Heather M. Gebhardt

VA Puget Sound Health Care System

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Mark A. Reger

Central Arkansas Veterans Healthcare System

Brooke A. Ammerman

University of Notre Dame

Sarah P. Carter

Uniformed Services University of the Health Sciences

Jonathan Buchholz

VA Puget Sound Health Care System

Sasha M. Rojas

University of Arkansas at Fayetteville

Jacob M. Lee

VA Puget Sound Health Care System

Raymond P. Tucker

Louisiana State University

Bridget B. Matarazzo

Mental Illness Research, Education and Clinical Centers

Jesse Markman

VA Puget Sound Health Care System

Greg M. Reger

University of Washington

Cooperative Institutions

VA Puget Sound Health Care System

University of Washington

United States Department of Veterans Affairs

VA San Diego Healthcare System

Seattle University

University of California, San Diego

University of Giessen

San Diego State University

Veterans Medical Research Foundation of San Diego

University of Puget Sound

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A peer veteran approach to the caring letters suicide prevention program: Preliminary data.

Psychological Services (2023)

Whitney S. Livingston Sarah P. Carter Rebecca Leitner Andrew T. Ton Heather M. Gebhardt

Caring Letters is a prevention program aimed at reducing suicide risk; however, clinical trials indicate mixed results among military and veteran samples. The present study aimed to pilot a new version of the Caring Letters intervention that was adapted to military culture in order to emphasize peer support. The supportive letters, traditionally sent from clinicians, were written by peer veterans (PVs) who volunteered from local Veteran Service Organizations (VSOs). PVs (

10.1037/ser0000760

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Citations (3)

Lessons Learned From Implementing a Caring Contacts Clinical Practice Guideline Recommendation

Psychiatric Services (2023)

Lynne Liu Shelan Porter Heather M. Gebhardt Jesse Markman Jonathan Buchholz

The U.S. Department of Veterans Affairs (VA) and Department of Defense clinical practice guideline on the treatment of veterans at risk for suicide recommends considering caring contacts interventions after a psychiatric hospitalization for suicidal ideation or suicide attempt. This quality improvement project examined the implementation of the recommendation at a large VA health care system. The project enrolled 29% of hospitalized veterans (N=135 of 462). Enrollment barriers included lack of staff availability and veteran ineligibility due to homelessness or housing instability. Opportunities to improve the reach of the intervention in future quality improvement processes are discussed, especially because acceptability of the intervention was high among veterans.

Veterans Affairs

Guideline

10.1176/appi.ps.20220629

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Patient Feedback on the Use of Predictive Analytics for Suicide Prevention

Psychiatric Services (2020)

Mark A. Reger Brooke A. Ammerman Sarah P. Carter Heather M. Gebhardt Sasha M. Rojas

Objective: There is significant debate about the feasibility of using predictive models for suicide prevention. Although statistical considerations have received careful attention, patient perspectives have not been examined. This study collected feedback from high-risk veterans about the U.S. Department of Veterans Affairs (VA) prevention program called Recovery Engagement and Coordination for Health–Veterans Enhanced Treatment (REACH VET). Methods: Anonymous questionnaires were obtained from veterans during their stay at a psychiatric inpatient unit (N=102). The questionnaire included three vignettes (the standard VA script, a more statistical vignette, and a more collaborative vignette) that described a conversation a clinician might initiate to introduce REACH VET. Patients rated each vignette on several factors, selected their favorite vignette, and provided qualitative feedback, including recommendations for clinicians. Results: All three vignettes were rated as neutral to very caring by more than 80% of respondents (at least 69% of respondents rated all vignettes as somewhat caring to very caring). Similar positive feedback was obtained for several ratings (e.g., helpful vs. unhelpful, informative vs. uninformative, encouraging vs. discouraging). There were few differences in the ratings of the three vignettes, and each of the three scripts was preferred as the "favorite" by at least 28% of the sample. Few patients endorsed concerns that the discussion would increase their hopelessness, and privacy concerns were rare. Most of the advice for clinicians emphasized the importance of a patient-centered approach. Conclusions: The results provide preliminary support for the acceptability of predictive models to identify patients at risk for suicide, but more stakeholder research is needed.

