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

• Sponsor: US Department of Veterans Affairs (U.S. Fed)
• Overall Status: Completed
• CT.gov ID: NCT00905827
• Collaborator: Medical University of South Carolina (Other), Washington Psychological Center (Other)
• Enrollment: 212
• Locations: 5
• Arms: 3
• Duration (Months): 41
• Patients Per Site: 42.4
• Patients Per Site Per Month: 1

Study Details

Study Description

Brief Summary

Suicide prevention among military Veterans has become a national priority; yet, there is a gap in suicide-specific intervention training for mental health students and professionals. The need for training in this area has become even more acute with the recent hiring by the Veterans Health Affairs (VHA) of thousands of clinicians to address the mental health needs of Veterans from all war eras. Since e-learning (online) education is more effective than traditional in-person (face-to-face) education for adult learners when methods, such as blended learning, are used, this mode of delivery may more easily meet the training and continuing education needs of busy medical professionals who may find it easier to fit online education into their daily schedules.

A well developed in-person training approach known as the Collaborative Assessment and Management of Suicidality (or CAMS) has been recommended in systematic reviews as an effective tool for assessing and managing suicidality, as well as decreasing providers' fears, improving their attitudes, increasing their knowledge, confidence, and competence, and dispelling myths. The overall aims of this project were to develop an e-learning alternative for the CAMS program, determine its effectiveness relative to in-person CAMS training, and assess factors that may relate to adoption and implementation of CAMS in general and specifically through e-learning and in-person modalities.

Condition or Disease	Intervention/Treatment	Phase
Suicide	Behavioral: CAMS	N/A

Detailed Description

There were four specific aims:

1. Refine a Collaborative Assessment and Management of Suicidality (or CAMS) e-learning course that covers the same material and meets the same learning objectives of CAMS in-person training.

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.

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.

1. 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.

H3, 4, 5: 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, duration of high risk episodes, and 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.

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

Of the 309 providers who met eligibility criteria, 230 consented and 212 completed the baseline assessments and were randomized. A total of 261 patients met eligibility criteria and information was abstracted on them.

We developed the CAMS-e, conducted a pilot, revised the e-CAMS, delivered the training in the first site, and again revised it. There is little difference in satisfaction ratings between the two types of training deliveries on the VA Evaluation of Training. Findings show that there were some modest immediate improvements due to the two training conditions; however, the effects were only sustainable at three months for one question related to hospitalization beliefs.

To date, the project has had the following impacts:

1. success in obtaining 6.5 continuing education units (CEUs) for the e-learning version

2. invitations to place e-CAMS on the Department of Defense learning platforms

3. VA Central Office has purchased a license to use the Suicide Status Form (SSF) as a clinical tool and template in the computerized electronic patient record system throughout the national VA. The template is in the developmental process.

4. Efforts are underway to move the CAMS e-learning on to the VA Training Management System (TMS) which will facilitate system wide dissemination and has the potential to increase adoption in VAMC's or by providers.

Additional impacts may be evident with regard to improved care once we complete analysis of the patient outcomes and provider adherence data. We have also considered a short manuscript on economic analysis

Study Design

• Study Type: Interventional
• Actual Enrollment: 212 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Single (Outcomes Assessor)
• Primary Purpose: Health Services Research
• Official Title: Patient and Provider Outcomes of E-Learning Training in Collaborative Assessment and Management of Suicidality
• Study Start Date: Jul 1, 2010
• Actual Primary Completion Date: Jul 1, 2013
• Actual Study Completion Date: Dec 1, 2013

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Intervention 1: in person CAMS In person Collaborative Assessment and Management of Suicidality (CAMS) training for providers	Behavioral: CAMS; Collaborative assessment management in suicidality
Experimental: Intervention 2: e-learning CAMS Online Collaborative Assessment and Management of Suicidality (CAMS) training for providers	Behavioral: CAMS; Collaborative assessment management in suicidality
No Intervention: Control: no training Control Group: no training

Outcome Measures

Primary Outcome Measures

1. Provider Self-efficacy and Beliefs About Suicidality [post-training]

   Assessed beliefs and confidence in managing suicidal individuals. Using a 5-point Likert scale, there were 11 items that addressed the following: competence, reactions, beliefs, motivations, and CAMS as it relates to their practice. Scores ranged from 11-55 with questions were phrased so higher scores indicated more positive views.

Secondary Outcome Measures

1. Satisfaction With Training [post-training]

   Evaluation included 20 standard items assessing providers satisfaction with training, including items similar to other published satisfaction surveys. Survey items were rated using a five-point Likert scale indicating the degree to which respondents agreed or disagreed. Questions were always phrased positively so that agree or strongly agree is equivalent to a positive response.

Eligibility Criteria

Criteria

• Ages Eligible for Study: 22 Years to 80 Years
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Inclusion Criteria:

• Mental health providers, psychiatrist, social workers, psychologist, advanced practice nurses and case managers

Exclusion Criteria:

• Previous CAMS Training

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	VA Medical Center, Birmingham, AL	Birmingham	Alabama	United States	35233
2	VA Medical Center, Tuscaloosa	Tuscaloosa	Alabama	United States	35404
3	Atlanta VA Medical and Rehab Center, Decatur, GA	Decatur	Georgia	United States	30033
4	Ralph H. Johnson VA Medical Center, Charleston, SC	Charleston	South Carolina	United States	29401-5799
5	Wm. Jennings Bryan Dorn VA Medical Center, Columbia SC	Columbia	South Carolina	United States	29209

Sponsors and Collaborators

• US Department of Veterans Affairs
• Medical University of South Carolina
• Washington Psychological Center

