Evaluating the Use of Peer Specialists to Support Suicide Prevention

评估使用同伴专家来支持自杀预防

• 批准号: 10705613
• 负责人: MATTHEW CHINMAN
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10705613
• 关键词: Address; Adult; Area; Attitude; Bipolar Depression; Caring; Case Management; Characteristics; Clinical; Clinical effectiveness; Communities; Community Healthcare; Community Integration; Community Participation; Complex; Connecticut; Data; Development; Effectiveness; Empathy; Enrollment; Feedback; Feeling suicidal; Fostering; Goals; Health Care Visit; Health Promotion; Healthcare; Healthcare Systems; Intervention; Interview; Investigation; Leadership; Life; Literature; Meaning and purpose; Measures; Medical; Medical center; Mental Health; Mentorship; Methods; Modification; Motivation; Nature; Needs Assessment; Outcome; Participant; Patient Self-Report; Patients; Perception; Primary Care; Procedures; Process; Prospective Studies; Provider; Psyche structure; Psychologist; Quality of life; Randomized; Randomized, Controlled Trials; Recovery; Rehabilitation Outcome; Rehabilitation therapy; Research; Research Personnel; Risk Reduction; Role; Self Perception; Services; Social support; Specialist; Suicide; Suicide prevention; System; Testing; Time; Training; Unipolar Depression; Veterans; Veterans Health Administration; Vocational rehabilitation; Work; acceptability and feasibility; behavioral health; clinical care; clinical practice; community living; disability; efficacy trial; eligible participant; experience; follow up assessment; follow-up; functional disability; high risk; implementation context; implementation facilitators; implementation strategy; improved; innovation; intervention mapping; novel; novel strategies; peer; peer support; physical conditioning; pilot test; post intervention; prevent; preventive intervention; programs; psychiatric disability; psychiatric rehabilitation; psychosocial rehabilitation; randomized trial; recruit; reducing suicide; rehabilitative care; self esteem; social; social integration; stem; stressor; suicidal; suicidal behavior; suicidal risk; suicide rate; theories

Preventing suicide is a top priority for the Veterans Health Administration (VHA). Despite ardent and sustained efforts over the last decade, the suicide rate for VHA patients remains significantly higher than civilians and non- VHA using Veterans. Suicide prevention efforts for high risk VHA patients focus on clinical (e.g., mental health) and service use (e.g., case management) factors. What has yet to be tested is an approach that targets factors in community living, which are better conceptualized as rehabilitative in nature. For it is not only mental and physical illnesses that heighten suicide risk in VHA patients, but also struggles with their sense of self-worth, meaning, and social connections in the community. To help patients with high risk of suicide, this application proposes to adapt and test a promising approach called PREVAIL, which uses ‘Peer Specialists’ (i.e., Veterans with psychiatric disabilities who have been trained to help others with similar conditions). Peer Specialists do not devalue clinical care but engage in rehabilitative tasks of building a life of self-respect and connectedness in one’s local community by offering empathy, hope, and advice based personal experience of mental health recovery. PREVAIL is promising, but still has not demonstrated clinical effectiveness and requires adaptation to address the unique characteristics of Veterans and the VA health care system. This project proposes to use Intervention Mapping, a multi-method, systematic approach using diverse stakeholders, to adapt and pilot PREVAIL. The VHA is the single, largest employer of Peer Specialists and research shows that they can enhance standard clinical care in mental health, physical health, and rehabilitative outcomes. However, Peer Specialists have only just begun to be deployed in suicide prevention efforts. The primary aims of this study are to: 1) Use Intervention Mapping to identify which components of PREVAIL require adaptation to reduce suicidal ideation in high risk VHA patients and to identify implementation strategies useful for the VHA system; and 2) Pilot test the feasibility and acceptability of the adapted PREVAIL, rehabilitative measures, and suicide-related outcomes for use in a rigorous prospective study. With guidance from a steering committee comprised of researchers, VHA leadership, and patients, needs assessment interviews with diverse VHA staff, Peer Specialists, and patients will be conducted to inform the adaptation. Based on results from the needs assessment and the literature on suicide prevention, psychiatric rehabilitation, and peer-based approaches, the steering committee will help adapt PREVAIL. Twelve high suicide risk Veterans with unipolar or bipolar depression will participate in a 3-month “pre- pilot” and provide feedback on how the adapted PREVAIL may be revised. After making any necessary modifications to the intervention, a second group of 12 high suicide risk Veterans with unipolar or bipolar depression will be recruited to participate in a formal pilot test to further evaluate the feasibility and acceptability of recruitment, retention, and assessment procedures. Patients will be from the West Haven and Newington Connecticut medical centers. The Peer Specialists will be from VA Connecticut’s Errera Community Care Center, one of VHA’s leading centers of innovation in psychosocial rehabilitation and one of the largest employers of Peer Specialists. All participants will receive standard VHA care from the Connecticut campuses while participating in this study. Participants will be assessed at baseline, post-intervention, and 3-month follow-up in their level of functional impairment and community integration; sense of hope, quality of life, meaning, and purpose; and self-views and social support. Chart reviews will also be completed at 3-month follow-up to assess for changes in health care visits involving suicidal behaviors. If acceptability (> 50% enrollment of eligible participants) and feasibility (> 70% of enrollees complete follow-up assessment) are demonstrated, this study will result in a novel rehabilitation-oriented suicide prevention intervention to test in a fully-powered randomized controlled efficacy trial.

