A peer veteran approach to the caring letters suicide prevention program: Preliminary data.

Caring Letters is a prevention program aimed at reducing suicide risk; however, clinical trials indicate mixed results among military and veteran samples. The present study aimed to pilot a new version of the Caring Letters intervention that was adapted to military culture in order to emphasize peer support. The supportive letters, traditionally sent from clinicians, were written by peer veterans (PVs) who volunteered from local Veteran Service Organizations (VSOs). PVs (n = 15) attended a 4-hr workshop to learn about Caring Letters and write six letters to a veteran with a recent hospitalization for suicide risk (hospitalized veterans [HVs]; n = 15 completed a baseline assessment). Letters from PVs were sent to HVs once a month for 6 months following discharge from the psychiatric inpatient unit. The study used a limited efficacy approach to examine feasibility outcomes including implementation procedures, participant recruitment and retention rates, and barriers and facilitators. Acceptability measures examined HV satisfaction, perceived privacy and safety, and PV workshop satisfaction. Among HVs, results suggested that suicidal ideation improved from baseline to follow-up (g = 3.19). Results suggested resilience scores improved among HVs (g = 0.99). Results also suggested a possible reduction in stigma associated with mental health treatment among PVs at 1-month postworkshop assessment. Interpretation of the results is limited by the design and sample size, but the results provide preliminary support for the feasibility and acceptability of a PV approach to Caring Letters. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Lessons Learned From Implementing a Caring Contacts Clinical Practice Guideline Recommendation.

The U.S. Department of Veterans Affairs (VA) and Department of Defense clinical practice guideline on the treatment of veterans at risk for suicide recommends considering caring contacts interventions after a psychiatric hospitalization for suicidal ideation or suicide attempt. This quality improvement project examined the implementation of the recommendation at a large VA health care system. The project enrolled 29% of hospitalized veterans (N=135 of 462). Enrollment barriers included lack of staff availability and veteran ineligibility due to homelessness or housing instability. Opportunities to improve the reach of the intervention in future quality improvement processes are discussed, especially because acceptability of the intervention was high among veterans.

Associations of housing status with substance abuse treatment and service use outcomes among veterans.

OBJECTIVE: This secondary analysis evaluated the prevalence and stability of homelessness over one year among veterans entering substance abuse treatment and explored associations among housing status, treatment outcomes, and Veterans Affairs (VA) service utilization. METHODS: Participants in a trial of on-site primary care for veterans entering substance abuse treatment (N=622) were placed in four groups based on housing status: housed at baseline and final follow-up (41%), homeless at baseline and final follow-up (27%), housed at baseline but homeless at final follow-up (8%), and homeless at baseline but housed at final follow-up (24%). Groups were compared on treatment retention, changes in Addiction Severity Index (ASI) composite scores, and VA service utilization and costs. RESULTS: Treatment retention and changes in ASI alcohol composites did not differ between groups. Compared with scores in the consistently housed group, the ASI drug composites improved less over time in the consistently homeless group (p=.031) and the ASI psychiatric composites improved less in the group housed at baseline and homeless at final follow-up (p=.019). All homeless groups were more likely than the consistently housed group to have inpatient admissions and incurred higher total treatment costs. The consistently homeless group was more likely to use emergency care than the consistently housed group. CONCLUSIONS: Homelessness affects substance abuse treatment outcomes and costs. Interventions are needed to reduce homelessness among veterans entering substance abuse treatment.