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Principal Investigator: Alan Teo
Organization: PORTLAND VA MEDICAL CENTER
Fiscal Year: 2024
Funding agency: Veterans Affairs
Background: This is a time of unprecedented loneliness and social isolation. Loneliness in particular is
a powerful predictor of suicidal ideation, suicide attempts, functional decline, and death. Loneliness can
and should be addressed by health systems. Due to risk for loneliness and negative health outcomes, a
group of particular concern is older adults with medical or psychiatric comorbidity who have limited
treatment engagement. Caring Contacts is an intervention that can address loneliness and poor
treatment engagement. However, it has only been evaluated in a narrow population of psychiatric
patients and not examined amongst patients impacted by the COVID-19 pandemic or other disasters.
Significance: This project addresses VA’s top clinical priority (suicide prevention), an overarching
priority of the Office of Research and Development (clinical trials), and multiple Health Service
Research and Development priority areas, including social determinants of health, aging, access to
care, mental health, suicide prevention, and population/whole health. The impact of this project is very
high because it will advance scientific understanding of key gaps related to the mechanisms and
outcomes of Caring Contacts, while also evaluating a timely, pragmatic, low-cost, and scalable
intervention for Veterans affected by lack of social connection and treatment engagement. If effective, it
will have applicability as a response to treatment disengagement and future disasters.
Innovation and Impact: We have taken an empirically-grounded suicide prevention intervention and
adapted it for Veterans with poor treatment engagement in VA outpatient care. This study is innovative
in testing an intervention responsive to the COVID-19 pandemic and its aftermath, and unique in using
a health services intervention strategy to target loneliness. The intervention’s peer support component
is highly novel for its low resource demands and potential for scalability.
Specific Aims: The overarching objective of this project is to evaluate “Crisis Caring Contacts” (CCC),
an adaptation of Caring Contacts tailored to reduce loneliness in the context of the pandemic. To reach
this objective we will achieve these aims: 1) Among older Veterans with poor treatment engagement,
evaluate the effectiveness of Crisis Caring Contacts in decreasing loneliness, compared to enhanced
usual care; 2) Evaluate the effect of Crisis Caring Contacts on other important outcomes, including
treatment engagement and suicidal ideation; 3) Explore potential moderators of treatment response to
Crisis Caring Contacts; and 4) Explore the effect of Crisis Caring Contacts on all-cause mortality and
suicide attempts.
Methodology: Our approach is to conduct a multisite, pragmatic randomized controlled trial of CCC.
We will target Veterans age 60 and over with active psychiatric or medical diagnoses who have had
limited treatment engagement in VA outpatient care. Those in the CCC treatment arm will be sent 10
postcards over 10 months by a Peer Support Specialist. Those in the enhanced usual care arm
(control) will be sent non-personalized, general health resource information. We will examine self-report
and administrative data outcomes over 24 months of follow-up.
Next Steps/Implementation: We will collect pre-implementation data from our study sites and share
this with our operational partner, the Office of Mental Health and Suicide Prevention (OMHSP). Crisis
Caring Contacts is highly suited to future implementation due to its scalability, ease of creating an
operational dashboard to identify Veterans who could receive the intervention, and ability to add study
materials to an implementation toolkit for VA Caring Contacts interventions.
Terms: <Access to Care><Active Follow-up><Acute><Address><Affect><Age><Aging><Ambulatory Care><Appointment><Area><COVID crisis><COVID epidemic><COVID pandemic><COVID-19><COVID-19 affected><COVID-19 consequence><COVID-19 crisis><COVID-19 effect><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 impact><COVID-19 impacted><COVID-19 pandemic><COVID-19 pandemic affected><COVID-19 pandemic consequence><COVID-19 pandemic effects><COVID-19 pandemic impact><COVID-19 pandemic impacted><COVID-19 period><COVID-19 public health crisis><COVID-19 years><CV-19><Caring><Cessation of life><Clinical><Clinical Trials><Control Groups><Coronavirus Infectious Disease 2019><Data><Death><Development and Research><Diagnosis><Disasters><Drugs><Feeling suicidal><Funding><Future><Gender><Grant><Health><Health Resources><Health Services><Health Services Accessibility><Health Services Evaluation><Health Services Research><Health system><Healthcare><Individual><Intervention><Intervention Strategies><Loneliness><Medical><Medical Care Research><Medication><Mental Health><Mental Health Services><Mental Hygiene><Mental Hygiene Services><Methodology><Non-pharmacologic Therapy><Nonpharmacologic Intervention><Nonpharmacologic Therapy><Nonpharmacologic approach><Nonpharmacologic treatment><Out-patients><Outcome><Outpatient Care><Outpatients><Overdose><Patient Self-Report><Patients><Pharmaceutical Preparations><Population><Preventative intervention><Preventative strategy><Prevention strategy><Preventive strategy><Psychological Health><R & D><R&D><Randomized, Controlled Trials><Research Resources><Resources><Risk><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Scientific Advances and Accomplishments><Self-Report><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Site><Social isolation><Social support><Socio-economic status><Socioeconomic Status><Specialist><Suicidal thoughts><Suicide><Suicide attempt><Suicide precaution><Suicide prevention><Survival Analyses><Survival Analysis><Testing><Time><Trust><Veterans><Work><acceptability and feasibility><access to health services><access to services><access to treatment><accessibility to health services><active followup><ages><arm><assess effectiveness><availability of services><care access><care as usual><care outcomes><compare to control><comparison control><coronavirus disease 2019><coronavirus disease 2019 consequence><coronavirus disease 2019 crisis><coronavirus disease 2019 effect><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 impact><coronavirus disease 2019 pandemic><coronavirus disease 2019 pandemic consequence><coronavirus disease 2019 pandemic impact><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19><coronavirus disease-19 global pandemic><coronavirus disease-19 impact><coronavirus disease-19 pandemic><coronavirus infectious disease-19><cost><dashboard><decline in function><decline in functional status><determine effectiveness><drug/agent><effectiveness assessment><effectiveness evaluation><effects following the COVID-19 pandemic><elderly patient><evaluate effectiveness><evidence base><examine effectiveness><experience><fatal attempt><fatal suicide><follow up><follow-up><followed up><followup><functional decline><functional status decline><future implementation><health care><health care outcomes><health service access><health services availability><healthcare outcomes><impact of the SARS-CoV-2 pandemic><innovate><innovation><innovative><intent to die><intervention arm><intervention for prevention><intervention refinement><interventional strategy><lonely><mental health care><mental healthcare><mortality><non fatal attempt><non-drug therapy><non-drug treatment><nondrug therapy><nondrug treatment><nonfatal attempt><novel><older adult><older adulthood><older patient><outpatient treatment><outreach><pandemic><pandemic disease><patient population><peer><peer support><post-pandemic><pragmatic effectiveness trial><pragmatic trial><prevent suicidality><prevent suicide><prevention intervention><preventional intervention strategy><preventive intervention><primary care visit><psychiatric co-morbidity><psychiatric comorbidity><randomized control trial><recruit><research and development><response><response to therapy><response to treatment><scientific accomplishments><scientific advances><service availability><services research><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><social><social health determinants><social support network><socio-demographics><socio-economic position><sociodemographics><socioeconomic position><suicidal attempt><suicidal ideation><suicidal thinking><suicidality prevention><suicide ideation><suicide intervention><suicide rate><suicides><therapeutic response><therapy response><thoughts about suicide><treatment access><treatment arm><treatment as usual><treatment response><treatment responsiveness><usual care><usual care arm><usual care control group><whole health><whole person health>