Impact of the Seeking Safety program on clinical outcomes among homeless female veterans with psychiatric disorders
Impact of the Seeking Safety program on clinical outcomes among homeless female veterans with psychiatric disorders
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DOI：
10.1176/ps.2008.59.9.996
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发表时间：
2008-09-01
影响因子：
3.8
通讯作者：
Rosenheck, Robert A.
中科院分区：
文献类型：
--
作者：
Desai, Rani A.;Harpaz-Rotem, Ilan;Rosenheck, Robert A.
目的：寻求安全是一种手动的认知行为治疗干预，旨在治疗有药物滥用和创伤史的患者。这项研究检查了其有效性时，与无家可归的退伍军人精神或药物滥用问题的退伍军人事务部医疗中心，有无家可归的退伍军人计划。研究方法：干预包括25次会议，涵盖的主题是帮助建立客户的生活安全，并以现在为重点，提供心理教育和应对技能。一个队列的无家可归的女性退伍军人（N=359）被招募之前，寻求安全实施（第一阶段）。在临床医生接受寻求安全的培训和认证后，招募了一个实施后队列，并提供寻求安全治疗（II期，N= 91）。第一阶段从2000年1月持续到2003年6月。第二阶段从2003年6月持续到2005年12月。干预持续了六个月。所有参与者每三个月接受一次采访，为期一年，并在研究期间接受强化病例管理和其他服务。使用混合模型比较各阶段的1年临床结局。结果：在基线时，各组之间几乎没有差异。所有进入无家可归妇女退伍军人计划的妇女在一年内的大多数临床结果指标上都有显着改善。寻求安全队列报告了一年多来在就业，社会支持，精神痛苦的一般症状和创伤后应激障碍症状方面的显着改善结果，特别是在回避和唤醒集群中。然而，寻求安全队列在过去30天内使用药物的可能性更大。结论：寻求安全性似乎对几种临床结局产生了适度的有益影响。虽然不相等的比较组和低随访率限制了这些结果的内部有效性，寻求安全的可用性可能是有益的无家可归的女性退伍军人。值得注意的是，它可以交付和实施的情况下，经理很少或没有以前的咨询经验。
Objective: Seeking Safety is a manualized cognitive-behavioral therapy intervention that is designed to treat clients with comorbid substance abuse and trauma histories. This study examined its effectiveness when used with homeless women veterans with psychiatric or substance abuse problems at 11 Department of Veterans Affairs medical centers that had Homeless Women Veterans Programs. Methods: The intervention consists of 25 sessions that cover topics to help build safety in clients' lives and is present-focused, offering psychoeducation and coping skills. A cohort of homeless women veterans (N=359) was recruited before Seeking Safety was implemented (phase I). After clinicians were trained and certified in Seeking Safety, a postimplementation cohort was recruited and offered Seeking Safety treatment (phase II, N= 91). Phase I lasted from January 2000 to June 2003. Phase II lasted from June 2003 to December 2005. The intervention lasted for six months. All participants were interviewed every three months for one year and received intensive case management and other services during the study. Mixed models were used to compare one-year clinical outcomes across phases. Results: There were few differences across groups at baseline. All women entering the Homeless Women Veterans Programs showed significant improvement on most clinical outcome measures over one year. The Seeking Safety cohort reported significantly better outcomes over one year in employment, social support, general symptoms of psychiatric distress, and symptoms of post-traumatic stress disorder, particularly in the avoidance and arousal clusters. However, the Seeking Safety cohort was significantly more likely to have used drugs in the past 30 days. Conclusions: Seeking Safety appears to have had a moderately beneficial impact on several clinical outcomes. Although the nonequivalent comparison groups and low follow-up rates limit the internal validity of these results, availability of Seeking Safety may be of benefit for homeless female veterans. It is noteworthy that it could be delivered and implemented by case managers with little or no prior counseling experience.