Implementation Strategies in Suicide Prevention

Implementation science is a field which studies the factors needed for ensuring an intervention is used and maintained when deployed in the real world. The goal of our review was to understand the current use of implementation strategies for supporting suicide prevention across diverse settings.
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BioMed Central
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Implementation strategies in suicide prevention: a scoping review - Implementation Science

Background Implementation strategies can be a vital leveraging point for enhancing the implementation and dissemination of evidence-based suicide prevention interventions and programming. However, much remains unknown about which implementation strategies are commonly used and effective for supporting suicide prevention efforts. Methods In light of the limited available literature, a scoping review was conducted to evaluate implementation strategies present in current suicide prevention studies. We identified studies that were published between 2013 and 2022 that focused on suicide prevention and incorporated at least one implementation strategy. Studies were coded by two independent coders who showed strong inter-rater reliability. Data were synthesized using descriptive statistics and a narrative synthesis of findings. Results Overall, we found that studies most commonly utilized strategies related to iterative evaluation, training, and education. The majority of studies did not include direct measurement of suicide behavior outcomes, and there were few studies that directly tested implementation strategy effectiveness. Conclusion Implementation science strategies remain an important component for improving suicide prevention and intervention implementation. Future research should consider the incorporation of more type 3 hybrid designs as well as increased systematic documentation of implementation strategies. Trial registration < de-identified >

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.

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Advancing the Science and Metrics on the Pace of Implementation

The persistent 17-year span between discovery and application of evidence in practice has been a rallying cry for implementation science. That frequently quoted time period often implies that implementation needs to occur faster. But what do we really know about the time required to implement new evidence-based practices into routine settings of care. Does implementation take 17 years? Is implementation too slow? Can it be accelerated? Or, does a slower pace of implementing new evidence-based innovations serve a critical function? In many cases—pandemics, health inequities, urgent social crises—pressing needs demand timely implementation of rapidly accruing evidence to reduce morbidity and mortality. Yet many central tenets of implementation, such as trust, constituent inclusion, and adaptation, take time and may require a slow pace to ensure acceptability and sustained uptake.

To date, little attention and scant data address the pace of implementation. Speed is a rarely studied or reported metric in implementation science. Few in the field can answer the question, “how long does implementation take?” Answering that question requires data on how long various implementation phases take, or how long it takes to achieve implementation outcomes such as fidelity, adoption, and sustainment. Importantly, we lack good data on how different implementation strategies may influence the amount of time to achieve given outcomes.

To advance knowledge about how long implementation takes and how long it “should optimally” take, this collection seeks to stimulate the publication of papers that can advance the measurement of implementation speed, along with the systematic study of influences on and impacts of speed across diverse contexts, to more adequately respond to emerging health crises and benefit from emerging health innovations for practice and policy. In particular, we welcome submissions on 1) methodological papers that facilitate development, specification, and reporting on metrics of speed, and 2) data-based research (descriptive or inferential) that reports on implementation speed metrics, contextual factors and/or active strategies that affect speed, or the effects of implementation speed on important outcomes in various contexts.

Areas of interest include but are not limited to:

• Data based papers documenting pace of moving through various implementation phases, and identifying factors (e.g., implementation context, process, strategies) that affect pace of implementation (e.g., accelerators and inhibitors)

• Data based papers from multi-site, including multi-national, studies comparing pace of innovation adoption, implementation, and sustainment across various contexts

• Data based papers reporting time to implementation in the face of urgent social conditions (e.g., climate change, disaster relief) Papers on how to accelerate time to delivery of treatment discoveries for specific health conditions (e.g., cancer, infectious disease, suicidality, opioid epidemic)

• Data based papers on the timeliness of policy implementation, including factors influencing the time from data synthesis to policy recommendation, and from policy recommendation to implementation

• Span of time needed to: achieve partner collaboration, including global health partnerships adapt interventions to make them more feasible, usable, or acceptable achieve specific implementation outcomes (e.g., adoption, fidelity, scale-up, sustainment) de-implement harmful or low-value innovations, or to identify failed implementation efforts

• Effect of implementation pace on attainment of key outcomes such as constituent engagement, intervention acceptability or sustainability, health equity, or other evidence of clinical, community, economic, and/or policy benefits.

• Papers addressing the interplay between pace and health equity, speed and sustainability, and other considerations that impact decision-making on implementation

• Methodological pieces that advance designs for testing speed or metrics for capturing the pace of implementation

• This Collection welcomes submission of a range of article types. Should you wish to submit to this Collection, please read the submission guidelines of the journal you are submitting to Implementation Science or Implementation Science Communications to confirm that type is accepted by the journal you are submitting to.

• Articles for this Collection should be submitted via our submission systems in Implementation Science or Implementation Science Communications. During the submission process you will be asked whether you are submitting to a Collection, please select "Advancing the Science and Metrics on the Pace of Implementation" from the dropdown menu.

• Articles will undergo the standard peer-review process of the journal they are considered in Implementation Science or Implementation Science Communications and are subject to all of the journal’s standard policies. Articles will be added to the Collection as they are published.

• The Editors have no competing interests with the submissions which they handle through the peer-review process. The peer-review of any submissions for which the Editors have competing interests is handled by another Editorial Board Member who has no competing interests.

Publishing Model: Open Access

Deadline: Dec 31, 2025