Implementation of brief cognitive behavioral therapy for suicide prevention in outpatient military clinics: A practice-based implementation network pilot

Abstract: INTRODUCTION: Prioritization of evidence-based practices is a key principle of the strategy to reduce suicide among service members. Brief Cognitive Behavioral Therapy for Suicide Prevention (BCBT-SP) is a manualized cognitive behavioral therapy targeting suicidal thoughts and behaviors. BCBT-SP has been found to be effective for military personnel of all suicide risk levels. This article reports on findings from an implementation pilot of BCBT-SP conducted by the Practice-Based Implementation Network (PBI Network), a joint initiative between the DoD and the VA to translate behavioral health research rapidly into clinical practice. MATERIALS AND METHODS: Military Health System behavioral health providers were trained in BCBT-SP and had a five-month period in which to use BCBT-SP as appropriate as part of their usual clinical practice. The PBI Network collected feedback on implementation from providers and clinic leaders identified as pilot champions, via quantitative and qualitative methods. RESULTS: Providers and pilot champions reported that BCBT-SP was acceptable. The BCBT-SP training was acceptable and prepared providers to use BCBT-SP. Some providers (27.78% of those trained) used BCBT-SP with at least one patient. Providers who did not use BCBT-SP reported several reasons including patients' schedules and clinical needs. Providers who did use BCBT-SP, along with pilot champions, reported that the feasibility of use of the treatment was negatively impacted by provider time constraints, with respect to accommodating the weekly cadence prescribed in the BCBT-SP protocol. Supportive leadership, provision of time for training, and flexible scheduling were factors that facilitated the use of BCBT-SP. CONCLUSIONS: While the feasibility of the use of BCBT-SP may have been limited by scheduling factors, BCBT-SP was an acceptable treatment for patients at risk for suicide being treated in military outpatient clinics. Feasibility could be strengthened with scheduling and workload changes. Military behavioral health providers appear receptive to evidence-based treatments that could help them continue to work to prevent suicide. Future research could address the suitability of versions of BCBT-SP that address different lengths and formats of delivery within a military population.