Mixed-methods formative evaluation of implementing an adapted suicide prevention treatment: Dialectical Behavior Therapy Skills Groups in the Veterans Health Administration.

Background: Preventing veteran suicide requires addressing mechanisms driving suicidal behavior, such as emotion dysregulation. Dialectical Behavior Therapy Skills Groups (DBT-SG) are well established for reducing emotion dysregulation, improving coping skills, and in some studies, reducing suicide attempt, but will require implementation support to deliver DBT-SG and to test its effectiveness within the Veterans Health Administration (VHA). Methods: We conducted a mixed-method developmental formative evaluation of DBT-SG at four VHA medical centers, guided by the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, as part of a hybrid effectiveness-implementation trial (Clinical trials ID, NCT05000749). Results: Quantitative Organizational Reasons for Change Assessment data ( Conclusions: Implementation barriers to DBT-SG at VHA include limited staffing, despite staff enthusiasm. The next phase of this project will evaluate DBT-SG effectiveness in a randomized controlled trial. Clinical trials registration: https://clinicaltrials.gov/study/NCT05000749, identifier NCT05000749.