Vignette

Veterans Affairs

10.1176/appi.ps.202000092

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Citations (16)

Kulturelle Geographien der Ökonomie

Spektrum Akademischer Verlag eBooks (2005)

Marc Boeckler Christian Berndt Heather M. Gebhardt R Glaser U Radtke

Cultural geographies of economies. For some time now economic geographers have wrestled with a dominant economic orthodoxy which advances an ahistoric, formalist and homogenous view of the economic. Obviously, this neoliberal world-transformation is highly entangled in the social and criticism of undersocialised economics are undersocialised themselves. Rather than continuously pointing to the unrealistic nature of autistic economics, the task should be to analyse how abstract economic thinking produces realities. This paper discusses four conceptual building stones for such a project and advances possible ways to put them to empirical use: virtualism; framing; disentangling; the economy as boundary practice, border pluralism and the composition of alternative economic orders

Framing (construction)

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[Criticism of customary peridontal therapy with reference to the hypotension theory and its practical results].

PubMed (1954)

Heather M. Gebhardt

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Understanding suicide: Development and pilot evaluation of a single-session inpatient psychoeducation group.

Psychological Services (2021)

Heather M. Gebhardt Brooke A. Ammerman Sarah P. Carter Ian H. Stanley

Suicide is a considerable public health concern, particularly among U.S. veterans. Despite inpatient psychiatric hospitalization being a primary recommended treatment for acute suicidality, available inpatient group treatments remain limited. The current quality improvement project (QIP) aimed to examine the feasibility and acceptability of a newly developed single-session suicide-focused psychoeducation for veterans during psychiatric hospitalization. This project was conducted in two phases among veterans hospitalized for suicidal thoughts or behaviors. The first phase (n = 56) aimed to refine the group content and explore feasibility and tolerability of the group. Following content revisions suggested by Phase 1 findings, Phase 2 (n = 78; Mage = 48.11; 87% male) aimed to replicate and extend tolerability findings, as well as assess the acceptability of the group on an inpatient unit and the alignment of group content with the primary group objectives. Veteran acceptability of the group was high, and content was reported to be new and useful by veterans. Minimal changes in distress from before to after the group were identified. Further, after group participation, veterans reported being more hopeful and motivated to learn skills to cope with their suicidal thoughts and behaviors (STB). Results support the acceptability and feasibility of the newly developed suicide psychoeducation group among veterans on a psychiatric inpatient unit, highlighting the need for future systematic investigations to determine whether the results extend to other settings and populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychoeducation

PsycINFO

Tolerability

Veterans Affairs

10.1037/ser0000543

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Veteran Preferences for the Caring Contacts Suicide Prevention Intervention

Suicide and Life-Threatening Behavior (2018)

Mark A. Reger Heather M. Gebhardt Jacob M. Lee Brooke A. Ammerman Raymond P. Tucker

Objective The Caring Contacts intervention has been implemented with a variety of methodologies. The purpose of this study was to examine high‐risk inpatient preferences for the Caring Contacts intervention. Method Veteran psychiatric inpatients ( N = 154) completed an anonymous patient preferences survey to obtain feedback on Caring Contact methods such as message wording, preferred correspondent, frequency of contact, duration of the intervention, imagery, and mailing modality. Results Eighty‐five percent of veterans Agreed or Strongly Agreed that they would like to receive Caring Contacts from at least one of the correspondent options, with inpatient or outpatient mental health counselor, or primary care physician most preferred. Example messages based on prior studies were overwhelmingly rated as caring and helpful; 84% believed that Caring Contacts could help suicidal individuals. Letters or postcards sent through postal mail were preferred over e‐mail or text messages. Participants most commonly thought Caring Contacts should be sent monthly for a period of a year. Conclusions The results of this study suggest that most high‐risk veterans would perceive Caring Contacts as helpful and caring. The results provide several practical, helpful tips for programs seeking to establish a Caring Contacts program.

