Increasing mental health services use through enabling resources & family support

梅根·谢泼德-巴尼根博士她在大学获得了卫生服务研究博士学位 她于2014年获得华盛顿大学硕士学位，2006年获得迈阿密大学硕士学位。从2015年7月至11月 2017年，Shepherd-Banigan博士是达勒姆VA卫生服务部的博士后研究员 研究与开发（HSR&D）创新中心（COIN），现在是VA健康研究 硬币里的科学家她的长期职业目标是发展她的职业生涯作为一个独立的VA健康 服务研究人员谁适用于多种方法来评估和提高的有效性， 心理健康和家庭服务提供系统。本申请的短期目标是描述 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研究旨在解决与心理治疗使用率低有关的科学差距 在退伍军人与创伤后应激障碍：目标1a-确定退伍军人和家庭的决定因素，预测启动和 完成创伤后应激障碍的心理治疗;目标1b-探索各种机制， [治疗准备]，以及开始和完成PTSD心理治疗;目标2-完善和测试 家庭参与的治疗准备干预的可行性，以增加启动和完成 目的3-分析使用VA支持服务是否可预测开始 通过加强经济扶持资源，完成创伤后应激障碍心理治疗。 该应用具有高度创新性，将通过提供以下方面的证据来推进临床实践：1） 复杂的退伍军人和家庭风险因素的作用，抑制PTSD治疗的使用和2）有前途的，战略 加强这些因素，包括家庭参与的治疗准备干预和VA 教育和职业康复服务，以增加对PTSD循证实践的接受 21该项目符合退伍军人事务部的优先事项，例如增加获得护理的机会和 EBP。 目标1中提出的研究将采用新颖的机器学习因果森林方法93来照顾者 支持计划调查数据和VA行政数据，以确定退伍军人和家庭的易感性， 使能因素和需求因素，并阐明如何使能资源（即感知的财政紧张，收入， 教育水平，家庭压力）调节治疗需求与使用/完成 psychotherapy.随后与退伍军人和家庭成员的定性访谈将寻求确定 退伍军人/家庭决定因素和服务使用之间的潜在机制。目标2的目标是 使用一个新的家庭参与策略，改进和测试现有家庭参与策略的可行性和可接受性74。 连续队列设计（SCD）的退伍军人谁被称为EBP心理治疗创伤后应激障碍。为 目标3、VHSC、退伍军人福利管理局和护理人员支持计划数据将结合起来， 检查VA支持服务使用对使用/完成心理治疗时间的影响 使用考克斯比例风险模型;将应用序贯分层匹配以最小化基线 治疗组之间的差异。在CDA资助的第三年结束时， 将提交给Aim 2干预的随机试验。 为了完成拟议的研究，申请人需要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;研讨会 关于随机临床试验和实施方法;临床阴影;和学术 会议和讲习班。

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.