge Restriction

2SSP step #1 - Identification

of Warning Signs

Emotion, Thought or Behavior

Recognition skills

3SSP step #2 - Internal

Coping StrategiesDistraction Skills

4SSP step #3 - Identifying

people to help distractMaking Friends Skills

5SSP step #4 - Sharing SSP with

Family

Interpersonal Skills/Practicing

Asking for Help

6SSP step #5 -

Professional Contacts

Skills to Maximize Treatment

Efficacy & Adherence

6SSP step #6 - Making

the Environment Safe

Means Restriction,

Psychoeducation About Methods

7 Improving Access to the SSPUse of Safety Planning Mobile

Apps and Virtual Hope Box

8 Physical Health ManagementDecreasing Vulnerability to

Negative Emotion

9 Building a Meaningful LifeBuilding Meaning and Reasons

for Living

10 Recap/Review

**PLF is one of the only manualized outpatient

group treatments for suicidal individuals.

PLF SKILLS AND SAFETY PLANNING IN A GROUP

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PLF is one of the only manualized outpatient group

treatments for individuals at high risk for suicide.

This is surprising given that groups:

1. Diminish social isolation and increasing social

support/social connectedness, a protective factor against

suicide;

2. It’s cost effectiveness and maximizing staff time;

3. The peer movement among those who have experienced

suicidal crises is strong and growing; and

4. Veterans and military service members are familiar with

working as a unit, with team approach to problems.

PLF = SAFETY PLANNING IN A

GROUP FORMAT

Page 23: NOVEL APPROACHES FOR HIGH-RISK SUICIDAL VETERANS · It is a prevention tool, developed collaboratively by patient and clinician (Stanley & Brown, 2008). ... tolerance and emotion

OPEN LABEL PILOT

Initial effectiveness in

depression, suicidal symptoms,

hopelessness.

Feedback on each session from

patient and PLF therapist.

Test feasibility and tolerability of

intervention on 50 Veterans.

Plus post-intervention

feedback from treating

clinician(s).

Page 24: NOVEL APPROACHES FOR HIGH-RISK SUICIDAL VETERANS · It is a prevention tool, developed collaboratively by patient and clinician (Stanley & Brown, 2008). ... tolerance and emotion

After 10 weeks of PLF, Veterans had:

>40% suicide symptom severity/ideation

>30% depression,

>20% hopelessness

PROJECT LIFE FORCE - OUTCOMES

CSSRS= Columbia Suicide Severity Rating Scale;

BDI= Beck Depression Inventory;

BHS= Beck Hopelessness Scale;

BSS= Beck Suicide Ideation Scale

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Feasibility/Acceptability Pilot

Data (N=45)

• <2.0 total hours/week per

clinician

• Veteran satisfaction 4.7 out

of 5 point likert scale

• 5.0 of 5 rating on

recommending the

treatment to others

• <17% attrition

• 100% of participants

developed updated safety

plans and increased use

patterns.

PROJECT LIFE FORCE - OUTCOMES

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More Effective Use of

Safety Plan

“Going through each step

in depth makes it a living

document, instead of just

filling it out on the fly and

never using it.”

QUALITATIVE FEEDBACK ON PLF

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Hope/Improved Depressive and Suicidal Feelings

“I wake up wanting to live now.”

More Effective Use of

Safety Plan

“Going through each step

in depth makes it a living

document, instead of just

filling it out on the fly and

never using it.”

QUALITATIVE FEEDBACK ON PLF

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Hope/Improved Depressive and Suicidal Feelings

“I wake up wanting to live now.”

Increased Connection &

Sense of Belongingness.

Lessened Loneliness

“To actually connect with my

brothers in this fight was

powerful. It’s another battle

we are facing.”

More Effective Use of

Safety Plan

“Going through each step

in depth makes it a living

document, instead of just

filling it out on the fly and

never using it.”

QUALITATIVE FEEDBACK ON PLF

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Keeping High-Risk Veterans Alive Through a

Group Safety Planning Intervention

Greg Brown, PhD

University of Pennsylvania

Philadelphia VA

Michael Thase MD

University of Pennsylvania

Philadelphia VA

Barbara Stanley, PhD

Columbia University

Psychiatric Institute

Hanga Galfalvy, PhD

Columbia University

Psychiatric Institute

Marianne Goodman, M.D.

Icahn School of Medicine,

Mount Sinai

James J. Peters VAMC

PROJECT LIFE FORCE RCT

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SESSION 9:

IN SESSION ACTIVITY

“Together we want to start to list all the big and little

reasons to keep on living.

We have listed some samples from other people, in

order to jumpstart your own list.

