Note: The views expressed in this blog poster are those of the author and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs or the United States government.

We say often that the “how” of suicide prevention is just as important as the “what”. Many intervention and prevention programs have been developed that are promising for reducing suicide risk, but it can be difficult for them to spread due to a variety of challenges such as gaps in training and logistical support. The goal of our review was to understand how the broader field has utilized implementation strategies for supporting suicide prevention interventions and programs. I strongly believe that we heal in community and that we also learn in community. Understanding strategies used by the field allows us to all grow together to ensure our interventions and programs reach those in need.

You might be wondering what implementation science is exactly and what are implementation strategies. Implementation strategies are strategies used to support a system in using a given intervention or program. Implementation science can be jargony, so I will share an example using one of my favorite foods, pizza. Imagine a local pizzeria wanted to start making a new kind of pizza that required more time to bake and different ingredients. Things that could come up include how much the new kind of pizza would add to the current menu, the degree to which ingredients are available and cost-effective, and if they had enough staff to support the process. In addition, it may be unclear whether the community wants this new kind of pizza or would prefer something different. Implementation science works to address these questions so that the pizza or a suicide prevention program can reach the end user. My team and I worked to identify what types of implementation strategies are currently in use as well as gaps in the literature. Our original goal was to understand how use of specific strategies is associated with successfully deploying interventions. Unfortunately, the state of the literature was not yet there for us to do so, as many papers did not clearly document their implementation processes and outcomes. There remains a strong need for sharing detailed experiences of implementing suicide prevention programs so we can build upon this collective wisdom.

As we think about the “how” of things, the work for this review occurred over several years with initial challenges with making sure we were capturing all the literature we could. It was both exciting and work-intensive to see the literature grow rapidly, as we did several rounds of gathering articles for our review. Once we started documenting the implementation strategies being used, it became clear that we needed to find some way to organize them, as the coding systems from the broader literature had dozens and dozens of strategies. We found that training and education-based strategies as well as iterative refinement (e.g., evaluating and revising interventions based on field experience) were the most commonly used across the field. This makes sense as increasing suicide prevention skills and systematically evaluating and optimizing an intervention are important for making a given intervention successful in a given setting. However, fewer studies worked to support clinicians and engage those who would use the intervention. Active engagement is important for ensuring that the interventions we make can be used effectively and respond to the needs of our communities.

Although we couldn’t clearly identify which implementation strategies work best, the hope is our review can encourage the field to share the work being done at a level where we can build upon our successes and challenges. For this year’s Suicide Prevention Month, I encourage you to take a moment for whatever you are doing to support suicide prevention and reflect on the “how”. That moment could help make sure that the next person in crisis is able to get to the support they need. In many ways, the multiple pieces needed for a positive experience happen long before the person even makes the call. Implementation science provides a way for those pieces to be assembled into a coherent puzzle to ensure all those at-risk for suicide get connected to care.