Crisis Line Facilitation
Condition: Suicide; Suicide, Attempted; Hospitals, Psychiatric
MeSH terms: Suicide; Suicide, Attempted
Study type: Interventional

Summary: 
      This study is a randomized controlled trial (n = 301) of a new single-session intervention,
      called Crisis Line Facilitation (CLF), compared to an enhanced usual care condition on
      utilization of the Veterans Crisis Line and other mental health services as well as suicide
      attempt(s). All participants were recruited during an inpatient psychiatric stay for the
      treatment of a recent suicidal crisis and will be re-assessed at 3-, 6- and 12-months post
      baseline. If successful, the proposed study will provide key data on the potential efficacy
      of a brief tool to improve the utilization of an existing resource, the Veterans Crisis Line,
      to reduce suicidal behaviors in VHA patients.
    

Detailed description: 
      Veterans Health Administration (VHA) patients are at a significantly elevated risk for fatal
      and non-fatal suicide attempts and identifying strategies to reduce the risk of suicidal
      behavior among members of the military and Veterans is a high national priority. The VHA has
      invested extensively in suicide prevention and, as part of these efforts; the Veterans Crisis
      Line was developed as an important resource for Veterans and their families. Utilization of
      the Veterans Crisis Line has expanded steadily since it first opened and, currently, it
      receives over 20,000 calls per month. Despite high utilization of the Crisis Line, no data
      are currently available on whether use of the Veterans Crisis Line reduces an individual's
      likelihood of a suicide attempt or death and it is not feasible to test the efficacy of the
      Crisis Line in a randomized controlled trial because it is nationally available to all
      Veterans and their families. More importantly, the Veterans Crisis Line may not reach those
      individuals at most acute risk for suicide. The investigators' study team conducted a small
      survey of Veterans treated for recent suicidal crisis in a VHA inpatient psychiatric unit and
      found that less than half had ever utilized the Veterans Crisis Line and less than a third
      had used it within the past year. Consequently, the investigators have developed and gathered
      pilot data on a brief intervention designed to increase utilization of the Veterans Crisis
      Line among high risk patients, called Crisis Line Facilitation (CLF). This single-session
      intervention involves a discussion of the patient's perceived barriers of crisis line use
      during periods of suicidal crisis. The CLF session ends with the patient calling the Crisis
      Line with the therapist in the room as a way for Veterans to practice the logistics of making
      the call and to have direct experiences that may counter any negative beliefs about Veterans
      Crisis Line use. This study recruited 301 participants who were treated for a suicidal crisis
      in VHA inpatient psychiatric but had not recently used the Veterans Crisis Line. This study
      is a randomized controlled trial of the impact of CLF compared to enhanced usual care (EUC)
      on utilization of the Veterans Crisis Line and other mental health services as well as
      suicide attempt(s). All participants will be re-assessed at 3-, 6- and 12-months post
      baseline. Analyses will also examine the extent to which post-baseline Crisis Line use
      mediates the effect of random assignment to CLF on subsequent suicidal behaviors. Qualitative
      interviews at the end of the study will help understand barriers and facilitators of future
      implementation of the CLF intervention. If successful, the proposed study will provide key
      data on the potential efficacy of a brief intervention to improve the utilization of an
      existing resource, the Veterans Crisis Line, to reduce suicidal behaviors in VHA patients.
      Developing a brief and effective approach to encourage use of the Crisis Line has the
      potential to have a significant and substantial impact on suicide rates within the VHA and
      could be modified and exported to other populations and settings.
    

Intervention name(s): Crisis Line Facilitation (CLF); Enhanced Usual Care (EUC)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): This single session therapist-delivered intervention addresses Veterans' perceived barriers and facilitators of crisis line use during periods of suicidal crisis. The CLF session culminates with the Veteran calling the Crisis Line with the therapist in the room as a way for the Veteran to practice the logistics of making the call and to have direct experiences that may counter any negative beliefs about Crisis Line use.; Those in the EUC condition received the same promotional items and information about the Veterans Crisis Line (VCL) as the CLF condition. Participants were encouraged to seek help via a provider or the VCL if they felt suicidal in the future. Research staff briefly explained key information about the VCL to those in the EUC condition (e.g., the links between the VCL and the VA, the 24/7/365 availability, etc.).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: Self-Injurious Behavior; suicide prevention