As we read together the following items, try and think

of the aspects of your life that you take for granted.

We want to write them down as reminders of the

beautiful and wonderful things in life.”

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EXAMPLES OF

REASONS FOR LIVING

Watching someone

talk about

something they’re

passionate about.

The first

snowfall of the

season.

Fresh baked

cookies.

Stepping on

crunchy

leaves.

Splashing in

puddles.

Traveling

around the

world

Your future

children, pets,

spouses, or

friends

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HOMEWORK

Add reasons for

living to your safety

plan.

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Special Design Features:

1) Multi-site RCT, n=265 suicidal

Veterans

2) Co-investigators Drs. Brown

and Stanley are creators of the

VA suicide safety plan

3) Rigorous multi-method

assessment of suicidal

behaviors with follow-up out to 1

year.

4) Assessment training and

adherence monitoring performed

by 3rd site.

5) Examining impact on suicide

safety planning quality

6) Explore “group cohesion” as

mediator

Study Assessments, Schedule and Purpose

Domain Measure Description Source

Study

Contac

t

(Month

)

Study

Purpose

Suicidal

Behavior and

Ideation

Columbia Suicide

Severity Rating

Scale–current &

since last visit

version

Interim history of suicide

related behaviors; severity

of ideation; intensity of

ideation subscales

Interview0, 3,

6,12

Primary

Outcome;

Suicidal

Ideation and

Behavior

Suicidal behavior,

Suicidal intention

Identification of suicidal

ideation and behavior in

medical record

Chart

abstraction12

Primary

Outcome

Suicide Death by suicide Death by suicide

Death

Certificates

NVDRS

12Primary

Outcome

DepressionBeck Depression

ScaleDepression

Self-

Report

0, 3,

6,12

Secondary

Outcome

HopelessnessBeck

Hopelessness

Scale

Hopelessness

Positive and Negative

Beliefs about the future

Self-

Report

0, 3,

6,12

Secondary

Outcome

Mental Health

Services

Self-report log

based on the

Modified Cornell

Services Index

MCSI

Use of mental health

services, SOC contacts

determined from medical

record

Log

maintained

by subject

& research

staff

3, 6,12

Secondary

Outcome

Safety PlanBrief Survey of

Safety Plan

Utilization

Subject self-report of using

the safety plan prior to

baseline assessment or

during follow-up and which

components were used

Self-report0, 3,

6,12

Secondary

Outcome

Suicide-

Related

Coping

Suicide-Related

Coping Measure

Report of coping behaviors

identified on the SPI and

confidence in managing

suicidal feelings.

Self-report0, 3,

6,12

Secondary

Outcome

Group

Cohesion

Group

Psychotherapy

Process Measure

Group Process Outcomes Self-report1,5,10

(weeks)Mediator

Demographic

and Medical

History

Information

Demographic

Information and

History of

Psychiatric,

Substance Use,

Medical

Information

MSRC Common Data

ElementsInterview 0,3 Descriptive

DiagnosisMini-International

Psychiatric

Interview

Axis I diagnosis Interview 0 Descriptive

Methodology

Merit

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SAFE ACTIONS FOR FAMILIES

TO ENCOURAGE RECOVERY

SAFER RCTFUNDING: VA MERIT, RR&D

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RATIONALE FOR FAMILY INVOLVEMENT

Psychological models of suicidality

emphasize the role of social factors in the

development and intensification of suicidal

thoughts and behavior:

• feeling like a burden on family and friends,

• feelings of isolation and not belonging,

• “unloveability” and

• perceptions of diminished support from

one’s family and social network

(Brenner et al, 2008; Farrell et al, 2015; Johnson et al, 2008; Joiner et

al, 2015, Owen et al, 2015; Ellis et al., 2015)

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RATIONALE FOR FAMILY INVOLVEMENT

2015 VA Behavioral Health Autopsy Program

(BHAP) Report based on interviews with 114

family members recommended:

1) educating families about suicide warning signs;

2) improving communication between the veteran and

family member;

3) involving the family in the veterans’ treatment to

enhance support and trust;

4) providing families with coaching on how to assist their

loved one to seek help.

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RATIONALE FOR FAMILY INVOLVEMENT

Treatments targeting Family Members

Currently, the only family based group treatment available is

called Family Connections (FCs; Hoffman et al., 2005, Hoffman,

Fruzzetti, & Buteau, 2007).

Depression

Patients of family members also show improvement and feel more

validated after FC.

