Evaluating the Use of Peer Specialists to Deliver Cognitive Behavioral Social Skills Training

背景：退伍军人健康管理局(VHA)倡导患有严重精神疾病的退伍军人- Ness(SMI)接受以恢复为导向的康复方法，目标是现实世界的功能。这样的一个 方法是认知-行为社交技能培训(CBSST)。不同于传统的认知行为疗法-- PY，CBSST是一种更注重康复的心理社会康复干预措施，向患有SMI的退伍军人提供培训 纠正思维上的错误，培养社交技能。虽然CBSST有效，但只有在促进的情况下才会进行测试 由硕士或博士级别的治疗师使用，这限制了它在VHA中的使用。然而，我们的试点数据显示Peer 专家-有SMI的个人，他们被雇用并接受培训，利用自己的恢复经验来帮助其他- 带有SMI的ERS还可以提供CBSST(称为CBSST-Peer)。独立社交技能培训(SST)也是一种 VHA正试图在全国范围内为患有SMI的退伍军人推出以恢复为导向的计划。几个同行SPE- 社会学家接受了与专业人士共同领导SST的培训。然而，SST并没有得到广泛的实施，因为- 原因专业人员很忙，同行专家提供的SST尚未进行测试。这项研究将评估 同行专家提供的CBSST和SST的有效性，这将增加退伍军人与 SMI必须进行有效的治疗。我们的目标是：目标1(有效性)：比较CBSST-Peer的影响 退伍军人SMI对接受同行专家提供的SST和同行专家领导的退伍军人的影响 以目标为重点的同等持续时间的机械化小组。我们还将评估SST和CBSST的保真度。目标2： (CBSST/SST的帮助--同行和执行障碍与促进者)：利用重点小组 与患者以及与同行专家和其他工作人员的访谈，以评估对SST-和CBSST-的看法 同行并找出未来实施的潜在障碍和促进者。方法：这是一项随机、 涉及252名患有SMI的退伍军人(来自匹兹堡、圣地亚哥各126名)的混合1试验，比较3种治疗方法 ARMS：CBSST-Peer VS SST-Peer VS SST-Peer vs.同等持续时间的手动、专注于目标的小组。杂交1号试验 评估干预措施的有效性，并收集可为今后采用干预措施提供信息的执行数据。在… 每个站点，跨越6个浪潮(1个浪潮=1个CBSST-Peer，1个SST-Peer，1个专注于目标的小组)，2个Peer专家 将共同领导18个、20周的小组。就像在试点中一样，同行专家将接受培训，并获得一小时的超级- 由CBSST开发人员编写的愿景周刊。SST推广的大师级培训师将对Peer进行培训和监督 每个站点的专家。所有三个ARM的会议都将被录音，并被评为25%的标准化保真度 措施。一项评估功能、生活质量、康复和症状的调查小组将被管理- 在每个波的退伍军人：基线，干预中期(10周)，干预结束(20周)， 随访(干预后32周、3个月)。我们将使用HLM检查所有结果，并进行治疗 条件包括作为时间不变的协变量，人的随机截获和时间的随机斜率。 相关协变量将包括站点、就诊次数、症状严重程度、服务使用和人口统计 变量。我们将评估治疗条件(CBSST-Peer与SST-Peer与目标聚焦)的效果 组)在预期的方向和时间X组的效果。关于SST-和CBSST-Peer Help的定性数据- 满足性和实施因素将从参与的退伍军人中随机抽样进行录音 在SST-和CBSST-Peer(每个站点4个焦点小组)中，参与同行专家(n=6-8次访谈 网站)和心理健康管理员(每个网站约n=3-4次访谈)。使用一种改进的接地理论- RY方法，逐字文本将被编码，以制定关于帮助的类别的答复，以及 未来在VHA实施SST-和CBSST-Peer的障碍和促进者。创新：没有研究 在严格的试验中测试了同行交付的SST或CBSST，或将两者进行了比较。意义/预期重新- 结果：CBSST和SST未广泛应用。如果SST-或CBSST-Peer有效，它可能会大大增加 提供循证服务退伍军人接受和加强VHA同行专家的服务。

Background: The Veterans Health Administration (VHA) is advocating that Veterans with serious mental ill- ness (SMI) receive recovery-oriented, rehabilitation approaches that target real-world functioning. One such approach is Cognitive-Behavioral Social Skills Training (CBSST). Unlike traditional cognitive-behavioral thera- py, CBSST is a more recovery-oriented psychosocial rehabilitation intervention that teaches Veterans with SMI to correct errors in thinking and build social skills. While effective, CBSST has only been tested when facilitated by masters- or doctoral-level therapists, which limits its use in VHA. However, our pilot data shows that Peer Specialists—individuals with SMI who are hired and trained to use their own recovery experience to assist oth- ers with SMI—can also provide CBSST (called CBSST-Peer). Stand-alone social skills training (SST) is also a recovery-oriented program that VHA is attempting to rollout nationwide for Veterans with SMI. A few Peer Spe- cialists have been trained to co-lead SST with professionals. However, SST is not widely implemented be- cause professionals are busy and Peer Specialist delivered SST has not been tested. This study will evaluate the effectiveness of Peer Specialist-delivered CBSST and SST, which would increase access Veterans with