Impact of Veteran Voices & Visions Peer Support Groups on Social Integration for Veterans with SMI/Psychosis

退伍军人声音的影响

• 批准号: 10583907
• 负责人: Ippolytos Andreas Kalofonos
• 金额: --
• 依托单位: VA GREATER LOS ANGELES HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10583907
• 关键词: Address; Alcohol abuse; Belief; COVID-19 pandemic; Caring; Collaborations; Collection; Communities; Country; Curiosities; Data; Dedications; Delusions; Development; Distress; Education; Employment; Enrollment; Feeling suicidal; Fostering; Frequencies; Friendships; Future; Geography; Goals; Grant; Guidelines; Hallucinations; Health Services; Health system; Hearing; Housing; Improve Access; Intervention; Interview; Life; Link; Loneliness; Manuals; Marriage; Measurement; Measures; Mental Health; Mental Health Services; Meta-Analysis; Modeling; Netherlands; Obesity; Occupations; Outcome; Outcome Measure; Participant; Personal Satisfaction; Phase; Population; Process; Property; Protocols documentation; Psychoses; Psychotic Disorders; Public Health; Quality of life; Random Allocation; Recovery; Research; Running; Safety; Self Administration; Self Efficacy; Smoking; Social Functioning; Social isolation; Specialist; Standardization; Support Groups; Surveys; Symptoms; Target Populations; Training; Training Programs; Transportation; Trust; Veterans; Vision; Voice; Vulnerable Populations; Work; acceptability and feasibility; adverse outcome; cohesion; design; efficacy study; empowerment; experience; follow up assessment; health related quality of life; high risk; improved; innovation; insight; internalized stigma; member; mortality; outcome disparities; peer; peer support; pilot trial; post intervention; programs; psychiatric symptom; psychosocial; psychotic symptoms; recruit; remediation; service engagement; severe mental illness; social integration; social movement; social stigma; suicidal risk; symposium; telehealth; videoconference; virtual; virtual platform; whole health

Veterans with Serious Mental Illness (SMI) struggle with social integration - participation in work, housing, and citizenship - due to symptoms, stigma, and psychosocial functioning deficits. This has a tremendous impact on mortality, comparable to that of smoking and greater than obesity and alcohol abuse. Despite considerable VA efforts to provide mental health care to Veterans with SMI, programs that promote social integration are lacking. Veterans with SMI are at especially high risk for poor social integration and suicidal ideation during the COVID-19 pandemic. There is an urgency to advance treatments targeting Veterans' social integration. This project addresses this need with a group-based, peer specialist (PS) co-facilitated psychosocial intervention for Veterans with SMI, called “Veteran Voices and Visions” (VVV). VVV targets Veterans with SMI who experience psychosis, a group particularly in need of support with social integration. Virtual VVV groups are co-led by VA mental health clinicians (MHCs) and PSs via online video conference. VVV is an adaptation of a community-based support group model called the Hearing Voices (HV) approach that was developed over 30 years ago in the Netherlands. It has since spread to over twenty-five countries, representing hundreds of support groups worldwide. The approach facilitates group cohesion around and normalization of the common psychotic symptoms of SMI: hallucinations, delusions, and social isolation. Despite its global scope, this approach has neither been formally adapted nor rigorously studied in public health systems, including the VA. This intervention has the potential to create and foster a supportive community that improves the social integration of participants by reducing their distress and self-stigma, and increasing self-efficacy. These three process outcomes are strongly associated with social integration. This proposal is directly aligned with VA priorities to advance the breadth of existing psychosocial interventions for Veterans with SMI, improve access via telehealth services, and support Veterans' independence, wellbeing, empowerment, and whole health. The goal of this proposal is (1) to develop a manual, training guidelines, and a fidelity scale for VVV, (2) to assess the feasibility and acceptability of VVV, and (3) collect pilot outcome data. The manual, training guidelines, and fidelity scale will be developed by the research team in collaboration with 4 advisory panels: Veterans with SMI, MHCs, PSs, and non-VA experts in HV. Then, 5 MHCs and 5 PSs will be trained to use the new VVV manual, and each MHC-PS pair will conduct a group with the new protocol. Thirty Veterans will be recruited to participate in these 5 groups and assessments will be conducted at baseline, midpoint, and post- intervention. Baseline assessments include measurement of psychiatric symptoms, level of distress from psychosis, internalized self-stigma, self-efficacy, sense of belonging, recovery, and social integration. Follow- up assessments conducted at 10 and at 20 weeks will include these same measurements as baseline, as well as a survey and qualitative interview on intervention acceptability. Feasibility data on numbers approached, enrolled, and retained, and treatment fidelity will be collected. Fidelity will be assessed in two ways: (1) facilitators will complete self-administered reflection worksheets after each session and (2) research team members will rate 5 randomly selected audio-recorded sessions from each group for formal fidelity ratings. The goal of the within-subjects trial evaluating feasibility and acceptability of the manualized VVV protocol for improving self-efficacy, self-stigma and social functioning in Veterans with psychosis. To that end, the study will be run using the full collection of measures that would be included in a subsequent RCT. However, since the study is designed to assess whether the proposed intervention can be successfully implemented in the target population and to evaluate the properties of a candidate set of outcome measures, rather than demonstrate efficacy, most of the analyses will be descriptive. This will lay the groundwork for a future Merit that will support a controlled efficacy study.