Burden

Grief

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QUALITATIVE INTERVIEWS:

RATIONALE FOR FAMILY INVOLVEMENT

Our Pilot Qualitative Study:

Family Themes

1) Fear of triggering urges, “I never know how he’ll react”

2) Feeling unsupported, “There’s no real support” and

3) Feeling overwhelmed, ”I didn’t know what to do”

Veterans felt alone and afraid to reach out to family members.

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PROTOCOL SUMMARY

SAFER is a novel, 4-

session manualized

intervention.

Through the use of psychoeducation,

disclosure and development/revision of

both the Veteran and a complementary

family member safety plan, SAFER

provides the tools and structure to support

family involvement in suicide safety

planning for Veterans at moderate risk for

suicide.

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(Stanley & Brown, 2008)

WHERE SAFER FITS IN…

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SAFER INTERVENTION

SAFER is a novel, manualized, weekly, 90-minute, individual

joining + 3-session family-based treatment.

Session

#Focus Homework

Individual

Joining

• Introductions, assess Veteran and family

interaction around suicide, review individual

concerns, motivation.

• Clarify intervention goals, ensure commitment.

1

• Review of barriers to Safety Planning and family

involvement.

• Review Veteran Safety Plan.

Veterans and family

members construct a list of

“reasons for living.”

2

• Construction of family member’s safety plan.

Practice using communication skills to facilitate

use of Veteran and family member plans.

• Review Reasons for Living homework.

Try to implement safety

plan in your life.

Booster • Review of Safety Plan use for dyad.

• Address implementation problems.

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ELIGIBILITY - VETERAN

Inclusion Criteria:

1. Moderate risk for suicide, defined as:

• evidence of current (within the past week) suicidal ideation, plan or intent on the

Columbia Suicide Severity Rating Scale (C-SSRS),

• Scoring < 4 on the C-SSRS Behavior Scale, and without history of suicide

attempt in the last three months.

2. Inclusion criteria also include the availability of a consenting, qualifying family member

or partner.

Exclusion criteria:

1. Alcohol or drug abuse or dependence.

2. For romantic couples, “severe” intimate-partner violence as defined by the revised 20-

item Conflict Tactics Scale Short Form (CTS2S) (Straus & Douglas, 2004);

3. Limited English proficiency.

ELIGIBILITY- VETERAN

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Inclusion Criteria:

Family members/friends must meet at least three (two for nonrelatives) of five criteria

established by (Pollak & Perlick, 1991):

1. Spouse, co-habiting significant other or parent;

2. More frequent contact than any other caregiver

3. Helps to support the Veteran

4. Contacted by treatment staff for emergencies;

5. Involvement in the patient’s treatment.

Exclusion criteria:

1. Alcohol or drug abuse or dependence

2. For romantic couples, “severe” intimate-partner violence as defined by the revised 20-item

Conflict Tactics Scale Short Form (CTS2S) (Straus & Douglas, 2004);

3. Limited English proficiency.

ELIGIBILITY- CAREGIVER

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PARTICIPANTS

0

5

10

15

20

25

30

35

40

Consented Baselines Randomized Post Post-3

Veterans Caregivers

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PARTICIPANTS

Veteran Race

White

Black

Native American

Other/Unknown

Multi-Racial

Native Hawaiian

Veteran Age Range: 35-84

Veteran Gender: 3 Females, 30 Males

Veteran Hispanic: 13/33

Caregiver Age Range: 24-66

Caregiver Gender: 11 Females, 9 Males

Caregiver Hispanic: 8/20

Caregiver Race

White

Black

Other/Unknown

Multi-Racial

Native Hawaiian

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QUALITATIVE FEEDBACK

“Having

someone to

reach out with

such as Dr. XX.”

“We need more

doctors, like Dr. XX,

that listen instead of

constantly

speaking.”

“SAFER helped me

keep my SSP

constantly in my head

and helped me go to

my safety zones.”

“Knowing that

we are not

alone.”

“To have a

plan that is

useful.”“I liked best finding

different ways to

help my husband.”

“Reaching out to

others that are going

through what my

husband is going

through is helpful.”

VETERANS

CAREGIVERS

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Caregivers are VERY burdened and the SAFER intervention

may be further burdening them.

• Length of SAFER intervention?

Veterans often do not have many people in their live.

Veterans who do have people in their lives often do not

want to participate.

• Is there a way to better engage caregivers?

Veterans are reluctant to ask for help, and hesitant to admit

vulnerability to family.

INTERIM LESSONS LEARNED

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Using TELEHEALTH to

Improve Outcomes In

Veterans at Risk for

Suicide

Gretchen Haas, Ph.D.

VA Pittsburgh Health Care System

Marianne Goodman, M.D.

