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. 2023 Nov 24;4(1):148.
doi: 10.1186/s43058-023-00530-3.

An exposure-based implementation strategy to decrease clinician anxiety about implementing suicide prevention evidence-based practices: protocol for development and pilot testing (Project CALMER)

Emily M Becker-Haimes  1   2 , Megan Brady  3 , Jesslyn Jamison  3 , Shari Jager-Hyman  3 , Megan E Reilly  3 , Esha Patel  3 , Gregory K Brown  3 , David S Mandell  3 , Maria A Oquendo  3
Affiliations

An exposure-based implementation strategy to decrease clinician anxiety about implementing suicide prevention evidence-based practices: protocol for development and pilot testing (Project CALMER)

Emily M Becker-Haimes et al. Implement Sci Commun. .

Abstract

Background: Clinicians often report that their own anxiety and low self-efficacy inhibit their use of evidence-based suicide prevention practices, including gold-standard screening and brief interventions. Exposure therapy to reduce clinician maladaptive anxiety and bolster self-efficacy use is a compelling but untested approach to improving the implementation of suicide prevention evidence-based practices (EBPs). This project brings together an interdisciplinary team to leverage decades of research on behavior change from exposure theory to design and pilot test an exposure-based implementation strategy (EBIS) to target clinician anxiety to improve suicide prevention EBP implementation.

Methods: We will develop, iteratively refine, and pilot test an EBIS paired with implementation as usual (IAU; didactic training and consultation) in preparation for a larger study of the effect of this strategy on reducing clinician anxiety, improving self-efficacy, and increasing use of the Columbia Suicide Severity Rating Scale and the Safety Planning Intervention in outpatient mental health settings. Aim 1 of this study is to use participatory design methods to develop and refine the EBIS in collaboration with a stakeholder advisory board. Aim 2 is to iteratively refine the EBIS with up to 15 clinicians in a pilot field test using rapid cycle prototyping. Aim 3 is to test the refined EBIS in a pilot implementation trial. Forty community mental health clinicians will be randomized 1:1 to receive either IAU or IAU + EBIS for 12 weeks. Our primary outcomes are EBIS acceptability and feasibility, measured through questionnaires, interviews, and recruitment and retention statistics. Secondary outcomes are the engagement of target implementation mechanisms (clinician anxiety and self-efficacy related to implementation) and preliminary effectiveness of EBIS on implementation outcomes (adoption and fidelity) assessed via mixed methods (questionnaires, chart-stimulated recall, observer-coded role plays, and interviews).

Discussion: Outcomes from this study will yield insight into the feasibility and utility of directly targeting clinician anxiety and self-efficacy as mechanistic processes informing the implementation of suicide prevention EBPs. Results will inform a fully powered hybrid effectiveness-implementation trial to test EBIS' effect on implementation and patient outcomes.

Trial registration: Clinical Trials Registration Number: NCT05172609 . Registered on 12/29/2021.

Keywords: Clinician anxiety; Evidence-based implementation strategy; Exposure therapy; Implementation; Suicide prevention.

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Conflict of interest statement

Dr. Oquendo and Dr. Brown receive royalties from the Research Foundation for Mental Hygiene for the commercial use of the Columbia Suicide Severity Rating Scale. Dr. Oquendo serves as an advisor to Alkermes, St. George’s University, and Fundación Jimenez Diaz; her family owns stock in Bristol Myers Squibb. Dr. Brown serves as an advisor for Oui Therapeutics, LLC, and Psych Hub, LLC. The other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Conceptual model of maladaptive anxious avoidance applied to suicide prevention EBPs, adapted from Becker-Haimes et al. ([12]; permission given)
Fig. 2
Fig. 2
Facilitating a cycle of approach for SSAI use
See this image and copyright information in PMC

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References

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