Group Motivational Interviewing (GMI) For Homeless Veterans in VA Services

针对 VA 服务中无家可归退伍军人的团体动机访谈 (GMI)

基本信息

批准号：
10028215
负责人：
ELIZABETH J SANTA ANA
金额：
--
依托单位：
RALPH H JOHNSON VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-02-01 至 2019-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10028215
关键词：
Address Adopted Adoption Alcohol abuse Alcohol or Other Drugs use Ambulatory Care Area Assertiveness Awareness Behavior Therapy Capital Case Manager Client Client satisfaction Clinical Communities Community Participation Continuity of Patient Care DSM-IV Data Dependence Development Diagnosis Direct Costs Disease Dropout Drug abuse Effectiveness Elements Employment Enrollment Evaluation Exhibits Facilities and Administrative Costs Future Goals Grant Health Services Healthcare Homelessness Housing Incidence Individual Infrastructure Intervention Measures Medical center Methods Modeling Monitor Morbidity - disease rate Outcome Participant Pathway interactions Patients Post-Traumatic Stress Disorders Process Psyche structure Psychopathology Quality of life Randomized Randomized Controlled Trials Recommendation Recovery Relapse Research Research Support Resources Risk Factors SF-12 Services Social support Specialist Structure Substance Use Disorder Substance abuse problem Therapeutic Thinness Time U.S. Department of Housing and Urban Development United States Department of Veterans Affairs Veterans Work Workload addiction cost cost estimate course implementation design dissemination research dual diagnosis effectiveness trial evidence base follow up assessment follow-up housing instability implementation research improved indexing innovation intervention cost mortality motivational enhancement therapy multimodality programs psychosocial recruit reduced substance use sobriety success supported housing systematic review treatment arm treatment as usual treatment planning treatment services trial comparing volunteer

项目摘要

DESCRIPTION (provided by applicant): Anticipated Impacts on Veterans Health Care: VA set an ambitious goal for ending homelessness among Veterans by 2015. HUD-VASH and Grant & Per Diem (GPD) are two primary VA housing programs to help Veterans exit homelessness. Substance abuse among Veterans in VA housing is a major risk factor for worsening psychopathology and housing instability. Despite recent adoption of a Housing First approach, many VA housing programs lack the staff infrastructure to manage substance use disorders (SUDs). This is a significant problem as 60% (conservative estimate) of Veterans in VA housing have SUDs and these Veterans show greater psychopathology compared to their counterparts without SUDs. These issues warrant substantial need for SUD programs in VA housing that are efficient to deploy, easily layered onto existing services, and require minimal staff to operate. The current study addresses this current void in VA treatment services in that it investigates the effectiveness, implementation process, and cost estimate of treatment of an adaptation of motivational interviewing, an empirically supported intervention with strong impact on reducing substance use and enhancing treatment engagement, in a group format, referred to as Group Motivational Interviewing (GMI) for Veterans with SUDs in VA housing. Data from this project, if shown to be promising, will establish the basis of a GMI dissemination and implementation course of action for highly vulnerable homeless Veterans in VA housing for achieving their greatest success in attaining housing stability. Background: There is a significant need for 'wraparound' treatment services in VA housing for addressing SUDs. Homeless Veterans with SUDs are vulnerable to treatment dropout, rendering them susceptible to relapse, while their continuation in outpatient care during their participation in VA housing leads to improved clinical outcomes. According to systematic reviews, individual MI reduces the incidence of SUD, when compared to no treatment, but is labor intensive. As VA moves toward a 'Housing First' paradigm where greater numbers of homeless Veterans will continue to use substances while in VA housing, delivery of GMI (which may be less labor intensive) to these patients will be important for initiating and maintaining their recovery as well as enhancing their psychosocial integration and quality of life. In a prior controlled trial conducted by the PI, GMI resulted in significantly higher outpatient treatment engagement and lower substance use compared to treatment-as-usual among dually diagnosed Veterans. Objectives: Study objectives are consistent with VA housing recommendations focusing on patient recovery, health services promotion, and treatment implementation evaluation. GMI will be compared to a control treatment condition (CT) on (Specific Aim I; Five outcomes: (Primary H1): treatment engagement; (Primary H1): substance use; (Secondary H2): psychosocial integration (e.g., social support, community participation); (Secondary H3) quality of life/psychiatric indices; and (Secondary H4): number of days engaging in structured/productive work activities in the 6-month follow up. Specific Aim II involves a process evaluation for documenting (A) formative (e.g., developmental), (B) process, and (C) summative outcomes; and Specific Aim III involves estimation of cost of intervention in terms of direct costs, indirect costs of staff, costs of capital and workload measures for future implementation and dissemination research. Methods: Randomized controlled trial comparing GMI to CT across five critical outcomes. 186 Veterans in VA housing services (93 per treatment arm) will be enrolled with a diagnosis of alcohol or drug abuse/dependence. Recruitment will take place in Charleston VAMC HUD-VASH & GPD. Participants will be randomly assigned to (1) GMI or (2) CT, each consisting of 4 sessions, and will be evaluated at 1, 3, and 6 months. Participants with a non-substance related DSM-IV-TR major Axis I disorder (e.g., MDD, PTSD) will be eligible for the study. Analyses will be conducted using generalized linear mixed models (GLMM) approach.

