A mixed methods pilot trial of the STEP-Home workshop to improve reintegration and reduce suicide risk for recently transitioned Veterans

STEP-Home 研讨会的混合方法试点试验，旨在改善最近转业的退伍军人重返社会并降低自杀风险

• 批准号: 10748489
• 负责人: Catherine Brawn Fortier
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-10-01 至 2027-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10748489
• 关键词: Address; Caring; Client satisfaction; Clinical; Communities; Data; Department of Defense; Diagnostic; Education; Educational workshop; Enrollment; Evaluation; Event; Exclusion; Face; Feeling suicidal; Focus Groups; Fostering; Future; Healthcare; Home; Intervention; Interview; Life; Measures; Mental Health; Methods; Military Personnel; Modeling; Outcome; Patient-Centered Care; Pilot Projects; Prevention education; Problem Solving; Psychiatric Diagnosis; Public Health; Questionnaires; Randomized, Controlled Trials; Rehabilitation therapy; Reporting; Resistance; Risk; Risk Factors; Role; Safety; Sample Size; Sampling; Services; Social isolation; Social support; Solid; Suicide; Suicide prevention; Target Populations; Traumatic Brain Injury; Veterans; Vocation; Work; acceptability and feasibility; active duty; arm; comorbidity; cost effective; current pandemic; design; emotion regulation; epidemiologic data; evidence base; functional status; implementation facilitators; improved; interest; military service; military veteran; outreach; pilot trial; post intervention; programs; recruit; reducing suicide; repository; service member; skills; social; standard of care; suicidal risk; suicide rate; telehealth; treatment as usual

Veterans face a “deadly gap” during their first year of transition from military to civilian life with limited available psychiatric services and increased suicide risk factors. During this critical transition period, Veteran suicide rate is double that of active service members and the general Veteran population. An average of 20 Veterans die from suicide each day, but only 6 of the 20 use VA services. VA care engagement has been shown to mitigate suicide risk; therefore, promoting engagement during the “deadly gap” could be essential to suicide prevention. Transitioning Veterans require outreach and services to provide them with support in their access to VA healthcare, suicide prevention education, and skills to manage their transition effectively. This proposal would bridge this important healthcare gap using STEP-Home. STEP-Home is an evidence-based, transdiagnostic, video telehealth rehabilitation workshop to improve reintegration, social support, and functioning among Veterans with high clinical comorbidity. STEP-Home is non-clinical, cost-effective, and skills-focused to maximally engage Veterans not participating in treatment who may be resistant to traditional “mental health” diagnostically focused approaches. To date, STEP-Home has not been adapted for the unique needs of recently transitioning Veterans or augmented for suicide prevention. This proposal will adapt and refine STEP- Home specifically for recently transitioning Veterans and add suicide prevention content and skills to create STEP-Home-SP. The proposed pilot study is designed to support STEP-Home and suicide prevention content experts in their refinement and evaluation of STEP-Home-SP. We will utilize the VA/Department of Defense Identity Repository (VADIR) to recruit recently transitioned Veterans nationwide. In Aim 1, we will develop STEP-Home-SP by adapting the STEP-Home telehealth intervention to specifically target recently transitioned Veterans and augment the workshop to include suicide prevention. In Aim 2, we will conduct a two-arm proof- of-concept acceptability and feasibility randomized controlled trial (RCT) of STEP-Home-SP versus Enhanced Usual Care (EUC=current standard of care + educational packet on suicide risk and connection to VA care) in recently transitioned Veterans. Lastly, we will explore reintegration status, VA care initiation, and candidate outcomes for STEP-Home-SP relative to EUC to inform a future full-scale RCT. If successful, fostering social, vocational, and community connection; building emotion regulation and impulse control skills; facilitating safety planning; and providing education and access to VA care upstream should result in decreased suicide risk during this critical transition and beyond.

退伍军人在从军事生活过渡到平民生活的第一年面临着“致命的差距”，可用资源有限 在这个关键的过渡时期，退伍军人自杀率增加。 是现役军人和一般退伍军人人数的两倍 平均有 20 名退伍军人死亡。 每天都有人自杀，但 20 名使用 VA 护理服务的人中只有 6 人被证明可以减轻自杀的影响。 自杀风险；因此，在“致命差距”期间促进参与对于预防自杀至关重要。 过渡退伍军人需要外展和服务，为他们获得 VA 提供支持 该提案将包括医疗保健、自杀预防教育以及有效管理其过渡的技能。 使用 STEP-Home 弥补这一重要的医疗保健差距 STEP-Home 是一种基于证据的跨诊断、 视频远程医疗康复研讨会，以改善重返社会、社会支持和功能 STEP-Home 是一种非临床、具有成本效益且注重技能的服务，可帮助患有高临床合并症的退伍军人。 最大限度地吸引那些可能对传统“心理健康”有抵抗力的未参加治疗的退伍军人 迄今为止，STEP-Home 尚未适应以诊断为重点的方法。 最近转业的退伍军人或加强自杀预防，该提案将调整和完善STEP-。 专门为最近转业的退伍军人提供的主页，并添加自杀预防内容和技能来创建 STEP-Home-SP 拟议的试点研究旨在支持 STEP-Home 和自杀预防内容。 我们将利用 VA/国防部的专家对 STEP-Home-SP 进行完善和评估。 身份存储库 (VADIR) 在全国范围内招募最近转业的退伍军人 在目标 1 中，我们将开发。 STEP-Home-SP 通过调整 STEP-Home 远程医疗干预来专门针对最近过渡的目标 退伍军人并扩大研讨会以包括预防自杀。在目标 2 中，我们将进行双臂验证。 STEP-Home-SP 与增强型的概念可接受性和可行性随机对照试验 (RCT) 常规护理（EUC=当前护理标准 + 关于自杀风险以及与 VA 护理的联系的教育包） 最后，我们将探讨最近转业的退伍军人的重返社会状态、退伍军人事务部护理启动和候选人。 STEP-Home-SP 相对于 EUC 的结果可为未来的全面随机对照试验提供信息 如果成功，可促进社会、 职业和社区联系；培养情绪调节和冲动控制技能； 规划；并提供教育和获得退伍军人管理局上游护理的机会应该会降低自杀风险 在这一关键转变期间及之后。