Sara J. Landes

Reducing veteran suicide is a high priority for the Veterans Health Administration (VHA). While dialectical behavior therapy skills groups (DBT-SG) may be as effective as comprehensive DBT in reducing suicide attempt, barriers and facilitators to this innovation in VHA are not well known. In preparation for a hybrid Type 1 effectiveness-implementation trial, we conducted individual semistructured qualitative interviews with 35 VHA staff (therapists, suicide prevention coordinators, local and national leaders) and identified themes using rapid qualitative analysis (Hamilton, 2013). Five themes emerged: (a) While leadership noted wanting innovative suicide prevention, (b) knowledge of DBT varied widely across respondents. (c) Implementation challenges, especially after COVID-19, included staff shortage and burnout. (d) DBT-SG may require adaptation to fit the diversity of the veteran population, including Indigenous, homeless, and urban veterans, and (e) virtual DBT-SG options hold promise for expanding reach and access and must be implemented with appropriate risk management. Enthusiasm for DBT-SG was high, and implementation challenges in a stressed health care system were noted. DBT-SG, especially delivered virtually, holds promise for VHA and will need to be implemented with attention to staffing, provider needs, and veteran diversity. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The older Alaska Native/American Indian (AN/AI) population is increasing faster than their U.S. peers overall. However, AN/AI peoples are less likely to receive palliative care, including advance care planning (ACP). ACP leads to better outcomes for patients, their families, and health systems, including decreased depression, anxiety, and grief, fewer non-beneficial end-of-life treatments, and reduced cost. ACP is typically documented in advance directives that specify patient preferences for life-sustaining treatments and who can make medical decisions on their behalf. AN/AI peoples are as likely as non-AN/AI peoples to utilize palliative care when it is culturally tailored. Therefore, there is an urgent need for strategies to provide tailored palliative and end-of-life care interventions for AN/AI people. Our team used community engagement methods to tailor an ACP communication intervention and pilot the tailored intervention—Jumpstart—with seriously ill adult AN/AI peoples within a Tribal health system. Most (95%) of patients in the pilot stated that Jumpstart helped them to have ACP conversations with their primary care providers. The current study uses a type 1 hybrid effectiveness-implementation randomized controlled trial to examine the effectiveness of a tailored ACP intervention and evaluate implementation variables. This study will provide critical evidence for improving care for seriously ill AN/AI peoples and their families.

Introduction: Veteran death by suicide is a complex issue made up of many factors. Despite the high need for mental health treatment, and treatments that specifically target suicide, evidence-based psychotherapies (EBPs) are difficult to access, even more so in rural areas. In concordance with the 2018 National Strategy for Preventing Veteran Suicide, VA suicide prevention leadership developed Suicide Prevention 2.0 (SP 2.0) to implement a public health model that includes community-based prevention strategies and improves clinical interventions within VA. The Suicide Prevention 2.0 Clinical Telehealth program was implemented in each of VA’s 18 regional Clinical Resource Hubs and expanded clinical intervention strategies within VA by implementing four EBPs for Suicide Prevention (EBP-SP) via telehealth: the Safety Planning Intervention, Problem-Solving Therapy for Suicide Prevention, Cognitive Behavioral Therapy for Suicide Prevention, and Dialectical Behavior Therapy. Methods: A wide variety of implementation strategies were used (e.g., access new funding, training, consultation, create new clinical teams). The primary inclusion criterion for veteran referral to SP 2.0 Clinical Telehealth is a recent history of suicidal self-directed violence. Implementation was guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework and RE-AIM was used as an evaluation framework. Results: By April 2023, SP 2.0 Clinical Telehealth services were available in all 18 regions and in 139 of 139 (100%) VA health care systems in the U.S. By the end of September 2024, the program had hired 137 therapists and retained 78.10% in their role, and 100% were trained in two or more EBP-SPs. By the end of September 2024, the program received 23,628 referrals nationwide. Increasing referral rates year over year suggests ongoing sustained reach. Discussion: SP 2.0 Clinical Telehealth represents the first and only enterprise-wide fully virtual evidence-based treatment program for veterans with a recent history of suicidal self-directed violence. The program’s implementation was successful in reaching all VISNs and all VA health care systems in the U.S. The SP 2.0 Clinical Telehealth program can be used as a model for other large health care systems looking to improve provision of evidence-based interventions for suicide prevention.

Veteran suicide is a public health crisis. Suicide rates for U.S. veterans have remained disproportionately higher than their nonveteran counterparts during the last 2 decades (White House, 2023; U.S. Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, Community-Based Interventions for Suicide Prevention, 2022). Additionally, the majority of veterans who die by suicide are not engaged in care from the Veterans Health Administration (U.S. Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, 2023). Veterans Health Administration's Suicide Prevention 2.0 (SP 2.0) was developed to address this problem through a combination of clinical and community-based efforts that form a comprehensive public health approach for veteran SP (Carroll et al., 2020). In this article, the authors briefly outline the national, regional, and local program development of VA's Community-Based Interventions for SP within SP 2.0. Then, they describe local-level program development and implementation of the Community Engagement and Partnership Coordinators. Community Engagement and Partnership Coordinators are tasked with developing and facilitating coalitions with local agencies and organizations aimed at reducing suicide risk among service members, veterans, and their families. The authors review the implementation of this program from 2020 to 2024 and then suggest directions for future program evaluation and research on the impact of this approach in preventing veteran suicide. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Research to develop and test complex health interventions has traditionally followed a multistage process encompassing (1) efficacy research (i.e. explanatory trials), to confirm the intervention’s effects under tightly controlled conditions; (2) clinical effectiveness research (i.e. effectiveness or pragmatic trials), to confirm the intervention’s effectiveness within routine practice settings and populations; and finally, (3) implementation research, to assess barriers and facilitators to use of the intervention in routine practice and to test strategies that support the intervention’s uptake and integration into care. This chapter describes an alternative research paradigm, called the hybrid effectiveness–implementation approach, which blends characteristics of effectiveness research and implementation research within a set of hybrid effectiveness–implementation studies – referred to as hybrid studies. The goal of this approach is to speed the translation of scientific discoveries into practice and optimise the use of scientific resources.

