Expanding Veteran Sponsorship Initiative+ to Support High-Risk Transitioning Servicemembers and Veterans: A Precision Medicine Approach

Summary

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.

Conditions

• Reintegration Difficulties
• Suicidal Ideation and Behaviors
• Health
• Connectedness

Interventions

BEHAVIORAL

Onward Ops- receive peer sponsor and community support

Onward Ops is a nonprofit organization dedicated to supporting U.S. military service members and their families as they transition from active duty to civilian life. It provides a structured, community-based approach to help ease the challenges of reintegration. Participants may engage in either the Onward Ops Solo or Co-Op track. Both tracks provide access to the Onward Ops dashboard- an online platform to manage transition plans, track progress, and explore curated resources. In addition, Co-Op participants are matched to a community-based, peer sponsor \& receive assistance from community partners.

BEHAVIORAL

VA stepped care services

The high-risk TSMVs receive approximately five sessions of VSI+ with optimally two sessions occurring prior to discharge with a TRICARE approved referral. VSI+ is delivered via telehealth video to allow flexibility and to accommodate the fact that TSMVs will be moving after discharge. The topics and tasks associated with each session involve items such as confirming TSMVs completed their VHA registration and VBA service-connected disability application, made contact with their VSI sponsor, submitted their military records to enable them to receive a VHA eligibility group, and directly connecting TSMVs to VHA primary care. Because VSI+ is designed as an adjunctive service and TSMVs may require a broad range of services and resources, the VSI+ social workers ensure ongoing communication with VSI sponsors, community partners, VHA primary care and mental health providers. TSMVs will have seamless access to the NVCC with ability to receive primary and specialty care.

Sponsors & Collaborators

• VISN 2 Mental Illness Research, Education and Clinical Center

  collaborator UNKNOWN

• VISN 17 Center of Excellence for Research on Returning War Veterans

  collaborator UNKNOWN

• Department of War Study to Assess Risk & Resilience in Servicemembers - Longitudinal Study

  collaborator UNKNOWN

• James J. Peters Veterans Affairs Medical Center

  collaborator FED

• Health Economics Resource Center

  collaborator UNKNOWN

• VA Office of Research and Development

  lead FED

Principal Investigators

• Joseph C Geraci, PhD · James J. Peters Veterans Affairs Medical Center

• Richard W Seim · Central Texas Veterans Health Care System Waco VA Medical Center, Waco, TX

• Emily R Edwards, PhD · James J. Peters Veterans Affairs Medical Center

• Marianne S. Goodman, MD · James J. Peters Veterans Affairs Medical Center

• Brigid B Connelly, MA · Rocky Mountain Regional VA Medical Center, Aurora, CO

• Erin P Finley, PhD MPH · VA Greater Los Angeles Healthcare System, West Los Angeles, CA

• Jean Yoon, PhD MHS · VA Palo Alto Health Care System, Palo Alto, CA

• David E Goodrich, EdD MS MA · VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA

Study Design

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2026-01-01

Primary Completion

2027-09-30

Completion

2027-09-30

Countries

• United States

Study Locations