Partnered Implementation Evaluation of a National Sponsorship Program for Transitioning Service Members

对转业军人国家赞助计划的合作实施评估

• 批准号: 10189418
• 负责人: Joseph C. Geraci
• 金额: --
• 依托单位: JAMES J PETERS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10189418
• 关键词: Academia; Acute; Address; Adoption; Caring; Cities; Clinic; Clinical Treatment; Communities; Community Services; Data; Department of Defense; Effectiveness; Elements; Enrollment; Epidemic; Evaluation; Feeling suicidal; Generalized Anxiety Disorder; Geographic Locations; Health; Hybrids; Individual; Intake; Intervention; Interview; Life; Maintenance; Measures; Medical center; Mental Depression; Methods; Military Personnel; Modeling; Modification; Monitor; New York City; Outcome; Outcome Measure; Patients; Periodicity; Post-Traumatic Stress Disorders; Prevention; Professional counselor; Program Evaluation; Program Sustainability; Public Health; Publishing; Questionnaires; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Risk; Running; Services; Severities; Site; Social support; Soldier; Suicide; Suicide prevention; Surveys; Texas; Time; United States; United States Department of Veterans Affairs; Veterans; Work; aged; base; community organizations; control trial; design; effectiveness evaluation; effectiveness implementation trial; experience; expiration; formative assessment; implementation evaluation; improved; interest; post 9/11; primary outcome; programs; psychological distress; recruit; routine care; service member; service utilization; stressor; suicidal behavior; suicidal morbidity; suicidal risk; suicide rate; treatment effect; trend

Problem in VA Proposal is Addressing. The United States is currently experiencing a national epidemic of suicide for its youngest Service Members (SMs) still serving in the Department of Defense (DOD, 2019) and those that have already transitioned out of the military. For example, the rate of suicide for Veterans aged 18- 34 years old having more than doubled from approximately 22 suicide deaths per 100,000 in 2006 to 45 per 100,000 in 2016 (VA, 2018; VA 2019). It appears that a period of significant risk for these young Veterans is during their first year after separating from the military with recent estimates suggesting an increase of nearly 50% during this period (Kang et al., 2015; Shen, Cunha, & Williams, 2016). As a result of the troubling trends, two executive orders have been issued within the last two years calling for federal organizations to work closer with local, nonprofit and academia organizations to implement a public health approach to suicide prevention. Preventing suicide remains a top priority for the VA with similar sentiments of a public health perspective to suicide prevention being recently published National Strategy for Preventing Suicide (VA, 2018). In this strategy, the VA acknowledged that it must reach out to Servicemembers (SMs) and Veterans in the community before they experience an acute crisis (VA, 2018). Similarly, VISN 17 made a significant commitment to the Expiration Term of Service (ETS) Sponsorship program in order to engage SMs prior to them exiting the military. Preliminary analysis was conducted for a recent randomized control trial with post- 9/11 Veterans in New York City that received the support from ETS Sponsors with the results showing a moderate treatment effect for both reduced transition stressors and improved social support (Geraci, 2018). Aims. We propose a Hybrid Type 2 effectiveness-implementation trial to evaluate the expansion of ETS Sponsorship across six cities from FY 2020 to 2023 in Texas. Aim #1 will determine the effectiveness of the ETS sponsorship program, as evidenced by measures of transition stressors, social support, psychological distress, suicidal ideation and behaviors, and VA/non-VA service utilization. Aim #2 will determine the feasibility and potential utility of implementing the ETS Sponsorship program to six cities in Texas. SMs that transition to cities without an established ETS Sponsorship program will experience their transition from military to civilian life as usual (i.e., services available from the U.S. Army Soldier for Life-Transition Assistance Program). After cities have implemented the ETS Sponsorship program, transitioning SMs will have access to an ETS Sponsor in their city and warm handoffs to community services. Methods. We will use a stepped wedge design while using other cities as controls until they begin implementation. This design will allow us to extend implementation support to the maximal number of cities and enhance the formative evaluation (periodic reflections with key partners and SM interviews). The stepped wedge design also enables us to make efficient use of all data available for within-site and between-site comparisons. For the within-site comparison, cities will act as their own controls in a program evaluation that compares cities pre- versus post- implementation. The comparison examines cities as they cross-over from control to intervention states. The between-site comparison evaluates the intervention period for a city vs. all other intervention and control periods for all cities. Outcomes of interest are measured for all transitioning SMs at each city within the given intervention time period. We randomized at the city level and will use individual SMs as the unit of observation for primary quantitative outcome measures. Six cities will participate in the program evaluation, with two cities allocated to each of the three start dates or steps. Hierarchical models will be run in which SMs are nested within city analyzing the results of the pre-implementation and post- implementation assessments. Hierarchical random effects models examine within- and between-group change across time and by condition.

