Maintaining Implementation Through Dynamic Adaptations (MIDAS) - Suicide Prevention 2.0 Clinical Telehealth (SP 2.0) (QUE 20-025)
Phase: NA
Conditions: Suicidal Self-directed Violence, Suicidal Preparatory Behavior
Sponsor: VA Office of Research and Development

 
MIDAS Quality Enhancement Research Initiative 
Center for Clinical Management Research 
2215 Fuller Rd (152) 
Ann Arbor, MI 48109 
(734) 845-3502 
 
 
 
 
 
Official Title of Project: Maintaining Implementation Through Dynamic Adaptations (MIDAS) - Suicide 
Prevention 2.0 Clinical Telehealth (SP 2.0) 
ClinicalTrials.gov ID: NCT06011759 
Date: 10/24/2025  
 
Background 
The suicide rate for Veterans is significantly greater than among non-Veteran U.S. adults.1 According to the VA 
Office of Suicide Prevention’s 2024 National Veteran Suicide Prevention Annual Report, there were 6,407 
Veteran suicide deaths in 2022 and suicide is the second leading cause of death for Veterans under 45 years 
old. To improve access to effective suicide prevention treatments, the Veterans Health Administration (VHA) 
recently initiated the Suicide Prevention 2.0 Clinical Telehealth (SP 2.0) program; a regional hub model for 
virtually delivering evidence-based suicide-specific psychotherapies. Referrals to SP 2.0 vary widely across 
VHA facilities. This study’s aim was to identify barriers and facilitators for program referrals to inform program 
and facility leaders and the deployment of implementation strategies. 
SP 2.0 Clinical Telehealth operates Clinical Resource Hubs at the VISN level and uses evidence-based 
interventions for suicide prevention, such as Safety Planning Intervention, Cognitive Behavioral Therapy for 
Suicide Prevention, Problem Solving Therapy for Suicide Prevention, and Dialectical Behavior Therapy.  
1. Morral et al., 2023, https://doi.org/10.1001/jamanetworkopen.2023.24191 
This project will include test two implementation strategies: (1) academic detailing (AD) and (2) Learn. Engage. 
Act. Process. (LEAP) team-based quality improvement (QI). The first strategy, AD, is designed to provide 
individual providers with the knowledge and motivation to use the EBPs. The second implementation strategy, 
LEAP, is a team-based strategy that engages frontline providers and staff in incremental cycles of 
improvement in the use of the EBP with the support of a coach. The LEAP program provides coaching within a 
structured, paced curriculum over a 6-month period, during which teams complete one improvement project 
following a Plan-Do-Study-Act (PDSA) cycle of change.2 
2. Damschroder et al., 2022, https://doi.org/10.1186/s43058-022-00297-z  
 
Aims 
This study will evaluate the following aims: 
1. Compare the effectiveness of two implementation strategies, LEAP Quality Improvement Learning 
Program and Academic Detailing (AD), on the following outcomes: 
a. SP2Clin Metric (primary outcome) – The quarterly SP2Clin metric data is reported and available 
on a VA national dashboard. The SP2Clin metric is calculated by the number of suicide 
prevention telehealth consults submitted among those with a suicide behavior event. 

2 
 
b. Referral to SP 2.0 Clinic (secondary outcome) – Change in number of referrals to the Suicide 
Prevention 2.0 Clinical Telehealth (SP 2.0) initiative 
2. We will also examine other pre-specified outcomes related to the implementation strategies: 
a. Change in quality improvement skills application – a 16-item measure of change in quality 
improvement skills application. Values 1 to 4 where higher values indicate more frequent use of 
quality improvement skills. 
b. Provider satisfaction with academic detailing – 7 items measuring satisfaction with Academic 
Detailing. Each response option uses a Likert-type scale with values 1 to 5 where higher values 
indicate higher satisfaction. 
c. Provider satisfaction with LEAP – 6-item measure of satisfaction with LEAP. Values 1 to 5 where 
higher values indicate higher satisfaction 
 
Methods 
Interested sites will be provided a site orientation meeting that outlines details around study participation and 
the QI strategies being offered. In prior trials, we found that random assignment into QI strategies (LEAP 
and/or AD) was a barrier to participation due to time constraints and limited staff bandwidth. For this study, we 
will allow sites to elect which QI strategies they would like to participate in based on their individual site 
characteristics, including site-specific barriers and facilitators. We will also engage both front-line workers and 
leadership during site recruitment to ensure leadership supports front-line workers’ participation in the project.  
 
Outcomes and Analysis 
To examine the effect of engagement in quality improvement activity on referral to the SP 2.0 program, we will 
compare participating sites with similar non-participating sites. Non-participating sites will be selected as 
matched controls, one for each participating site. Control sites will be matched 1:1 to participating sites on 
number of suicide behavior events and prevalence of Suicide Prevention Telehealth Program consults 
submitted at baseline. T-tests will be conducted to compare participating and control sites on the primary and 
secondary outcomes. For the other pre-specified outcomes, descriptive statistics will be generated.  
 
 
List of Abbreviations 
Academic detailing (AD) 
Learn. Engage. Act. Process. (LEAP) 
Maintaining Implementation through Dynamic Adaptations (MIDAS) 
Plan-Do-Study-Act (PDSA) 
Quality improvement (QI) 
Suicide Prevention 2.0 Clinical Telehealth (SP 2.0)