患有严重精神疾病 (SMI) 的退伍军人在融入社会方面遇到困难 - 参与工作、住房和生活 公民身份——由于症状、耻辱和社会心理功能缺陷，这对公民身份产生了巨大影响。 尽管VA相当大，但死亡率与吸烟相当，高于肥胖和酗酒。 为了通过 SMI 为退伍军人提供心理保健服务，促进社会融合的计划包括 患有 SMI 的退伍军人在社会融入不良和自杀意念的风险特别高。 COVID-19 大流行。迫切需要推进针对退伍军人社会融合的治疗。 该项目通过以小组为基础的同行专家 (PS) 共同促进的心理社会解决了这一需求 针对患有 SMI 的退伍军人的干预措施称为“退伍军人的声音和愿景”(VVV)，其目标是患有 SMI 的退伍军人。 心理体验者是一个特别需要虚拟 VVV 团体支持的群体。 由 VA 心理健康领班 (MHC) 和 PS 通过在线视频会议共同领导，VVV 是一种改编。 一种基于社区的支持小组模型，称为“聆听声音”(HV) 方法，该模型是在 30 年前在荷兰，此后已传播到超过 25 个国家，代表了数百个国家。 该方法促进了群体凝聚力和共同点的正常化。 SMI 的精神病症状：幻觉、妄想和社会孤立尽管其影响范围遍及全球， 该方法尚未在包括退伍军人管理局在内的公共卫生系统中得到正式采用或严格研究。 这种干预措施有可能创建和培育一个支持性社区，从而改善社会状况 通过减少参与者的痛苦和自我耻辱并提高自我效能来整合这三者。 流程结果与社会融合密切相关。该提案与 VA 直接一致。 优先事项是扩大针对患有 SMI 的退伍军人的现有心理社会干预措施的广度，改善可及性 通过远程医疗服务，支持退伍军人的独立、福祉、赋权和整体健康。 该提案的目标是 (1) 制定 VVV 手册、培训指南和保真度量表，(2) 评估 VVV 的可行性和可接受性，以及 (3) 收集试点结果数据。 研究团队将与 4 个顾问小组合作制定指南和保真度量表： 拥有 SMI、MHC、PS 的退伍军人和 HV 中的非 VA 专家然后，将培训 5 名 MHC 和 5 名 PS 来使用该技术。 新的 VVV 手册，每个 MHC-PS 将按照新的配对协议进行一个小组。 招募参加这 5 个小组的人员，并将在基线、中点和后期进行评估 基线评估包括精神症状、痛苦程度的测量。 精神病、内化的自我耻辱、自我效能、归属感、康复和社会融合。 第 10 周和第 20 周进行的评估将包括与基线相同的测量值，以及 作为有关干预措施可接受性的调查和定性访谈， 登记并保留，并且将通过两种方式评估治疗忠诚度：(1) 主持人将在每次会议后完成自我管理的反思工作表和 (2) 研究团队 成员将对每组中随机选择的 5 个录音会话进行评分，以进行正式的保真度评级。 受试者内试验的目标是评估手动 VVV 方案的可行性和可接受性 改善患有精神病的退伍军人的自我效能、自我耻辱和社会功能。 将使用后续 RCT 中包含的完整措施集合来运行。 该研究旨在评估拟议的干预措施是否能够在 目标人群并评估一组候选结果测量的属性，而不是 为了证明有效性，大多数分析都是描述性的，这将为未来的优点奠定基础。 这将支持一项对照功效研究。