Abstract：
The USA is undergoing a suicide epidemic for its youngest Veterans (18-to-34-years-old) as their suicide rate has almost doubled since 2001. Veterans are at the highest risk during their first-year post-discharge, thus creating a \"deadly gap.\" In response, the nation has developed strategies that emphasize a preventive, universal, and public health approach and embrace the value of community interventions. The three-step theory of suicide suggests that community interventions that reduce reintegration difficulties and promote connectedness for Veterans as they transition to civilian life have the greatest likelihood of reducing suicide. Recent research shows that the effectiveness of community interventions can be enhanced when augmented by volunteer and certified sponsors (1-on-1) who actively engage with Veterans, as part of the Veteran Sponsorship Initiative (VSI).
The purpose of this randomized hybrid type 2 effectiveness-implementation trial is to evaluate the implementation of the VSI in six cities in Texas in collaboration with the US Departments of Defense, Labor and Veterans Affairs, Texas government, and local stakeholders. Texas is an optimal location for this large-scale implementation as it has the second largest population of these young Veterans and is home to the largest US military installation, Fort Hood. The first aim is to determine the effectiveness of the VSI, as evidenced by measures of reintegration difficulties, health/psychological distress, VA healthcare utilization, connectedness, and suicidal risk. The second aim is to determine the feasibility and potential utility of a stakeholder-engaged plan for implementing the VSI in Texas with the intent of future expansion in more states. The evaluators will use a stepped wedge design with a sequential roll-out to participating cities over time. Participants (n=630) will be enrolled on military installations six months prior to discharge. Implementation efforts will draw upon a bundled implementation strategy that includes strategies such as ongoing training, implementation facilitation, and audit and feedback. Formative and summative evaluations will be guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and will include interviews with participants and periodic reflections with key stakeholders to longitudinally identify barriers and facilitators to implementation.
This evaluation will have important implications for the national implementation of community interventions that address the epidemic of Veteran suicide. Aligned with the Evidence Act, it is the first large-scale implementation of an evidence-based practice that conducts a thorough assessment of TSMVs during the \"deadly gap.\"
ClinicalTrials.gov ID number: NCT05224440 . Registered on 04 February 2022.
The purpose of this randomized hybrid type 2 effectiveness-implementation trial is to evaluate the implementation of the VSI in six cities in Texas in collaboration with the US Departments of Defense, Labor and Veterans Affairs, Texas government, and local stakeholders. Texas is an optimal location for this large-scale implementation as it has the second largest population of these young Veterans and is home to the largest US military installation, Fort Hood. The first aim is to determine the effectiveness of the VSI, as evidenced by measures of reintegration difficulties, health/psychological distress, VA healthcare utilization, connectedness, and suicidal risk. The second aim is to determine the feasibility and potential utility of a stakeholder-engaged plan for implementing the VSI in Texas with the intent of future expansion in more states. The evaluators will use a stepped wedge design with a sequential roll-out to participating cities over time. Participants (n=630) will be enrolled on military installations six months prior to discharge. Implementation efforts will draw upon a bundled implementation strategy that includes strategies such as ongoing training, implementation facilitation, and audit and feedback. Formative and summative evaluations will be guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and will include interviews with participants and periodic reflections with key stakeholders to longitudinally identify barriers and facilitators to implementation.
This evaluation will have important implications for the national implementation of community interventions that address the epidemic of Veteran suicide. Aligned with the Evidence Act, it is the first large-scale implementation of an evidence-based practice that conducts a thorough assessment of TSMVs during the \"deadly gap.\"
ClinicalTrials.gov ID number: NCT05224440 . Registered on 04 February 2022.
摘要：
美国正在经历其最年轻的退伍军人（18至34岁）的自杀流行，因为他们的自杀率自2001年以来几乎翻了一番。退伍军人在出院后第一年的风险最高，从而造成了“致命的差距”。\"作为回应,国家制定了强调预防性的战略，普遍,和公共卫生方法，并接受社区干预的价值。自杀的三步理论表明，减少重返社会困难并促进退伍军人过渡到平民生活的社区干预措施最有可能减少自杀。最近的研究表明，当志愿者和认证赞助商（一对一）积极参与退伍军人时，社区干预的有效性可以得到增强，作为退伍军人赞助倡议（VSI）的一部分。
这项随机混合2型有效性实施试验的目的是与美国国防部合作，评估VSI在德克萨斯州六个城市的实施情况。劳工和退伍军人事务，德州政府,和当地利益相关者。德克萨斯州是大规模实施的最佳地点，因为它拥有这些年轻退伍军人的第二大人口，并且是美国最大的军事设施的所在地。胡德堡.第一个目标是确定VSI的有效性，重返社会困难的措施证明了这一点，健康/心理困扰，VA医疗保健利用，连通性，和自杀风险。第二个目标是确定在德克萨斯州实施VSI的利益相关者参与计划的可行性和潜在效用，以期在更多州进行未来扩展。评估人员将使用阶梯式楔形设计，并随着时间的推移依次向参与城市推出。参加者（n=630）将在出院前六个月在军事设施中注册。实施工作将利用捆绑的实施战略，其中包括持续培训、实施便利化，审计和反馈。形成性评价和总结性评价将由接触指导，有效性,收养,实施,和维护（RE-AIM）框架，并将包括与参与者的访谈和与主要利益相关者的定期思考，以纵向确定实施的障碍和促进者。
这项评估将对国家实施社区干预措施以应对退伍军人自杀的流行具有重要意义。与《证据法》保持一致，这是首次大规模实施循证实践，在“致命缺口”期间对TSMV进行彻底评估。\"
ClinicalTrials.govID号：NCT05224440。2022年2月4日注册。
这项随机混合2型有效性实施试验的目的是与美国国防部合作，评估VSI在德克萨斯州六个城市的实施情况。劳工和退伍军人事务，德州政府,和当地利益相关者。德克萨斯州是大规模实施的最佳地点，因为它拥有这些年轻退伍军人的第二大人口，并且是美国最大的军事设施的所在地。胡德堡.第一个目标是确定VSI的有效性，重返社会困难的措施证明了这一点，健康/心理困扰，VA医疗保健利用，连通性，和自杀风险。第二个目标是确定在德克萨斯州实施VSI的利益相关者参与计划的可行性和潜在效用，以期在更多州进行未来扩展。评估人员将使用阶梯式楔形设计，并随着时间的推移依次向参与城市推出。参加者（n=630）将在出院前六个月在军事设施中注册。实施工作将利用捆绑的实施战略，其中包括持续培训、实施便利化，审计和反馈。形成性评价和总结性评价将由接触指导，有效性,收养,实施,和维护（RE-AIM）框架，并将包括与参与者的访谈和与主要利益相关者的定期思考，以纵向确定实施的障碍和促进者。
这项评估将对国家实施社区干预措施以应对退伍军人自杀的流行具有重要意义。与《证据法》保持一致，这是首次大规模实施循证实践，在“致命缺口”期间对TSMV进行彻底评估。\"
ClinicalTrials.govID号：NCT05224440。2022年2月4日注册。