尽管预防自杀一直是退伍军人健康管理局 (VHA) 的首要任务。 在过去的十年中，VHA 患者的自杀率仍然显着高于平民和非 使用退伍军人的 VHA 预防高风险 VHA 患者的自杀工作侧重于临床（例如心理健康） 和服务使用（例如，案例管理）因素还有待测试的是针对因素的方法。 在社区生活中，这更好地被概念化为康复性质，因为它不仅是精神上的，也是康复上的。 身体疾病会增加 VHA 患者的自杀风险，但也会影响他们的自我价值感， 为了帮助自杀风险高的患者，该应用程序的意义和社会关系。 建议调整和测试一种名为 PREVAIL 的有前途的方法，该方法使用“同行专家”（即退伍军人） 患有精神障碍但接受过帮助其他有类似情况的人的培训的人则不会。 贬低临床护理的价值，但从事康复任务，建立自尊和联系的生活 通过提供基于个人心理健康经验的同理心、希望和建议，为当地社区提供帮助 PREVAIL 的康复前景良好，但尚未证明临床有效性，需要适应。 该项目建议利用退伍军人和退伍军人管理局医疗保健系统的独特特征。 干预映射，一种利用不同利益相关者进行调整和试点的多方法、系统方法 VHA 是同行专家的单一最大雇主，研究表明他们可以增强能力。 然而，同行专家在心理健康、身体健康和康复结果方面提供标准临床护理。 刚刚开始应用于自杀预防工作。这项研究的主要目的是：1）使用。 干预映射以确定 PREVAIL 的哪些组成部分需要调整以减少自杀意念 高风险 VHA 患者并确定对 VHA 系统有用的实施策略；以及 2) 进行试点测试； 改编后的 PREVAIL、康复措施和自杀相关结果的可行性和可接受性 在由研究人员组成的指导委员会的指导下，VHA 进行了严格的前瞻性研究。 领导层和患者，与不同的 VHA 工作人员、同行专家和患者进行需求评估访谈 将根据需求评估的结果和相关文献进行调整。 自杀预防、精神康复和基于同伴的方法，指导委员会将帮助适应 12 名患有单相或双相抑郁症的高自杀风险退伍军人将参加为期 3 个月的“预防自杀”活动。 试点”，并在做出任何必要的修改后提供有关如何修改改编后的 PREVAIL 的反馈。 对干预措施进行修改后，第二组由 12 名患有单相或双相情感障碍的高自杀风险退伍军人组成 将招募抑郁症患者参加正式的试点测试，以进一步评估可行性和可接受性 招募、保留和评估程序的患者将来自西黑文和纽因顿。 康涅狄格州医疗中心的同行专家将来自 VA 康涅狄格州埃雷拉社区护理中心， VHA 领先的社会心理康复创新中心之一以及最大的雇主之一 所有参与者都将在康涅狄格州校区获得标准 VHA 护理。 参与这项研究的参与者将在基线、干预后和 3 个月的随访中接受评估。 他们的功能障碍和社区融入程度、生活质量、意义和 自我观点和社会支持也将在 3 个月的随访中完成以进行评估。 涉及自杀行为的医疗保健就诊的变化 如果可接受（> 50% 的合格注册人数）。 参与者）和可行性（> 70% 的参与者完成后续评估）得到证明，本研究 将产生一种新型的以康复为导向的自杀预防干预措施，以在全动力随机试验中进行测试 对照疗效试验。