10.1111/sltb.12528

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Characterizing Veterans Crisis Line callers and regional follow-up efforts

Military Psychology (2021)

Brooke A. Ammerman Sarah P. Carter Kara A. Walker Heather M. Gebhardt Sasha M. Rojas

The Veterans Crisis Line (VCL) is a national resource offering Veterans 24/7 access to crisis responders and follow-up by a licensed mental health clinician at a Veterans Affairs medical center. This quality improvement project aimed to improve local suicide prevention efforts at the VA Puget Sound Health Care System by characterizing 344 VCL calls and outcomes. Data was extracted from documentation by national VCL responders and local Suicide Prevention Team members. Overall, most callers were assessed at low-to-moderate risk. VCL responders were more likely to assess callers reporting suicidal ideation (SI) as high-risk, but less likely to assess those reporting financial issues as high-risk. VCL calls about SI, about physical health, or that occurred on weekends were more likely to end with immediate evaluation (i.e., emergency room, evaluated by first-responders) compared to their respective comparison groups. VCL calls assessed as high-risk were more likely to report SI during local follow-up contact, whereas VCL calls ending in immediate evaluation (i.e., emergency room, evaluated by first-responders) were less likely to report SI during follow-up with the local VA clinician; 17% of VCL calls without SI reported SI at follow-up. Training of local Suicide Prevention Team members should include that SI can change rapidly and requires assessment regardless of SI during the VCL call.

Veterans Affairs

10.1080/08995605.2021.1963631

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An Initial Investigation of Suicide Attempt Disclosures Among US Veterans

Crisis (2020)

Brooke A. Ammerman Sarah P. Carter Heather M. Gebhardt Jonathan Buchholz Mark A. Reger

Background: Patient disclosure of prior suicidal behaviors is critical for effectively managing suicide risk; however, many attempts go undisclosed. Aims: The current study explored how responses following a suicide attempt disclosure may relate to help-seeking outcomes. Method: Participants included 37 veterans with a previous suicide attempt receiving inpatient psychiatric treatment. Veterans reported on their most and least helpful experiences disclosing their suicide attempt to others. Results: Veterans disclosed their suicide attempt to approximately eight individuals. Mental health professionals were the most cited recipient of their most helpful disclosure; romantic partners were the most common recipient of their least helpful disclosures. Positive reactions within the context of the least helpful disclosure experience were positively associated with a sense of connection with the disclosure recipient. Positive reactions within the most helpful disclosure experience were positively associated with the likelihood of future disclosure. No reactions were associated with having sought professional care or likelihood of seeking professional care. Limitations: The results are considered preliminary due to the small sample size. Conclusion: Findings suggest that while positive reactions may influence suicide attempt disclosure experiences broadly, additional research is needed to clarify factors that drive the decision to disclose a suicide attempt to a professional.

Self-disclosure

10.1027/0227-5910/a000727

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Experience and impact of inappropriate patient sexual behaviors within a large VA healthcare system

Journal of Hospital Medicine (2024)

Heather M. Gebhardt Aaron M. Norr Jesse Markman Mark A. Reger

Abstract Inappropriate patient sexual behaviors (IPSBs) can negatively impact work performance, job satisfaction, and the psychological well‐being of clinicians and staff. Although the Veterans Health Administration (VHA) is the largest integrated healthcare system in the United States, the rate of IPSBs in VHA hospitals is unknown. The unique demographic and cultural characteristics of military populations may be associated with IPSBs. To evaluate the extent and impact of IPSBs within a large VA healthcare system (VAHS), a survey was disseminated to all staff. Among the 32% of staff who responded ( N = 1359), over half ( n = 789; 58.1%) of participants reported at least one instance of IPSB during the past year; this included 67.9% ( n = 644) of staff who identified as women and 33.4% ( n = 126) of staff who identified as men. There was a significantly greater impact of IPSBs for women, as compared to men, on psychological well‐being ( X 2 1 = 60.4, p < .001, odds ratio [OR] = 4.55, 95% confidence interval [CI]: [3.08, 6.79]), work satisfaction ( X 2 1 = 43.0, p < .001, OR = 3.51, 95% CI: [2.40, 5.18]), and workplace practices ( X 2 1 = 48.9, p < .001, OR = 4.02, 95% CI: [2.69, 6.11]). The results of this project highlight the need for overcoming barriers to reducing the pervasiveness and impact of these experiences.

Healthcare system

10.1002/jhm.13313

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