描述（由申请人提供）：对退伍军人卫生保健的预期影响：VA设定了一个雄心勃勃的目标，目的是在2015年之前结束退伍军人的无家可归者。Hud-Vash and Grant＆Per＆Per Diem（GPD）是两个主要的VA住房计划，以帮助退伍军人退出无家可归者。 VA住房中退伍军人之间的药物滥用是加剧心理病理学和住房不稳定的主要危险因素。尽管最近采用了住房第一种方法，但许多VA住房计划仍缺乏管理物质使用障碍（SUD）的员工基础设施。这是一个重大的问题，因为VA住房中的退伍军人有60％（保守的估计）患有SUD，而与没有SUD的同行相比，这些退伍军人表现出更大的精神病理学。这些问题需要有效地部署，易于分层到现有服务上的SUD计划的巨大需求，并要求最小的员工运营。 The current study addresses this current void in VA treatment services in that it investigates the effectiveness, implementation process, and cost estimate of treatment of an adaptation of motivational interviewing, an empirically supported intervention with strong impact on reducing substance use and enhancing treatment engagement, in a group format, referred to as Group Motivational Interviewing (GMI) for Veterans with SUDs in VA housing.该项目的数据（如果证明是有希望的话）将建立GMI传播和实施方案的基础，以实现弗吉尼亚州住房中高度脆弱的无家可归者退伍军人，以实现他们在实现住房稳定性方面取得最大的成功。背景：弗吉尼亚州住房中的“环绕式”治疗服务非常需要解决SUDS。有泡沫的无家可归者容易受到治疗辍学的影响，使他们容易复发，而他们在参加VA住房期间的门诊护理继续进行，从而改善了临床结果。根据系统的评论，与没有治疗相比，个体MI降低了SUD的发病率，但劳动密集型。随着VA朝着“住房的第一”范式迈进，在VA住房中，更多的无家可归的退伍军人将继续使用物质，对这些患者的GMI（可能较少的劳动力）提供（可能较少）对于启动和维持康复以及增强其心理社会融合和生活质量至关重要。在PI进行的先前对照试验中，与双线诊断的退伍军人相比，GMI导致门诊治疗的参与度明显更高，并且使用物质使用较低。目标：研究目标与VA住房建议一致，该建议的重点是患者康复，卫生服务促进和治疗实施评估。 GMI will be compared to a control treatment condition (CT) on (Specific Aim I; Five outcomes: (Primary H1): treatment engagement; (Primary H1): substance use; (Secondary H2): psychosocial integration (e.g., social support, community participation); (Secondary H3) quality of life/psychiatric indices; and (Secondary H4): number of days engaging in structured/productive work activities in the 6-month follow UP VA住房服务（每个治疗部门93）将在Charleston VAMC HUD-VASH＆GPD中进行诊断为酒精或滥用药物/依赖。参与者将被随机分配给（1）GMI或（2）CT，每个CT由4个会议组成，并在1、3和6个月时进行评估。患有与非固定性相关的DSM-IV-TR主要轴I障碍（例如MDD，PTSD）的参与者有资格进行研究。分析将使用广义线性混合模型（GLMM）方法进行。