Initial Testing of Whole Health STEPS (Structured Tiered Engagement with Peer Support)

Whole Health STEPS 的初步测试（具有同伴支持的结构化分层参与）

• 批准号: 10265541
• 负责人: EMILY JOHNSON
• 金额: --
• 依托单位: SYRACUSE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2025-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10265541
• 关键词: Belief; Caring; Categories; Characteristics; Clinical; Clinical Trials Design; Confidence Intervals; Data; Data Analyses; Data Collection; Development; Diagnostic; Doctor of Philosophy; Drops; Elements; Enrollment; Equipment and supply inventories; Evidence based practice; Feedback; Future; Goals; Health; Health Services; Healthcare; Hour; Individual; Intervention; Interview; Manuals; Mental Health; Mental Health Services; Mental disorders; Methods; Military Personnel; Mission; Modeling; Occupational; Outcome; Outcome Measure; Participant; Patient-Focused Outcomes; Population; Primary Health Care; Process; Process Assessment; Provider; Psyche structure; Psychologist; Psychotherapy; Qualitative Evaluations; Qualitative Methods; Randomized; Randomized Clinical Trials; Recording of previous events; Recovery; Research; Research Training; Role; Self Assessment; Self Management; Self-Direction; Services; Side; Specialist; Structure; Symptoms; Techniques; Telephone; Testing; Time; Training; Training Support; United States Department of Veterans Affairs; Veterans; Vision; Waiting Lists; Well in self; acceptability and feasibility; associated symptom; barrier to care; base; career; design; feasibility research; feasibility testing; flexibility; functional disability; functional outcomes; health care service; health goals; health plan; improved; improved functioning; novel strategies; patient engagement; patient oriented; peer; peer support; primary care setting; primary outcome; psychosocial; retention rate; satisfaction; skills; social; statistics; telephone coaching; tool; uptake; willingness

This RR&D CDA2 will support training for Emily M. Johnson, PhD, as a RR&D research psychologist and develop and evaluate a new package of services, Whole Health STEPS (Structured Tiered Engagement with Peer Support). The training goals for this project are to develop skills in (1) designing and evaluating adaptive stepped care interventions, (2) frameworks for enhancing and evaluating implementation in patient-centered interventions, (3) qualitative methods for enhancing stakeholder engagement and evaluating Veteran engagement in healthcare, and (4) clinical trials design for brief psychosocial interventions. These trainings will support my career focused on patient centered intervention and increasing Veteran engagement in healthcare using methods prioritizing stakeholder engagement.] Whole Health STEPS is an 8-week stepped-care package of four levels of Whole Health services facilitated by a peer support specialist. The four levels include supported self-management (an individual Whole Health STEPS orientation session and use of a self-directed Whole Health tool), brief telephone coaching (weekly 15-minute telephone-based coaching using focused prompts), Whole Health Coaching (weekly hour-long sessions incorporating the full coaching framework), and referral to a higher level of care. Across all levels, Veterans will have brief weekly telephone assessments using the Whole Health Goal Attainment Scale to evaluate progress and inform step-up decisions. Veterans who are not making progress at any of the given levels will be stepped-up to a higher level of care. [The research will involve qualitative stakeholder engagement interviews with primary care peer support staff (n=12), an open trial of Whole Health STEPS (n=10), and a pilot randomized clinical trial (n=44)] with a waitlist control to evaluate the preliminary impact of Whole Health STEPS on reducing functional impairment. [The design also supports further revision of the Whole Health STEPS manual] and evaluates research and intervention feasibility. Specifically, this trial will evaluate feasibility of several aspects of Whole Health STEPS including Veteran satisfaction, peer relationship, intervention retention, fidelity, and appropriateness of the new elements (i.e., the step-up decision points). Further, the design will evaluate research feasibility for a subsequent larger trial including assessment retention and participant willingness to be randomized. The primary patient outcome will be functional impairment evaluated by the Inventory of Psychosocial Functioning. [Stakeholders participating in the interviews will be asked to complete one research interview. Veterans in the open trial will be asked to complete assessments at baseline, after each session, and at the end of Whole Health STEPS.] All Veterans in the pilot RCT will be asked to complete research assessments at baseline, 2 months, and 4 months. Veterans randomized to receive Whole Health STEPS immediately will complete Whole Health STEPS in the first two months. Veterans randomized to the waitlist control will receive Whole Health STEPS between 2 and 4 months. Veterans will be randomized using a stratified permuted block design based on baseline functional impairment. The primary outcome will be evaluated by calculating Cohen’s d effect size at the 2-month assessment point and comparing with a pre-established one-sided confidence interval using a non-central t distribution method. Other quantitative outcome measures will be evaluated with descriptive statistics including means, standard deviations, and confidence intervals. Retention rates will be evaluated using percent of Veterans who withdraw or drop out over time. Qualitative feedback will be evaluated using the Rapid Assessment Process, a qualitative approach designed to provide a rapid but comprehensive qualitative evaluation to interpret and implement changes in a short time frame using triangulation, iterative data analysis, and additional data collection.