Investigators

• Principal Investigator: Kathryn M. Magruder, PhD MPH BA, Ralph H. Johnson VA Medical Center, Charleston, SC

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

• Responsible Party: US Department of Veterans Affairs
• ClinicalTrials.gov Identifier: NCT00905827
• Other Study ID Numbers: EDU 08-424; 19016
• First Posted: May 21, 2009
• Last Update Posted: Apr 24, 2015
• Last Verified: Oct 1, 2014

• Keywords provided by US Department of Veterans Affairs: suicide; assessment; management; Provider Training; health services
• Additional relevant MeSH terms: Suicide

Study Results

Participant Flow

Arm/Group Title	Intervention 1: In-person CAMS	Intervention 2: E-learning CAMS	Control
Arm/Group Description	Intervention: in-person CAMS training	Intervention: e-learning CAMS training	Control: no training
Period Title: Overall Study
STARTED	70	69	73
COMPLETED	70	69	73
NOT COMPLETED	0	0	0

Baseline Characteristics

Arm/Group Title	Intervention 1: In-person CAMS	Intervention: E-training CAMS	Control	Total
Arm/Group Description	Intervention: in-person CAMS training for providers	Intervention: e-training CAMS training for providers	Control: no training	Total of all reporting groups
Overall Participants	70	69	73	212
Age, Customized (participants) [Number]
20-29 years	4 5.7%	4 5.8%	6 8.2%	14 6.6%
30-39 years	22 31.4%	22 31.9%	23 31.5%	67 31.6%
40-49 years	15 21.4%	13 18.8%	22 30.1%	50 23.6%
50-59 years	19 27.1%	22 31.9%	18 24.7%	59 27.8%
60-69 years	10 14.3%	8 11.6%	4 5.5%	22 10.4%
Sex: Female, Male (Count of Participants)
Female	47 67.1%	49 71%	59 80.8%	155 73.1%
Male	23 32.9%	20 29%	14 19.2%	57 26.9%
Race/Ethnicity, Customized (participants) [Number]
White	45 64.3%	45 65.2%	46 63%	136 64.2%
African American	15 21.4%	19 27.5%	14 19.2%	48 22.6%
Hispanic	0 0%	2 2.9%	1 1.4%	3 1.4%
Other	6 8.6%	1 1.4%	4 5.5%	11 5.2%
Profession (participants) [Number]
Psychiatrist	12 17.1%	12 17.4%	12 16.4%	36 17%
Psychologist	16 22.9%	13 18.8%	18 24.7%	47 22.2%
Midlevel Provider	42 60%	44 63.8%	43 58.9%	129 60.8%

Outcome Measures

1. Primary Outcome

Title	Provider Self-efficacy and Beliefs About Suicidality
Description	Assessed beliefs and confidence in managing suicidal individuals. Using a 5-point Likert scale, there were 11 items that addressed the following: competence, reactions, beliefs, motivations, and CAMS as it relates to their practice. Scores ranged from 11-55 with questions were phrased so higher scores indicated more positive views.
Time Frame	post-training

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention 1: In-person CAMS	Intervention 2: E-learning CAMS	Control
Arm/Group Description	Intervention: in-person CAMS training	Intervention: e-learning CAMS training	Control: no training
Measure Participants	70	69	73
Mean (Standard Error) [units on a scale]	45.6 (0.5)	44.9 (0.5)	43.0 (0.6)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Intervention 1: In-person CAMS, Control
	Comments	Pairwise comparisons (ANOVA simple effect comparisons) adjusted for baseline scores
	Type of Statistical Test	Superiority or Other
	Comments
Statistical Test of Hypothesis	p-Value	<0.01
	Comments
	Method	ANOVA
	Comments

Statistical Analysis 2

Statistical Analysis Overview	Comparison Group Selection	Intervention 2: E-learning CAMS, Control
	Comments	Pairwise comparisons (ANOVA simple effect comparisons) adjusted for baseline scores
	Type of Statistical Test	Superiority or Other
	Comments
Statistical Test of Hypothesis	p-Value	0.01
	Comments
	Method	ANOVA
	Comments

2. Secondary Outcome

Title	Satisfaction With Training
Description	Evaluation included 20 standard items assessing providers satisfaction with training, including items similar to other published satisfaction surveys. Survey items were rated using a five-point Likert scale indicating the degree to which respondents agreed or disagreed. Questions were always phrased positively so that agree or strongly agree is equivalent to a positive response.
Time Frame	post-training

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Intervention 1: In-person CAMS	Intervention 2: E-learning CAMS
Arm/Group Description	Intervention: in-person CAMS training	Intervention: e-learning CAMS training
Measure Participants	70	69
Agree	66 94.3%	62 89.9%
Neutral	3 4.3%	2 2.9%
Disagree	1 1.4%	5 7.2%

Adverse Events

Time Frame	1 year
Adverse Event Reporting Description	DSMB assembled annually
Arm/Group Title	Arm 1		Arm 2		Arm 3
Arm/Group Description	Intervention: in person CAMS training for providers CAMS: Collaborative assessment management in suicidality		Intervention: e-learning CAMS training for providers CAMS: Collaborative assessment management in suicidality		Control Group: no training
All Cause Mortality
	Arm 1		Arm 2		Arm 3
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	/ (NaN)		/ (NaN)		/ (NaN)
Serious Adverse Events
	Arm 1		Arm 2		Arm 3
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/70 (0%)		0/69 (0%)		0/73 (0%)
Other (Not Including Serious) Adverse Events
	Arm 1		Arm 2		Arm 3
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/70 (0%)		0/69 (0%)		0/73 (0%)

Limitations/Caveats

Providers in this VISN may not be representative of providers in other VAMCs.

More Information

Certain Agreements

All Principal Investigators ARE employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.