Increasing mental health services use through enabling resources & family support

梅根·谢泼德·巴尼根博士在该大学获得卫生服务研究博士学位 2014年获得华盛顿大学硕士学位，2006年获得迈阿密大学理工学院硕士学位。2015年7月-11月 2017年，谢泼德-巴尼根博士是达勒姆退伍军人健康服务中心的博士后研究员 研发(HSR&D)创新中心(COIN)，现在是退伍军人健康研究中心 硬币里的科学家。她的长期职业目标是作为一名独立的退伍军人保健人员发展她的职业生涯 服务研究人员，应用多种方法来评估和改进 心理健康和家庭服务提供系统。这个应用程序的短期目标是描述 加强退伍军人和家庭对精神卫生服务利用的决定因素。 拟议的CDA研究试图解决与心理治疗使用率较低相关的科学空白 在患有创伤后应激障碍的退伍军人中：目标1a-确定预测入伍和成长的退伍军人和家庭决定因素 完成创伤后应激障碍的心理治疗；目标1b--探索将扶持资源联系起来的机制， [治疗准备]，启动和完成创伤后应激障碍心理治疗；目标2--改进和测试 家庭参与治疗准备干预的可行性，以增加治疗的开始和完成 EBP心理疗法治疗创伤后应激障碍；目标3-分析VA支持服务的使用是否预示着启动 通过加强经济扶持资源，完成创伤后应激障碍心理治疗。 这项应用具有很高的创新性，将通过提供关于1)的证据来推动临床实践 复杂的退伍军人和家庭危险因素对创伤后应激障碍治疗的抑制作用和2)前景看好的策略 加强这些因素，包括家庭参与的治疗准备干预和退伍军人事务部 教育和职业康复服务，以增加对创伤后应激障碍循证做法的接受 21该项目符合退伍军人管理局的优先事项，例如增加获得护理的机会和吸收 EBPS。 目标1中提出的研究将使用新的机器学习因果森林方法93来照顾 支持计划调查数据和退伍军人管理数据，以确定退伍军人和家庭倾向， 扶持和需求因素，并阐明扶持资源(即感知到的财务压力、收入、 教育水平、家庭压力)缓和治疗需要与使用/完成治疗之间的联系 心理治疗。随后对退伍军人和家属的定性采访将寻求确定 退伍军人/家庭决定因素与服务使用之间的潜在机制。目标2的目标是 改进和测试现有家庭参与策略74的可行性和可接受性 在接受EBP心理疗法治疗创伤后应激障碍的退伍军人中进行连续队列设计(SCD)。为 AIM 3、VHSC、退伍军人福利管理和护理人员支持计划数据将结合在一起，以 研究退伍军人支持服务使用对心理治疗使用/完成时间的影响 使用COX比例风险模型；将应用序贯分层匹配来最小化基线 治疗组之间的差异。在CDA资助的第三年结束时，一份优异奖申请 将被提交以资助AIM 2干预的随机试验。 要完成拟议的研究，申请人需要具备以下四个方面的额外技能和内容专业知识 领域：[1]干预和实施科学；2)定性和定量方面的先进方法 研究；3)心理健康临床研究和背景；以及4)专业发展和网络。] 具体主题和活动将包括机器学习和定性研究课程；讲习班 关于随机临床试验和实施方法；临床跟踪；和学术 会议和研讨会。

Megan Shepherd-Banigan, Ph.D., obtained her doctorate in Health Services Research from the University of Washington in 2014 and her M.P.H from the University of Miami in 2006. From July 2015-November 2017, Dr. Shepherd-Banigan was a post-doctoral research fellow at the Durham VA Health Services Research & Development (HSR&D) Center of Innovation (COIN) and is now a VA Health Research Scientist in the COIN. Her long-term professional goal is to grow her career as an independent VA health services researcher who applies a diverse array of methods to evaluate and improve the effectiveness of mental health and family service delivery systems. The short-term objective of this application is to describe and strengthen Veteran and family determinants of mental health service utilization. The proposed CDA research seeks to address scientific gaps related to the low use of psychotherapy among Veterans with PTSD: Aim 1a— Identify Veteran and family determinants that predict initiation and completion of psycho-therapy for PTSD; Aim 1b— Explore mechanisms linking enabling resources, [treatment preparedness], and initiation and completion of PTSD psychotherapy; Aim 2— Refine and test the feasibility of a family-involved treatment preparedness intervention to increase initiation and completion of EBP psychotherapy for PTSD; Aim 3— Analyze whether use of VA supportive services predicts initiation and completion of PTSD psychotherapy by strengthening economic enabling resources. This application is highly innovative and will advance clinical practice by contributing evidence about 1) the role of complex Veteran and family risk factors that inhibit PTSD treatment use and 2) promising, strategies to strengthen these factors, including a family-involved treatment preparedness intervention and VA education and vocational rehabilitation services to increase uptake of PTSD evidenced-based practices (EBPs).21 This project is consistent with VA priorities, such as increased access to care and uptake of EBPs. The research proposed in Aim 1 will employ novel machine learning causal forest methods93 to Caregiver Support Program survey data and VA administrative data to identify Veteran and family predisposing, enabling, and need factors and elucidate how enabling resources (i.e. perceived financial strain, income, education level, family strain) moderate the association between need for treatment and use/completion of psychotherapy. Subsequent qualitative interviews with Veterans and family members will seek to identify the underlying mechanisms between Veteran/family determinants and service use. The goal of Aim 2 is to refine and test the feasibility and acceptability of an existing family engagement strategy74 using a successive cohort design (SCD) among Veterans who were referred to EBP psychotherapy for PTSD. For Aim 3, VHSC, Veteran Benefits Administration, and Caregiver Support Program data will be combined to examine the effect of VA supportive service use on time to use/completion of psychotherapy treatment using Cox proportional hazard models; sequential stratified matching will be applied to minimize baseline differences between treatment groups. By the end of the 3rd year of CDA funding, a merit award application will be submitted to fund a randomized trial of the Aim 2 intervention. To complete the proposed research, the applicant requires additional skills and content expertise in four areas: [1) intervention and implementation science; 2) advanced methods in qualitative and quantitative research; 3) mental health clinical research and context; and 4) professional development and networking.] Specific topics and activities will include courses in machine learning and qualitative research; workshops about randomized clinical trials and implementation methods; clinical shadowing; and academic conferences and workshops.