Training Clinicians to Provide Collaborative Assessment and Management of Suicidality - Group (CAMS-G) for Veterans

Gutierrez, Peter M.; O’Connor, Stephen S.; Johnson, Lora L.; Dwyer, Megan; Mund, Nora E.; Jobes, David A.

doi:10.1080/21635781.2019.1705214

Cited by 5 publications

(9 citation statements)

References 34 publications

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“…The results of this small pilot study of CAMS-G support that it is a feasible and acceptable outpatient intervention for veterans at risk of suicide. In line with previous research (Gutierrez et al, 2020), the intervention was delivered by the co-facilitators with fidelity and no drift over time was noted. Veterans receiving CAMS-G were positive about their experience and provided descriptions of how they learned new skills, felt supported by the other veterans in the group, and would have been amenable to a higher dose of treatment than the weekly 90-min group sessions they received.…”

Section: Discussionmentioning

confidence: 76%

“…This group process has been described previously (Johnson et al, 2014(Johnson et al, , 2019. A feasibility trial conducted at a VA community-based outpatient clinic (Gutierrez et al, 2020) supported the utility of the clinician manual and training model. CAMS-G is an open-enrollment group generally capped at 6-8 participants who attend weekly 90-min groups until meeting resolution criteria as assessed with the Suicide Status Form (SSF; Jobes, 2016) described in detail below.…”

Section: Cams and Cams -Gmentioning

confidence: 99%

“…Minimization randomization has been encouraged as an alternative to a stratification random strategy in clinical trials with limited sample size, as it requires fewer combinations on matching variables (Comtois et al, 2011). Groups were conducted as described in Gutierrez et al (2020). Due to the much smaller than planned sample size, the research team decided to proceed with all planned assessments and comparisons, but findings are presented with the caveat that most if not all analyses are under-powered.…”

Section: Participantsmentioning

confidence: 99%

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Pilot study of the Collaborative Assessment and Management of Suicidality—Group

Gutierrez

Johnson

Podlogar

et al. 2021

Suicide & Life Threat Behav

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BACKGROUND AND SIGNIFICANCEOur military and veteran population are presently at increased risk for suicide when compared to the general population (Sher & Yehuda, 2011;Ursano et al., 2015). Research into the veteran population and clinicians' approaches to treating those at elevated risk of suicide is essential. To date, the existing studies on treatments for suicide are dominated by empirical investigations of those with a history of attempting suicide identified and treated in hospital emergency departments or on inpatient units. Remarkably limited attention has been focused on outpatient-based identification and treatment. However, the best current evidence for treating suicide risk lies in highly structured suicide-focused outpatient care (Brown et al., 2005;Jobes et al., 2015). Thus,

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Section: Discussionmentioning

confidence: 76%

Section: Cams and Cams -Gmentioning

confidence: 99%

Section: Participantsmentioning

confidence: 99%

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Pilot study of the Collaborative Assessment and Management of Suicidality—Group

Gutierrez

Johnson

Podlogar

et al. 2021

Suicide & Life Threat Behav

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“…Since the initial study conducted in years 2012–2015 (Johnson et al, 2014), there has been a growing interest in using group modalities within military and veteran settings for suicide prevention. Results from this follow-up study and more recent research (Goodman et al, 2020; Gutierrez et al, 2020) can inform strategies for suicide prevention for veterans that are transitioning back to the community during the high-risk, posthospitalization period. Results may generalize to other adult populations, but additional research is necessary to confirm that hypothesis.…”

Section: Discussionmentioning

confidence: 88%

Three-year follow-up of suicide prevention-focused group therapy for veterans.

