Patient and Provider Outcomes of E-Learning Training in Collaborative Assessment and Management of Suicidality

Suicide prevention among military Veterans has become a national priority; yet, there is a gap in suicide-specific intervention training for mental health students and professionals. The need for training in this area has become even more acute with the recent hiring by the Veterans Health Affairs (VHA) of thousands of clinicians to address the mental health needs of Veterans from all war eras. Since e-learning (online) education is more effective than traditional in-person (face-to-face) education for adult learners when methods, such as blended learning, are used, this mode of delivery may more easily meet the training and continuing education needs of busy medical professionals who may find it easier to fit online education into their daily schedules.

A well developed in-person training approach known as the Collaborative Assessment and Management of Suicidality (or CAMS) has been recommended in systematic reviews as an effective tool for assessing and managing suicidality, as well as decreasing providers' fears, improving their attitudes, increasing their knowledge, confidence, and competence, and dispelling myths. The overall aims of this project were to develop an e-learning alternative for the CAMS program, determine its effectiveness relative to in-person CAMS training, and assess factors that may relate to adoption and implementation of CAMS in general and specifically through e-learning and in-person modalities.

There were four specific aims:

1. Refine a Collaborative Assessment and Management of Suicidality (or CAMS) e-learning course that covers the same material and meets the same learning objectives of CAMS in-person training.
2. Test the effectiveness of the CAMS e-learning modality compared to the CAMS in-person modality and a concurrent non-intervention control in terms of provider evaluation and behavior.

   HO: Providers in each of the two CAMS arms will demonstrate higher levels of content mastery and confidence in acquired skills than providers in the no CAMS arm.

   H2: In the 12 months post-training, suicidal patients of providers in each of the two CAMS arms will receive higher rates of CAMS guideline concordant treatment, compared with providers in the no CAMS arm.
3. Test the effectiveness of the CAMS e-Learning delivery compared to the CAMS in-person delivery and a concurrent non-intervention control in terms of patient outcomes.

   H3, 4, 5: In the 12 months post-training, suicidal patients of CAMS e-learning providers and CAMS in-person providers will be similar for health services use patterns, duration of high risk episodes, and number of high risk episodes per patient.

   H6: In the 12 months post training, suicidal patients of providers in the no CAMS arm will have higher rates of emergency room use and inpatient mental health admissions, have a longer average duration of high risk episodes, and have more high risk episodes per patient.
4. Assess factors that facilitate or inhibit adoption of CAMS through e-Learning or In-person.

Of the 309 providers who met eligibility criteria, 230 consented and 212 completed the baseline assessments and were randomized. A total of 261 patients met eligibility criteria and information was abstracted on them.

We developed the CAMS-e, conducted a pilot, revised the e-CAMS, delivered the training in the first site, and again revised it. There is little difference in satisfaction ratings between the two types of training deliveries on the VA Evaluation of Training. Findings show that there were some modest immediate improvements due to the two training conditions; however, the effects were only sustainable at three months for one question related to hospitalization beliefs.

To date, the project has had the following impacts:

1. success in obtaining 6.5 continuing education units (CEUs) for the e-learning version
2. invitations to place e-CAMS on the Department of Defense learning platforms
3. VA Central Office has purchased a license to use the Suicide Status Form (SSF) as a clinical tool and template in the computerized electronic patient record system throughout the national VA. The template is in the developmental process.
4. Efforts are underway to move the CAMS e-learning on to the VA Training Management System (TMS) which will facilitate system wide dissemination and has the potential to increase adoption in VAMC's or by providers.

Additional impacts may be evident with regard to improved care once we complete analysis of the patient outcomes and provider adherence data. We have also considered a short manuscript on economic analysis

Eligibility Criteria:
Inclusion Criteria:

* Mental health providers, psychiatrist, social workers, psychologist, advanced practice nurses and case managers

Exclusion Criteria:

* Previous CAMS Training