Veteran Sponsorship for Suicide Prevention
What You Need to Know Before You Apply
What is the purpose of this trial?
Background Young Veterans in the U.S. face a heightened risk of suicide, particularly during the first year after leaving military service-a period often referred to as the "deadly gap." Suicide rates among Veterans aged 18 to 34 have nearly doubled since 2001, and research shows that reintegration challenges during this transition are closely linked to increased suicide risk.
The Veteran Sponsorship Initiative (VSI) was developed to address this critical period by connecting Transitioning Servicemembers and Veterans (TSMVs) with trained, VA-certified peer sponsors. These sponsors help TSMVs navigate civilian life and access VA care. Early evaluations show that TSMVs matched with sponsors are more likely to report lower levels of reintegration difficulties, higher levels of social support, engage in VA services and report lower rates of depression and suicide risk.
This project enhances VSI by integrating predictive analytics-developed in partnership with Harvard Medical School and the DoW STARRS-LS team-to identify high-risk TSMVs before they leave the military. Those identified receive not only a sponsor but also targeted VA mental and health care services. This hybrid effectiveness-implementation study will evaluate the impact of this enhanced model (VSI+) on mental health outcomes and VA engagement among 2,700 high-risk TSMVs.
Method/Design
The purpose of this PEI proposal is to evaluate VSI expansion into VSI+ with enrollment occurring on four US Army installations (FY2026-2027). The study employs a pragmatic cluster-randomized trial with embedded mixed-method implementation evaluation to compare three arms:
1. Transition as Usual (TAU)
2. VSI Base= peer sponsorship and community support
3. VSI+= VSI Base plus VA stepped care services
The evaluation is guided by the RE-AIM framework to assess:
* Reach (enrollment rates)
* Effectiveness (reintegration difficulties, depression, anxiety, suicidal ideation/behavior, and VA utilization outcomes)
* Adoption (site and staff uptake)
* Implementation (fidelity and feasibility)
* Maintenance (sustainability)
Study Aims
1. Effectiveness: Evaluate the impact of VSI Base and VSI+ on reintegration difficulties, depression, anxiety, suicidal ideation/behavior, and VA utilization outcomes.
2. Implementation: Assess the feasibility and fidelity of implementing VSI Base and VSI+ across multiple sites using a bundled strategy.
3. Economic Impact: Estimate the budget impact of VSI Base and VSI+ on healthcare costs, including inpatient, emergency, and outpatient care.
Who Is on the Research Team?
David E Goodrich, EdD MS MA
Principal Investigator
VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA
Joseph C Geraci, PhD
Principal Investigator
James J. Peters Veterans Affairs Medical Center
Erin P Finley, PhD MPH
Principal Investigator
VA Greater Los Angeles Healthcare System, West Los Angeles, CA
Emily R Edwards, PhD
Principal Investigator
James J. Peters Veterans Affairs Medical Center
Richard W Seim
Principal Investigator
Central Texas Veterans Health Care System Waco VA Medical Center, Waco, TX
Brigid B Connelly, MA
Principal Investigator
Rocky Mountain Regional VA Medical Center, Aurora, CO
Marianne S. Goodman, MD
Principal Investigator
James J. Peters Veterans Affairs Medical Center
Jean Yoon, PhD MHS
Principal Investigator
VA Palo Alto Health Care System, Palo Alto, CA
Are You a Good Fit for This Trial?
This trial is for U.S. Transitioning Servicemembers and Veterans (TSMVs) aged 18 or older who are at high risk of suicide, especially during their first year after military service. Participants must enroll before discharge and plan to transition from one of the specified military installations during an active enrollment period.Inclusion Criteria
Timeline for a Trial Participant
Screening
Participants are screened for eligibility to participate in the trial
Pre-Discharge Intervention
TSMVs receive approximately two sessions of VSI+ intervention prior to discharge, including suicide risk screening and initial case management
Post-Discharge Intervention
TSMVs continue to receive VSI+ intervention, including ongoing case management and sponsor support, for approximately 6 months post-discharge
Follow-up
Participants are monitored for reintegration difficulties, mental health outcomes, and VA utilization
What Are the Treatments Tested in This Trial?
Interventions
- Onward Ops- receive peer sponsor and community support
- VA stepped care services
Trial Overview
The study compares three approaches: usual transition support, peer sponsorship with community support (VSI Base), and VSI Base plus additional VA stepped care services (VSI+). It aims to see if these can reduce reintegration difficulties, depression, anxiety, suicidal thoughts/behaviors, and improve engagement with VA services.
How Is the Trial Designed?
3
Treatment groups
Experimental Treatment
Active Control
Arm 3. VSI+, n=900 * receives Onward Ops peer sponsor and community services * receives VA stepped care services
Arm 2. VSI Base, n=900 * receives Onward Ops peer sponsor and community services * receives no VA stepped care services
Arm 1. Transition as Usual, n=900 * receives no Onward Ops services * receives no VA stepped care services
Find a Clinic Near You
Who Is Running the Clinical Trial?
VA Office of Research and Development
Lead Sponsor
VISN 17 Center of Excellence for Research on Returning War Veterans
Collaborator
Department of War Study to Assess Risk & Resilience in Servicemembers - Longitudinal Study
Collaborator
James J. Peters Veterans Affairs Medical Center
Collaborator
Health Economics Resource Center
Collaborator
VISN 2 Mental Illness Research, Education and Clinical Center
Collaborator
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