此RR＆D CDA2将支持Emily M. Johnson博士的培训，作为RR＆D研究心理学家和 开发和评估一套新的服务，整个健康步骤（结构化分层参与 同伴支持）。该项目的培训目标是发展（1）设计和评估适应性的技能 阶梯式护理干预措施，（2）用于增强和评估以患者为中心的实施的框架 干预措施，（3）增强利益相关者参与和评估退伍军人的定性方法 参与医疗保健以及（4）简短的社会心理干预措施的临床试验设计。这些培训将 支持我的职业专注于以患者为中心的干预措施，并增加了在医疗保健中的退伍军人参与 使用优先考虑利益相关者参与的方法。 由同伴支持专家准备的四个级别的整个健康服务。这四个级别包括 支持自我管理（一个个体的整个健康步骤导向课程和使用自我指导的 整个健康工具），简短的电话辅导（每周15分钟的基于电话的教练使用专注 提示），整个健康教练（每周一小时的课程增加了完整的教练框架），并且 转介到更高的护理水平。在各个层面上，退伍军人将进行简短的每周电话评估 使用整个健康目标达到量表来评估进度并为升级决策提供信息。退伍军人 在任何给定级别中没有取得进展的人将得到更高水平的护理。 [这 研究将涉及与初级保健同伴支持人员的定性利益相关者参与访谈 （n = 12），整个健康步骤（n = 10）的公开试验，以及一个候补名单的飞行员随机临床试验（n = 44）] 控制整个健康步骤对减少功能障碍的初步影响。 [这 设计还支持整个健康步骤手册的进一步修订]，并评估研究和 干预可行性。具体而言，该试验将评估整个健康步骤的几个方面的可行性 包括退伍军人满意度，同伴关系，干预保留，忠诚度和适当性 元素（即升级决策点）。此外，设计将评估研究可行性 随后的大型试验，包括评估保留和参与意愿。这 主要的患者结果将是通过心理社会功能清单评估功能障碍。 [将要求参加访谈的利益相关者完成一次研究访谈。退伍军人 将要求开放式审判在基线，每次会议之后以及整体结束时完成评估 健康步骤。] PILOT RCT中的所有退伍军人将被要求在基线上完成研究评估，2 几个月和4个月。随机接收整个健康步骤的退伍军人将立即完成 最初两个月的整个健康步骤。随机分配到候补名单控制的退伍军人将获得整体 健康步骤在2到4个月之间。退伍军人将使用分层排列的块设计随机分组 基于基线功能障碍。主要结果将通过计算Cohen的D来评估 在2个月的评估点上的效果大小，并与预先建立的单方面置信度进行比较 使用非中央t分布方法的间隔。其他定量结果指标将通过 描述性统计数据，包括均值，标准偏差和置信区间。保留率将是 使用随着时间的推移退出或退出的退伍军人评估。定性反馈将是 使用快速评估过程进行评估，这是一种定性方法，旨在提供快速但 全面的定性评估，以在短时间内解释和实施变化 三角剖分，迭代数据分析和其他数据收集。