Patient and Provider Outcomes of E-Learning Training in Collaborative Assessment and Management of Suicidality

1. Refine a CAMS e-learning course that covers the same material and meets the same
learning objectives of CAMS in-person training.

We will refine an interactive, e-learning version of the standard CAMS in-person
training approach and conduct qualitative de-briefing sessions with 10 providers.
Revisions will be made based on this feedback.

2. Test the effectiveness of the CAMS e-learning modality compared to the CAMS in-person
modality and a concurrent non-intervention control in terms of provider evaluation and
behavior.

We will assess provider evaluation of the two learning experiences and a third arm, a
concurrent non-intervention control condition, in order to capture information that
would improve the experiences, rating content mastery, interactivity or participation,
confidence in acquired skills, and satisfaction with convenience of learning
experience. More importantly, in order to capture provider behavior, we will abstract
information from the charts of high risk patients to assess CAMS guideline concordance
for both learning modalities and a concurrent non-intervention control condition.

HO: Providers in each of the two CAMS arms will demonstrate higher levels of content
mastery and confidence in acquired skills than providers in the no CAMS arm.

H2: In the 12 months post-training, suicidal patients of providers in each of the two
CAMS arms will receive higher rates of CAMS guideline concordant treatment, compared
with providers in the no CAMS arm.

3. Test the effectiveness of the CAMS e-Learning delivery compared to the CAMS In-person
delivery and a concurrent non-intervention control in terms of patient outcomes.

We will assess patient outcomes of the two modalities through medical record
abstraction of high risk patients, including the following information: health services
use (inpatient and outpatient; mental health and non-mental health; emergency room
use), duration of high risk episodes, number of high risk episodes.

H3: In the 12 months post-training, suicidal patients of CAMS e-learning providers and
CAMS in-person providers will be similar for health services use patterns.

H4: In the 12 months post-training, suicidal patients of CAMS e-learning providers and
CAMS in-person providers will have similar duration of high risk episodes.

H5: In the 12 months post-training, suicidal patients of CAMS e-learning providers and
CAMS in-person providers will be similar for number of high risk episodes per patient.

H6: In the 12 months post training, suicidal patients of providers in the no CAMS arm
will have higher rates of emergency room use and inpatient mental health admissions,
have a longer average duration of high risk episodes and have more high risk episodes
per patient.

4. Assess factors that facilitate or inhibit adoption of CAMS through e-Learning or
In-person.

We will complete a formative evaluation using RE-AIM to document both the facilitating and
inhibiting factors related to both e-learning and in-person CAMS uptake. We do not present
a specific hypothesis for this aim, but rather seek to evaluate at all levels factors that
relate to adoption and implementation of CAMS guidelines.

This project is consistent with both the Institute of Medicine recommendations related to
the training of health professionals for the highest quality and safest care (15) and policy
reports from other national sources on suicide prevention which recommend empirically-based
training, systematic evaluation of training, and outcome research (16-18). The rationale
for this study is that there is a critical need to provide the growing numbers of veterans
at risk for suicide with the safest and highest quality of care. Most mental health
providers have not been trained in an empirically-based system for assessment or management
of suicide (such as CAMS). Efficient forms of learning must be developed to train the
increasing numbers of mental health providers being employed by the VA. CAMS e-Learning has
the potential to provide effective and efficient training for large numbers of adult
learners. It is unknown whether an e-Learning delivery will be as effective as the
In-person version has demonstrated itself to be.