Background: Community-engaged dissemination and implementation research focuses on the implementation of evidence-based interventions within clinical or community-based settings. It uses community-engaged processes or partnerships. This includes (but is not limited to) community-based participatory research (CBPR). CBPR is an approach that centers actively engaging and collaboratively sharing power with community members, which can increase the value of studies for the communities being served and researchers. Community members include those who are most affected by the research (e.g. patients, citizens) and those most invested in the communities being researched (e.g. advocates, leaders). Main body: Policy implementation research is the subfield of implementation science that aims to understand how policies are implemented and improve their implementation. Previous literature discusses policy co-design, defined as actively partnering with community members in the policy making process. In this article, we suggest ways to integrate CBPR methods within policy implementation research as well. We specifically discuss ways that community-members can be actively and substantively engaged in policy implementation in addition to policy making. Conclusion: Policy implementation research researchers who wish to approach their work through a CBPR lens would benefit from our overarching recommendation to meaningfully engage community members throughout the policy implementation research process including (i) building or maintaining meaningful partnerships, (ii) engaging in transparent and equitable resource sharing, cost charging, compensation, and incentives. (iii) co-designing/co-conceptualizing projects, (iv) co-refining the project and co-selecting strategies for project completion, (v) bi-directional learning and open channels of communication during the project period, and (vi) taking action on harmful or inequitable policy implementation research and results of research. We argue that if policies are causing harm or not reaching marginalized communities, researchers should alert policymakers, frontline staff, and community members to this information and actively assist in providing solutions to this issue. Ideally, the steps outlined in this article will enable researchers to directly uncover the presence of harm and/or lack of reach of policies and form the communication channels that would enable researchers to inform policymakers and community members.

Transferring successful implementation strategies from research to practice requires approaches for assessing fidelity to the strategy’s core components. Implementation facilitation (IF) is a strategy involving an interactive process of problem-solving, enabling, and supporting individuals in efforts to implement clinical innovations that occurs in the context of a recognized need for improvement and supportive interpersonal relationships. Because IF is a dynamic strategy involving numerous activities, our objective was to conduct a rigorous consensus development process to identify core activities for monitoring fidelity to IF when applied in clinical settings. We first conducted a scoping literature review to identify the range of activities used when IF has been applied in clinical settings, searching multiple citation databases for English-language articles including “facilitation” or other commonly-used terms for the strategy published from 1996–2015. Through multi-stage screening, 135 articles (from 94 studies) were identified for data extraction on IF activities, frequency with which IF activities were identified as ‘core’ by study authors, and study outcomes. From the literature review, we identified 32 distinct IF activities and developed definitions/examples for each. Next, we conducted a 3-stage, modified-Delphi expert panel consensus development process to identify core IF activities across three implementation phases (i.e., Pre-Implementation, Implementation, Sustainment). The expert panel identified 8 core activities for the Pre-Implementation Phase, 8 core activities for the Implementation Phase, and 4 core activities for the Sustainment Phase. This work provides an important foundation for developing measures/tools to assess use of core IF activities to ensure the strategy is delivered with fidelity.

Trauma exposure and mental health problems adversely affect work functioning. Sexual minority women are at increased risk for trauma exposure, depression, and PTSD. Sexual minority women also experience unique stressors related to their sexual orientation, which can directly impact work functioning. However, little research to date has examined the impact of trauma exposure and mental health problems among sexual minority women on their occupational outcomes. The goal of the current study was to examine whether trauma exposure, mental health problems, and minority stressors were associated with occupational functioning 1 year later in a large sample of young adult lesbian and bisexual women. The study utilized a subset of data (N = 304) from a larger longitudinal study on health risk behaviors among young adult lesbian and bisexual women. Results indicated that trauma exposure, posttraumatic stress, depression, and perceived heterosexism were each associated with subsequent work limitations, but after accounting for shared variance between predictors, only perceived heterosexism and depression were uniquely associated with subsequent work functioning. These findings highlight the roles of mental health and sexual orientation-related stress in the challenges that lesbian and bisexual women experience at work and point to a need for additional research to better understand risk and protective factors related to negative employment outcomes among lesbian and bisexual women.

Mental illness and suicide are significant public health problems. Limited resources put individuals at greater risk, particularly in rural areas with fewer health providers. Community pharmacists are the most accessible health professionals in rural communities and are interested in addressing mental health concerns. Research is limited on how to implement mental health interventions in community pharmacy settings. The objectives of this study were to assess community pharmacists' perceptions of mental health interventions and barriers and facilitators to implementation and prioritize interventions to be pilot tested. Qualitative interviews were conducted with community pharmacists (N=17). Interviews focused on perceptions of mental health interventions in pharmacy settings. Data were analyzed using template analysis. A stakeholder meeting reviewed data and prioritized interventions to be pilot tested. Pharmacists viewed implementing mental health interventions positively. Barriers included lack of mental health knowledge, time, diagnosis, and concerns about workflow. Facilitators included accessible settings, knowing the community, and seeing patients frequently. The most common needs for implementation were education and payment. Pharmacists preferred progress monitoring in collaboration with a prescriber and mental health first aid training. Further research is needed to gather feedback from prescribers to inform implementation.