Current Projects
A Novel Peer-Delivered Recovery-Focused Suicide Prevention Intervention for Veterans With Serious Mental Illness
Principal Investigator: Samantha Chalker, Ph.D.
We are currently investigating the feasibility and acceptability of a Veteran-centric, peer-led suicide prevention program called SUPPORT (SUicide Prevention by Peers Offering Recovery Tactics). SUPPORT is a strengths-based program the integrates compensatory cognitive strategies, recovery principles, and suicide prevention strategies to help Veterans meaningfully engage in life. The program is designed to enhance personal recovery by fostering effective management of suicide thoughts and behaviors.
SUPPORT was co-developed by Veterans, Veteran Peer Specialists, and experts in the fields of suicide prevention, rehabilitation and recovery services, peer services, and serious mental illness. SUPPORT was designed for and tailored to the unique experiences of Veterans with serious mental illness. A workbook is provided to all Veterans, which they are encouraged to complete with their Peer Specialist and in-between appointments. The content is formatted into four recovery-focused modules (empowerment, hope, goals, connection). Compensatory cognitive strategies (called learning strategies in SUPPORT) are embedded throughout to build daily habits to work towards meaningful goals as well as to enhance recall and engagement in materials for adaptive coping during high suicide risk situations. The four modules are delivered in weekly one-on-one appointments for approximately 50-minutes each within the Peer Specialist’s usual VA clinic in which they work. Based on Veteran preference, these appointments are virtual or in-person. Then, the Peer Specialist conducts brief check-in calls at two and four weeks after the final module to reinforce the intervention material and offer additional resources as needed. We are looking forward to adapting this program to other settings (e.g., emergency departments, inpatient psychiatric units) and populations (e.g., civilians experiencing psychosis).
Training: Before meeting with a Veteran to deliver SUPPORT, the VA employed Peer Specialist completes the SUPPORT Training, which includes two four-hour trainings. SUPPORT 101 is a training designed for peers to learn foundational suicide prevention information and tools. The Peer Specialist is then trained in how to deliver SUPPORT to Veterans with serious mental illness experiencing elevated suicide risk.
Consultation & Supervision: After the training, Peer Specialists delivering SUPPORT participate in a twice monthly consultation group. The consultation group serves as dedicated time to discuss immediate concerns, fidelity feedback, general delivery processing, and implementation or administrative needs. Study supervision is also offered one-on-one on demand by approved licensed providers. Peer Specialists are encouraged to maintain their regular supervision with their direct clinical supervisor.
Over five years, this study aims to refine and pilot this program. The study consists of two phases including N=65 Veterans with serious mental illness. Phase 1 (1.5 years) employed a user-centered design approach to refine SUPPORT materials aided by scientific and consumer advisory board members as well as training our Peer Specialists to fidelity on pilot cases (n=15) in an open trial. Phase 2 (3.5 years) will pilot a feasibility and acceptability randomized controlled trial (n=50) of SUPPORT compared to enhanced standard care. The primary purpose of Phase 1 is to collect quantitative and qualitative data to ensure appointment topics and strategies are helpful and relevant to refine the protocol as well as training of Peer Specialists to reach fidelity. Phase 2 will evaluate feasibility and acceptability. Phase will also obtain preliminary data of the impact of SUPPORT for a potential efficacy study. The primary outcomes to be evaluated in the Phase 2 pilot is change in personal recovery and suicide ideation severity. Secondary outcomes concern Veteran functioning (i.e., psychosocial functioning, quality of life, recall). Additional exploratory outcomes include cognitive strategy use and measures of suicide risk. We have developed a targeted/planned enrollment specifically to ensure the inclusion of women and racial/ethnic minorities. VA San Diego Healthcare System serves a diverse population of Veterans, including gender, race/ethnicity, age/era, and co-morbid mental health and physical diagnoses. Veterans with SMI will be eligible to participate by endorsing past-month active suicide thoughts and/or past-three months suicide behavior.
Counselors Assisting Veterans to Engage in Services (CAVES)
Principal Investigator: Angie Waliski, Ph.D.
This project aims to expand access to high-quality suicide prevention training for people who support Service Members, Veterans, and their families in rural communities. We will identify and adapt existing evidence-based training materials from the VA and national organizations to meet the needs of both licensed professionals (e.g., counselors, social workers, psychologists) and non-licensed healthcare supporters who help Veterans access care. The training will focus on three key strategies: identifying and screening individuals at risk for suicide, promoting connectedness and smooth care transitions, and improving safety planning and lethal means safety. Additional content for licensed providers will include clinical guidelines and intervention approaches.
We will also partner with state agencies, professional organizations, and Veteran groups to recruit participants and deliver the training across rural communities. In the first year, we will conduct pilot trainings (in-person and/or virtual) and evaluate their impact on participants’ knowledge, skills, and confidence in supporting Veterans at risk for suicide. Findings will guide future expansion of the program, with the goal of scaling training statewide and ensuring long-term sustainability.