James J. Peters VA Medical

Center, Bronx, NY

Adam Wolkin, M.D.

VA New York Harbor Health Care System

Funded by: Linked Standard Research Grant

American Foundation for Suicide Prevention (AFSP)

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TECHNOLOGY AND SUICIDE PREVENTION

Telehealth technology has become more interactive,

less money and, more available to healthcare

providers as a means of treating chronic medical

diseases.• Approximately 50% of >3.4 billion smartphone/tablet

users have downloaded mHealth apps as of 2018.

• Surveys from psychiatric out-patients reported that 69%

of people, and 80% of those ages <45, have a desire to

use mobile apps to track mental health.

• However, there is a lack of comprehensive evidence-

base for mobile apps.

• There is a complete lack of outcome data on the

efficacy of mHealth interventions for suicidal

behavior.

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TECHNOLOGY AND SUICIDE PREVENTION

Crisis Text Line

Caring contacts via text message/emails

Automatic detection of suicidality from social media content (FB & Twitter)

Mobile Applications

Daily interactive monitoring systems

Examples:

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PILOT DATA

Three separate randomized pilot trials (n = 117 Veterans) were conducted.

Diagnoses of Veterans included Major Depressive Disorder or Schizophrenia/Schizoaffective Disorders.

No completed suicides and only 1 suicide attempt.

Demonstrated that the Telehealth intervention leads to decreased suicidal ideation within three months.

Preliminary data from these veteran cohorts demonstrated high acceptability rates.

Initial device used in pilot

studies

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INTERACTIVE VOICE RESPONSE SYSTEM (IVR)

Length of callsis 5-8

minutes

Daily Calls

Responses automatically

upload to online portal

Nurses monitor

responses every 4 hours

Voice & keypad

responses

2 scripts for participants:

Depression & Schizoprehnia

Have you been

acting in a way

that disregards

your safety?

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TELEHEALTH IVR SYSTEM

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TELEHEALTH IVR SYSTEM

Five Suicide Questions:

1. Have you been acting in a way that disregards your safety?

2. Have you felt today that life is not worth living?

3. Have you thought today that you would be better off dead?

4. Have you had thoughts today of wanting to harm yourself even if

you have not intended to do it?

5. Do you have any intent to take your own life today or have you

been thinking about a plan to do it?

Nursing staff contacts site PI: Dr. Goodman

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TELEHEALTH STUDY GOALS

Test the effectiveness of telehealth

interventions on suicidal ideation

and suicidal behaviors

(exploratory).

Test if the telehealth system

decrease risk factors and increase

protective factors.

Sustain connections with

healthcare providers during the

three months following

hospital discharge.

Allows for a longitudinal view

of suicidal risk information.

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TELEHEALTH PROTOCOL SUMMARY

Daily telehealth monitoring

includes questions for participants

about suicide, depressive

symptoms and medication

adherence.

Participants will be randomized into

either: Interactive Voice Response

System (IVR) or Treatment As Usual

(TAU).

3 month intervention will have

clinical assessments at 2, 4, 8,

and 12 weeks post-discharge.

Recruitment:

In-patient unit

40 participants per site.

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POTENTIAL BENEFITS

• The daily check-in provides: • participants with hope & a sense of being

listened to

• reminders to focus on their mental health, which

may improve medication adherence

• consistency & a sense that one is

not alone

• a friendly voice

• a way to catch symptoms before they are too

severe

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POTENTIAL OBSTACLES

• Participants don’t answer their

phone, don’t have minutes on their

phone or charge their phone

• Participants don’t like the IVR voice or

scripts and inability to engage in

conversation

• Participants turn off their phone

when depressed

• IVR System feels too mechanical,

too repetitive and inflexible

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Sarah R. Sullivan, M.S., MHC-LPClinical Research Coordinator

718-584-9000 x5149

[email protected]

Marianne Goodman, M.D.

James J. Peters Veterans Affairs Medical Center

Associate Director, VISN 2 Mental Illness, Research, Education, Clinical

Center (MIRECC)

Director, Suicide Prevention and Treatment Research Program

Clinical Professor Psychiatry, Icahn School of Medicine

Past President, North American Society for the Study of Personality

Disorders (NASSPD)

718-584-9000 x5188

[email protected]

K. Nidhi Kapil-Pair, Ph.D.

Clinical Psychologist, Postdoctoral Fellow

718-584-9000 x5231

[email protected]

Angela P. Spears, BS

Clinical Research Assistant

718-584-9000 x3021

[email protected]

Rachel E. Harris, MA

Clinical Research Coordinator

718-584-9000 x3718

[email protected]

Presenter Contact

Information

THANK YOU!!