Cognitive Rehabilitation for Homeless OEF/OIF/OND Veterans

无家可归的 OEF/OIF/OND 退伍军人的认知康复

• 批准号: 9922121
• 负责人: Elizabeth W Twamley
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9922121
• 关键词: Activities of Daily Living; Address; Affect; Afghanistan; Appointment; Attention; Award; Beds; Brain; Cognition; Cognitive; Cost Savings; Decision Making; Education; Educational Intervention; Educational process of instructing; Employment; Face; Failure; Future; Health; Health Care Costs; Healthcare; Heterogeneity; Homelessness; Housing; Impaired cognition; Impairment; Income; Individual; Innovative Therapy; Intervention; Iraq; Judgment; Learning; Mediating; Medical; Memory; Mental Depression; Mental Health; Mental disorders; Neurobehavioral Manifestations; Neurocognitive; Neuropsychology; Outcome; Pathway interactions; Population; Post-Traumatic Stress Disorders; Problem Solving; Quality of life; Randomized Controlled Trials; Recording of previous events; Recovery; Rehabilitation therapy; Request for Applications; Research; Residential Treatment; Risk; Route; Schools; Services; Severities; Sleep; Stress; Substance abuse problem; Telephone; Traumatic Brain Injury; Veterans; Work; cognitive function; cognitive performance; cognitive rehabilitation; cognitive testing; cognitive training; community reintegration; disability; evidence base; executive function; follow-up; functional disability; functional restoration; improved; improved functioning; prevent; primary outcome; programs; prospective memory; psychosocial; psychosocial rehabilitation; public health relevance; skills; supported housing; treatment adherence; treatment program

 DESCRIPTION (provided by applicant): Ending homelessness among Veterans by 2015 is a national priority. Although there are many routes to homelessness, the end result of homelessness frequently involves a failure in planning, problem-solving, or both. Planning and problem-solving are executive functions dependent upon intact brain functioning, and these and other neurocognitive abilities may be impaired in up to 80% of homeless individuals, affecting their organization, judgment, decision-making, and ability to benefit from psychosocial rehabilitation interventions. Thus, cognitive impairment may be an underappreciated yet pervasive barrier to efforts toward ending homelessness. Causes of cognitive impairment in homeless individuals include traumatic brain injury, psychiatric illness, substance abuse, and other medical conditions. Cognitive impairment may interact with these conditions to result in poor housing outcomes, poor treatment adherence, and risk of continued homelessness. Cognitive assessment and rehabilitation in the setting of homeless services is not common, with no known studies to date of cognitive rehabilitation for homeless individuals. We have a golden opportunity to address these research gaps by studying Veterans at the Aspire Center, a 40-bed Residential Rehabilitation Treatment Program (domiciliary) serving homeless returning Veterans with mental health conditions (psychiatric illness, substance abuse, and traumatic brain injuries). In a 15-week randomized controlled trial, Veterans with cognitive or functional impairments will receive an evidence-based, 10-week Compensatory Cognitive Training (CCT) intervention or an education control condition to examine the effects of cognitive rehabilitation in this Veteran population. CCT aims to improve real-world cognitive performance by teaching strategies to improve prospective memory (remembering to do things), attention, learning/memory, and executive functioning. Strategies to reduce stress and improve sleep are also included. CCT has been shown to improve cognition, functional capacity, neurobehavioral symptom severity, and quality of life in individuals with cognitive impairment associated with psychiatric illness and in Veterans with TBI. During the trial, assessments will be administered at baseline, 5 weeks, 10 weeks, and 15 weeks, and monthly follow-up phone calls will assess housing and employment/education status for one year following program discharge. We expect CCT-associated improvements in cognition and functional skills (co-primary outcomes) and generalization to reduced levels of disability, along with improved community reintegration outcomes (better housing stability and participation in work or school). By attending to and treating the cognitive impairments that many of these Veterans will have, we can potentially alter the course of the Veterans' trajectories and prevent future homelessness and its negative health consequences, resulting in both healthcare cost savings and improved quality of life for Veterans.

 描述（由申请人提供）： 到2015年，退伍军人的无家可归是一个国家优先事项。尽管有许多无家可归的路线，但无家可归的最终结果经常涉及计划，解决问题或两者兼而有之。计划和解决问题是执行功能取决于完整的大脑功能，这些和其他神经认知能力可能会受到多达80％的无家可归者的损害，从而影响其组织，判断力，决策以及从心理社会康复干预措施中受益的能力。这就是认知障碍可能是为消除无家可归的努力而被低估但普遍存在的障碍。无家可归者认知障碍的原因包括脑损伤，精神病，药物滥用和其他医疗状况。认知障碍可能与这些条件相互作用，从而导致住房结果不佳，治疗依从性不佳以及持续无家可归的风险。在无家可归者服务的环境中，认知评估和康复并不常见，没有针对无家可归者进行认知康复的知名研究。我们有一个金色的机会来解决这些研究差距，通过在Aspire Center进行退伍军人，这是一个40张床的住宅康复治疗计划（住所康复治疗计划（住所），为患有精神健康状况的无家可归者退伍军人服务（精神病，药物滥用，药物滥用和创伤性大脑）在15周的随机对照或良好的攻击性训练中，将接受验证的攻击性，将接收良好的攻击，这是10周的经验训练（10周）。教育条件在这项退伍军人人群中检查认知康复的影响。患有精神病和患有TBI的退伍军人。在试验期间，评估将在基线，5周，10周和15周时进行，每月的随访电话将评估计划出院后一年的住房和就业/教育状况。我们预计，CCT相关的认知和功能技能（共同成果）和概括为降低残疾水平以及社区重新融合成果（更好的住房稳定性和参与工作或学校的参与），与CCT相关。通过关注和治疗这些退伍军人中许多退伍军人的认知障碍，我们可以潜在地改变退伍军人的轨迹过程，并防止未来的无家可归者及其负面的健康后果，从而既节省了医疗保健成本又可以改善退伍军人的生活质量。