Abstract

Summary/Abstract Background: Veterans Health Administration (VHA) created a Veterans Crisis Line (VCL) as a 24-hour point of contact for Veterans who are at high-risk for suicide. There is a paucity of research on the potential impact of VCL interventions and a need to examine the use of emergency dispatches (i.e., 911) because of their life- saving potential and possible negative consequences. Significance/Impact: The study examines the potential impact of VCL initiated emergency dispatches on critical outcomes among VCL callers who are at high risk for suicide. It responds to the President’s Roadmap to Empower Veterans and End a National Tragedy of Suicide (PREVENTS) and the HSR&D (HX-19-004) Targeted Solicitation for Health Services Research on Veteran Suicide Prevention. Innovation: The study will involve the first analyses to link VHA databases to examine the associations of emergency dispatches with critical outcomes and obtain Veterans’ and responders’ experiences with emergency dispatches. Specific Aims: Aim 1: Determine the association of an emergency dispatch with suicide deaths. Objectives are to 1a) identify key correlates of receiving an emergency dispatch, 1b) determine the association of emergency dispatch with treatment engagement within 30-days, and 1c) risk for suicide death over 365 days. We expect an emergency dispatch to be associated with higher treatment engagement (H1) and lower risk for suicide deaths (H2). Aim 2: Determine the association of agreeing to receive an emergency dispatch with combined suicide deaths and attempts. Objectives are to 2a) identify key correlates of agreeing to the dispatch, 2b) determine the association of agreement with treatment engagement within 30 days, and 2c) risk for combined suicide deaths and attempts over 365 days. We expect caller agreement with an emergency dispatch to be associated with higher treatment engagement (H3) and lower risk for combined suicide deaths and attempts (H4). Aim 3: Explore the experiences of Veteran VCL callers who receive and responders who initiate emergency dispatches. Objectives are to 3a) gather data on Veterans’ experiences with the call, emergency dispatch, and subsequent care, 3b) gather data on responder experiences initiating emergency dispatches, and 3c) identify potential improvements in emergency dispatch policy and measurement. Methodology: Quantitative analyses will examine key correlates of emergency dispatches and agreement, and their prospective associations with treatment engagement and suicide outcomes. Qualitative interviews with Veteran callers and VCL responders will be used to understand their experiences with emergency dispatches, evaluate the ecological validity of quantitative findings and inform policy and research. Implementation/Next Steps: Findings will be presented to Veteran stakeholders and VCL leadership and responders to identify potential policy changes and variables that should be measured for future research. They may also contribute to research on implementing new emergency dispatch procedures across VCL sites.

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DRA: Mental, Cognitive and Behavioral Disorders

DRE: Treatment - Observational, TRL - Applied/Translational

Keywords: Suicide

MeSH Terms: None at this time.