O’Connor¹,

Johnson²,

Gutierrez³

et al. 2023

Psychological Services

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The purpose of this study was to determine the long-term effects of a suicide prevention-focused group therapy for veterans recently discharged from an inpatient psychiatry setting following a suicidal crisis. There was interest in examining the impact of mechanisms of change identified in previous research on the group, including group cohesion, working alliance, and group sessions attended. Data were abstracted from the electronic medical record 3 years following completion of a previous study that involved the group therapy. A series of generalized linear and logistic mixed models were conducted to measure the associations between group cohesion, working alliance, session attendance, and health service utilization and suicide attempts. Thirty randomly selected veterans from the original sample completed a semistructured interview to discuss their experience in the group therapy. Study team members reviewed each transcription to identify themes related to veterans' experiences in the suicide prevention-focused group therapy. No suicides were observed in the 3-year follow-up period. When examining the full sample (N = 134), session attendance and inpatient hospitalization were not significantly associated but were positively associated after removing subjects who attended zero sessions (N = 93). Higher group cohesion was associated with a reduced likelihood of inpatient psychiatric hospitalization and greater engagement in outpatient mental health services. Four themes emerged regarding veterans' experience in the group through an analysis of the semistructured interviews. Suicide prevention-focused group therapy among veteran service members was not associated with an elevated risk of mortality. Future research is needed to further elucidate mechanisms of change and moderators of response. Impact StatementSuicide prevention-focused group therapy may be an effective modality of treatment for suicidal veterans recently discharged from an inpatient psychiatric setting. Establishing cohesion among veteran group members appears to be one of the strongest mechanisms involved, as it was associated with reduced likelihood of subsequent inpatient psychiatric hospitalization and greater utilization of outpatient behavioral healthcare across a 3-year period of time.

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“…Notably, there is currently no known research on CAMS in the Australian public health system. Although some research on CAMS has included delity monitoring (13), there is also no known research speci cally on the implementation of CAMS in a naturalistic setting outside a clinical trial.…”

mentioning

confidence: 99%

Developing a Tailored Implementation Action Plan for a Suicide Prevention Clinical Intervention in an Australian Mental Health Service: A Qualitative Study Using the EPIS Framework.

Zbukvic

Rheinberger

Rosebrock

et al. 2020

Preprint

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Background: Tailoring implementation strategies to local contexts is a promising approach to supporting implementation and sustainment of evidence-based practices in health settings. While there is increasing research on tailored implementation of mental health interventions, implementation research on suicide prevention interventions is limited. This study aimed to evaluate implementation and subsequently develop a tailored action plan to support implementation, sustainment and scale-up of an evidence-based suicide prevention intervention - Collaborative Assessment and Management of Suicidality (CAMS) - in an Australian public mental health service.Methods: This study took place within a larger randomised stepped-wedge design suicide prevention trial. Approximately 150 mental health staff working within a regional and remote community Local Health District in Australia were trained in CAMS. Semi-structured interviews and focus groups with frontline staff and clinical leaders were conducted to examine barriers and facilitators to using CAMS. Data were analysed using a reflexive thematic analysis approach and mapped to the Exploration, Preparation, Implementation and Sustainment (EPIS) framework. This was followed by stakeholder engagement to design a tailored implementation action plan based on a ‘tailored blueprint’ methodology.Results: A total of 22 barriers to implementing CAMS were identified. Based on the perceived impact on implementation fidelity and the feasibility of addressing identified barriers, six barriers were prioritised for addressing through an implementation plan. These barriers were mapped to evidence-based implementation strategies and, in collaboration with local health district staff, goals and actionable steps for each strategy were generated. This information was combined into a tailored implementation plan to support the sustainable use of CAMS as part of routine care within this mental health service. Conclusions: This study provides an example of a collaborative approach to tailoring strategies for implementation on a large scale. Novel insights were obtained into the challenges of evaluating the implementation process and barriers to implementing an evidence-based suicide prevention treatment approach within a geographically large and varied mental health service in Australia.Trial registration: This study was conducted as part of the LifeSpan suicide prevention trial. Trial registration for LifeSpan in Australia New Zealand Clinical Trials Register, ID: ACTRN12617000457347. Prospectively registered on 28 March 2017.

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Training Clinicians to Provide Collaborative Assessment and Management of Suicidality - Group (CAMS-G) for Veterans

Cited by 5 publications

References 34 publications

Pilot study of the Collaborative Assessment and Management of Suicidality—Group

Pilot study of the Collaborative Assessment and Management of Suicidality—Group

Three-year follow-up of suicide prevention-focused group therapy for veterans.

Developing a Tailored Implementation Action Plan for a Suicide Prevention Clinical Intervention in an Australian Mental Health Service: A Qualitative Study Using the EPIS Framework.

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