# Examining the Effectiveness of an Adaptive Implementation Intervention to Improve Uptake of the VA Suicide Risk Identification Strategy

> **NIH VA I50** · VA EASTERN COLORADO HEALTH CARE SYSTEM · 2021 · —

## Abstract

Reducing Veteran suicide has been one of the Department of Veterans Affairs’ (VA) top priorities for the past
decade. Efforts to address Veteran suicide have typically included downstream approaches focused on suicide
risk management for those who have previously been identified to be at elevated risk. The Joint Commission,
however, released a Sentinel Event Alert1 highlighting findings that a substantial number of those who died by
suicide had not presented to mental health clinics or psychiatric units. Research suggests that many
individuals, including Veterans who die by suicide had been seen by their primary care provider or in other
medical settings within the year of their death2-4. Based on this, the Office of Mental Health and Suicide
Prevention (OMHSP) tasked an interdisciplinary workgroup to develop an evidence-based, population-level
approach to identifying suicide risk in Veterans who present in a wide range of healthcare settings. From this
work, the largest implementation of a system-wide suicide risk screening and evaluation initiative within a U.S.
healthcare system was developed - the VA Suicide Risk Identification Strategy (VA Risk ID). VA Risk ID is
comprised of three stages: The first stage utilizes the Patient Health Questionnaire-95, item 9 as a primary
screen to maximize sensitivity; the second stage uses the Columbia Suicide Severity Rating Scale Screener6 as a
secondary screen to maximize specificity, and the third stage uses the VA Comprehensive Suicide Risk
Evaluation (CSRE) to gather information related to clinical impressions of acute and chronic suicide risk,
which are used to develop a risk mitigation plan.
 The goal of the proposed project is to employ a Sequential Multiple Assignment Randomized Trial
(SMART) design to improve the implementation of VA Risk ID’s three-stage screening and evaluation process
to fidelity (in correct sequence, by the appropriate provider, and within the designated time frame) for
Veterans receiving annual screenings for depression and PTSD. Within the SMART, two evidence-based
implementation interventions will be compared to Implementation as Usual (IAU): Audit and Feedback (A/F)
and Audit and Feedback plus External Facilitation (A/F+EF). IAU is available to all sites and includes proactive
technical assistance, tools, training and a quality assurance dashboard. A/F will provide sites with frequent,
non-punitive reports that include information on: individual site performance and comparisons with national
average (based on VA Risk ID clinical performance measures), specific areas of improvement and suggested
actions. A/F+EF groups will receive A/F reports and external facilitation, which includes strategies such as,
stakeholder engagement, identification of barriers and facilitators and problem-solving. This project will occur
over three phases: run-in phase, intervention phase I and intervention phase II. The unit of intervention is the
site and randomization will occur at the site lev...

## Key facts

- **NIH application ID:** 10181065
- **Project number:** 5I50HX003008-02
- **Recipient organization:** VA EASTERN COLORADO HEALTH CARE SYSTEM
- **Principal Investigator:** NAZANIN Hadaeghi BAHRAINI
- **Activity code:** I50 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-10-01 → 2022-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10181065

## Citation

> US National Institutes of Health, RePORTER application 10181065, Examining the Effectiveness of an Adaptive Implementation Intervention to Improve Uptake of the VA Suicide Risk Identification Strategy (5I50HX003008-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10181065. Licensed CC0.

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