STEP-Home: Cognitive, emotional and vocational reintegration for OEF/OIF veterans

STEP-Home：OEF/OIF 退伍军人的认知、情感和职业重新融入

• 批准号: 8730869
• 负责人: Catherine Brawn Fortier
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-01 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8730869
• 关键词: Address; Adherence; Anxiety; Appointment; Attention; Automobile Driving; Blast Cell; Center for Translational Science Activities; Clinical; Cognitive; Communities; Comorbidity; Competence; Complex; Development; Diagnosis; Educational workshop; Emotional; Enrollment; Face; Family; Freedom; Future; Goals; Grant; Headache; High Prevalence; Home environment; Hospitals; Impairment; Individual; Intervention; Investigation; Life; Manuals; Measures; Memory; Mental Depression; Mental Health; Military Personnel; Modeling; Monitor; Parents; Participant; Patient Self-Report; Phase; Pilot Projects; Population; Post-Traumatic Stress Disorders; Prevalence; Problem Solving; Process; Productivity; Quality of life; Recruitment Activity; Rehabilitation therapy; Reporting; Research; Resistance; Running; Sampling; Schedule; Self Care; Self Perception; Sleep; Stress; Substance abuse problem; Symptoms; Training; Training Programs; Traumatic Brain Injury; Unemployment; Validity and Reliability; Veterans; Vocational rehabilitation; War; Work; World Health Organization Disability Assessment Schedule; anger management; base; chronic pain; clinical Diagnosis; cognitive skill; cohort; combat; community reintegration; daily functioning; design; emotion regulation; evidence base; experience; functional status; improved; interest; meetings; mild traumatic brain injury; multidisciplinary; operation; programs; psychoeducation; psychologic; public health relevance; skill acquisition; skills; skills training; standard of care; stress disorder; tool; traditional therapy; willingness

Veterans from Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) represent a clinically complex and growing group who require non-stigmatizing and multidisciplinary interventions that effectively target their many comorbidities that may be associated with mTBI and PTSD. The purpose of this SPiRE pilot proposal is to develop a reintegration workshop, STEP-Home, for use in OEF/OIF Veterans to aid in their transition from military to civilian life (transitioning "Home"), and to evaluate the feasibility of this program in a small pilot investigation. Our research indicates that 50% of participants enrolled in the VA RR&D supported TBI Center of Excellence, the Translational Research Center for TBI and Stress Disorders (TRACTS), report significant difficulty in functional status, which will be targeted by STEP-Home. This cohort suffers from high co-prevalence rates of emotional (e.g., posttraumatic stress disorder, depression, substance abuse) and physical (e.g., traumatic brain injury, chronic pain) wounds. Problems with memory, concentration, sleep, headaches, increased anxiety and irritability are common hallmarks of such wounds. Research indicates that a majority of combat veterans experience difficulty in readjusting to civilian life after returning from combat, and mental health problems are frequently cited as driving this difficulty. Unfortunately, this group of veterans has also been demonstrated to be highly resistant to psychological treatment and difficult to engage, showing particularly high rates of appointment no-shows and scheduling difficulties. STEP-Home hopes to address this by offering an alternative non-stigmatizing, skills-based workshop available to all OEF/OIF veterans regardless of clinical diagnosis. The STEP-Home workshop is based on the evidence-based rehabilitation program "STEP" that has been shown to be effective in ameliorating cognitive and emotional deficits following mild traumatic brain injury (mTBI) in civilians (Short-Term Executive Plus, STEP). We will target the specific needs of OEF/OIF veterans by focusing the content of the civilian STEP program on reintegration issues commonly faced after return home from combat (Veteran-specific program components). We have four primary aims in this proposal. First, we will develop the STEP-Home intervention including condensing and adapting the validated STEP program, creating a STEP-Home manual, developing a therapist training plan, and identifying assessment tools. Second, we will develop a fidelity monitoring plan to monitor and enhance the reliability and validity of STEP-Home. Third, we will pilot a small trial to examine feasibility and acceptability (tolerability/adherence) of STEP-Home. This STEP-Home pilot study will be offered to approximately 24 individuals returning from OEF/OIF, regardless of clinical diagnosis, who are enrolled in the VA RR&D supported TBI Center of Excellence, TRACTS. Fourth, we will evaluate the promise of our adapted intervention. The successful completion of the aims proposed has the potential to significantly improve the quality of life for all OEF/OIF veterans through this intervention aimed at readjustment to the civilian setting.

持久自由与行动伊拉克自由（OEF/OIF）的经营退伍军人代表临床 需要进行非耻辱和多学科干预措施的复杂和成长的群体，这些干预措施有效 针对可能与MTBI和PTSD相关的许多合并症。这个尖顶飞行员的目的 提案是开发一个重返社会研讨会，即阶级房屋，用于OEF/OIF退伍军人，以帮助他们 从军事生活过渡到平民生活（过渡“家庭”），并评估该计划的可行性 小型飞行员调查。我们的研究表明，有50％的参与者参加了VA RR＆D的支持 TBI卓越中心，TBI和压力障碍转化研究中心（区域）报告 功能状态的严重困难将以阶级为目标。这个队列遭受高 情绪的共阳性率（例如创伤后应激障碍，抑郁症，药物滥用）和 身体（例如，脑外伤，慢性疼痛）伤口。记忆，集中度，睡眠问题， 头痛，焦虑和烦躁不合是这种伤口的常见标志。研究表明 大多数战斗退伍军人在从战斗中返回后对平民生活的重新调整感到困难， 心理健康问题经常被认为是推动这一困难的。不幸的是，这群退伍军人 也已被证明对心理治疗具有很高的抵抗力，并且很难参与 尤其是高预约率的未分享和安排困难。踩踏希望解决 通过为所有OEF/OIF退伍军人提供的替代性非耻辱，基于技能的工作坊 无论临床诊断如何。台阶研讨会基于循证康复 程序“步骤”已被证明可以有效地改善认知和情感缺陷。 平民的轻度创伤性脑损伤（MTBI）（短期高管加，步骤）。我们将针对特定 OEF/OIF退伍军人的需求通过将平民步骤计划的内容集中在重返社会问题上 通常是在战斗（资深特定计划组件）返回家园后面对的。我们有四个 该提案的主要目的。首先，我们将制定台阶干预措施，包括凝结和 调整经过验证的步骤程序，创建阶梯手册，制定治疗师培训计划， 并确定评估工具。其次，我们将制定一个保真监视计划，以监视和增强 台阶的可靠性和有效性。第三，我们将试行一项小型试验，以检查可行性和 步进室的可接受性（耐受性/依从性）。此步进试点研究将提供给 无论临床诊断如何，大约24个人从OEF/OIF返回 VA RR＆D支持TBI卓越中心，区域。第四，我们将评估适应的承诺 干涉。提出的目标的成功完成有可能显着改善 通过这种干预措施，所有OEF/OIF退伍军人的生活质量旨在调整平民环境。