VA提案中的问题正在解决。美国目前正在经历 自杀的最年轻的服务成员（SMS）仍在国防部任职（国防部，2019年）和 那些已经从军队过渡的人。例如，年龄18-的退伍军人的自杀率 34岁的年龄从2006年的每100,000人约22次自杀死亡增加了一倍以上 2016年为100,000（VA，2018； VA 2019）。看来这些年轻退伍军人有重大风险的时期是 在与军方分离后的第一年，最近的估计表明几乎增加了 在此期间的50％（Kang等，2015； Shen，Cunha和Williams，2016年）。由于令人不安的趋势， 在过去两年中，已发出了两项行政命令，要求联邦组织更紧密地工作 与地方，非营利组织和学术组织一起实施一种预防自杀的公共卫生方法。 防止自杀仍然是VA的重中之重，具有类似的公共卫生观点的观点 预防自杀是最近发布的预防自杀战略（VA，2018年）。在这个 策略，弗吉尼亚州承认，它必须与Servicembers（SMS）和退伍军人联系 在经历严重危机之前的社区（VA，2018年）。同样，Visn 17显着 对服务期限（ETS）赞助计划的承诺，以便在 他们离开军队。对最近的随机对照试验进行了初步分析， 纽约市的9/11退伍军人获得了ETS赞助商的支持，结果显示 减少过渡压力源和改善社会支持的中等治疗效果（Geraci，2018年）。 目标。我们提出了一项混合2型有效性实施试验，以评估ETS的扩展 从2020财年到2023年在得克萨斯州的六个城市的赞助。 AIM＃1将决定 ETS赞助计划，通过过渡压力源，社会支持，心理学的措施证明 困扰，自杀构想和行为以及VA/非VA服务利用。 AIM＃2将确定 向德克萨斯州六个城市实施ETS赞助计划的可行性和潜在效用。短信 没有建立的ETS赞助计划过渡到城市将经历他们从军事的过渡 像往常 程序）。城市实施了ETS赞助计划后，过渡SMS将可以访问 ETS的赞助商在他们的城市中，并为社区服务提供了温暖的交接。 方法。我们将在使用其他城市作为控件的同时使用梯级楔形设计直到它们开始 执行。该设计将使我们能够将实施支持扩展到最大数量的城市 并增强形成性评估（通过关键合作伙伴和SM访谈的定期反思）。走了 楔形设计还使我们能够有效利用所有可用于现场和现场间的数据 比较。对于现场比较，城市将在计划评估中充当自己的控制 比较城市前与实施后。比较检查城市从 控制干预状态。地点比较评估城市的干预期与所有人的干预期 所有城市的其他干预和控制期。为所有过渡SMS测量了感兴趣的结果 在给定的干预期内的每个城市。我们在城市一级随机，将使用个人 SMS作为初级定量结果度量的观察单位。六个城市将参加 计划评估，两个城市分配给了三个开始日期或步骤中的每个城市。分层模型将 在城市中嵌套SMS的运行，分析了实施前和后的结果 实施评估。分层随机效应模型检查组内和间变化 跨时间和条件。

项目成果

Supporting servicemembers and veterans during their transition to civilian life using certified sponsors: A three-arm randomized controlled trial.

使用经过认证的赞助商支持现役军人和退伍军人过渡到平民生活：一项三组随机对照试验。

• DOI: 10.1037/ser0000764
• 发表时间: 2023
• 期刊: Psychological services
• 影响因子: 2.3
• 作者: Geraci,JosephC;Dichiara,Ariana;Greene,Ashley;Gromatsky,Molly;Finley,ErinP;Kilby,Daniel;Frankfurt,Sheila;Edwards,EmilyR;SolomonKurz,A;Sokol,Yosef;Sullivan,SarahR;Mobbs,Meaghan;Seim,RichardW;Goodman,Marianne
• 通讯作者: Goodman,Marianne