SMI have to effective treatment. Our aims are: Aim 1 (Effectiveness): To compare the impact of CBSST-Peer on outcomes in Veterans with SMI to Veterans receiving Peer Specialist-delivered SST and Peer Specialist-led manualized, goal-focused groups of equal duration. We will also assess fidelity of SST and CBSST. Aim 2: (Helpfulness of CBSST/SST--Peer and implementation barriers and facilitators): To use focus groups with patients and interviews with Peer Specialists and other staff to assess perceptions of SST- and CBSST- Peer and identify potential barriers and facilitators to future implementation. Methods: This is a randomized, Hybrid 1 trial involving 252 Veterans with SMI (n=126 each from Pittsburgh, San Diego) comparing 3 treatment arms: CBSST-Peer vs. SST-Peer vs. a manualized, goal-focused group of equal duration. Hybrid 1 trials test the effectiveness of an intervention and collect implementation data that could inform its future adoption. At each site, across 6 waves (a wave = 1 CBSST-Peer, 1 SST-Peer, 1 goal focused group), 2 Peer Specialists will co-lead 18, 20-week groups. Like in the pilot, Peer Specialists will be trained and receive an hour of super- vision weekly by the CBSST developers. Master trainers from the SST rollout will train and supervise Peer Specialists in each site. All three arms' sessions will be taped and 25% rated for fidelity on standardized measures. A survey battery that assesses functioning, quality of life, recovery, and symptoms will be adminis- tered to the Veterans in each wave at: baseline, mid-intervention (10 weeks), end-of-intervention (20 weeks), and follow-up (32 weeks, 3 months post intervention). We will examine all outcomes using HLM, with treatment condition included as a time-invariant covariate, and random intercepts for person and random slopes for time. Relevant covariates will include site, treatment attendance, symptom severity, service use, and demographic variables. We will evaluate the effect for treatment conditions (CBSST-Peer vs. SST-Peer vs. goal focused group) in the expected direction and the time X group effect. Qualitative data on SST- and CBSST-Peer help- fulness and implementation factors will be audio-recorded from a random sample of Veterans who participated in SST- and CBSST-Peer (4 focus groups per site), participating Peer Specialists (interviews with n=6-8 per site), and mental health administrators (interviews with about n=3-4 per site). Using a modified grounded theo- ry approach, verbatim text will be coded to develop categories of responses regarding the helpfulness of, and barriers and facilitators to, future implementation of SST- and CBSST-Peer in VHA. Innovation: No study has tested peer-delivered SST or CBSST, or compared the two, in a rigorous trial. Significance/Expected Re- sults: CBSST and SST are not widely available. If SST- or CBSST-Peer is effective, it could greatly increase the delivery of evidence-based services Veterans receive and enhance the services by VHA Peer Specialists.