Addressing veterans' social determinants of health in the context of suicide prevention: Staff-identified implementation barriers and strategies

BACKGROUND: Suicide prevention is a top clinical priority in the United States, and healthcare systems are increasingly addressing adverse life circumstances and social drivers that heighten suicide risk. Within the Veterans Health Administration (VHA), Suicide Prevention Coordinators (SPCs) play a central role in identifying and supporting Veterans at risk of suicide, including efforts to address adverse social determinants of health (SDH). 

OBJECTIVE: This study explores (1) barriers SPCs face when addressing Veterans' adverse SDH within the context of suicide prevention care and (2) strategies SPCs employ to address these barriers. 

DESIGN: We analyzed transcripts from semi-structured telephone interviews conducted with SPCs between February and May 2022 using a rapid turn-around qualitative approach informed by the Consolidated Framework for Implementation Research (CFIR). 

PARTICIPANTS: We recruited 15 SPCs using purposive sampling to ensure maximum variation by facility complexity, as defined by VHA. 

APPROACH: The CFIR-informed interview guide elicited SPCs' perspectives across multiple topics, including how SPCs connect Veterans with services to address adverse SDH within and outside of VHA, perceived challenges to these processes, and strategies used to address identified barriers. 

KEY RESULTS: Barriers and strategies were identified across three CFIR domains. Outer setting barriers included eligibility policies and resource constraints; strategies focused on leveraging specialized VHA staff to connect Veterans with available services. Inner setting barriers included limited staff capacity and communication challenges between programs; SPCs responded by initiating improvements to referral tracking and follow-up. Barriers in the individuals (Veteran) domain included limited awareness of available services; strategies included engaging Veterans' families when feasible. 

CONCLUSIONS: These findings inform ongoing suicide prevention efforts with VHA and other healthcare systems by highlighting the importance of leveraging community resources, expanding and supporting specialized roles, engaging Veterans' families and other supports, and formalizing collaboration and communication across programs.