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

评估使用同伴专家提供认知行为社交技能培训

• 批准号: 10186532
• 负责人: MATTHEW CHINMAN
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10186532
• 关键词: Address; Administrator; Adopted; Adoption; Advocate; Attitude; Audiotape; Behavioral; Caring; Categories; Clinical; Code; Cognitive; Cognitive Therapy; Collaborations; Communication; Data; Education; Educational Curriculum; Effectiveness; Effectiveness of Interventions; Focus Groups; Foundations; Future; Goals; Healthcare; Healthcare Systems; Homelessness; Hour; Hybrids; Impairment; Independent Living; Individual; Intercept; Intervention; Interview; Knowledge; Lead; Letters; Measures; Medical center; Mental Health; Methods; Outcome; Outcome Study; Participant; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Quality of life; Randomized; Recovery; Rehabilitation therapy; Research; Role; Sampling; Schizophrenia; Services; Severities; Site; Social Functioning; Social Perception; Socialization; Specialist; Strategic Planning; Structure; Supervision; Surveys; Symptoms; Techniques; Testing; Text; Thinking; Time; Training; Update; Veterans; Veterans Health Administration; Work; arm; base; cognitive skill; cognitive testing; cognitive training; cost; effective therapy; effectiveness evaluation; effectiveness testing; effectiveness trial; evidence base; experience; follow-up; hospital bed; implementation barriers; implementation determinants; implementation facilitators; improved; improved functioning; improved outcome; innovation; novel; peer; peer support; post intervention; primary outcome; programs; psychosocial; psychosocial rehabilitation; recruit; response; severe mental illness; skills; skills training; social communication; social skills; standard care; standardize measure; treatment arm; treatment effect

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.

背景：退伍军人健康管理局（VHA）主张，退伍军人与严重的精神疾病- 精神分裂症（SMI）接受以恢复为导向的康复方法，以现实世界的功能为目标。一个这样 认知行为社会技能培训（CBSST）。与传统的认知行为疗法不同， CBSST是一种更注重恢复的心理社会康复干预， 纠正思维错误，培养社交技能。虽然有效，但CBSST仅在促进时进行了测试 这限制了它在VHA中的使用。然而，我们的试点数据显示， 专家-患有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人。 具有SMI的用户也可以提供CBSST（称为CBSST-Peer）。独立的社会技能培训（SST）也是一个 VHA正试图在全国范围内为SMI退伍军人推出以恢复为导向的计划。几个小伙伴-- 社会学家已接受培训，与专业人员共同领导SST。然而，SST并没有得到广泛的实施- 因为专业人员正忙碌，同行专家交付的SST尚未经过测试。本研究将评估 同行专家提供的CBSST和SST的有效性，这将增加退伍军人的访问， SMI必须进行有效治疗。我们的目标是：目标1（有效性）：比较CBSST同行的影响 关于患有SMI的退伍军人与接受同行专家提供的SST和同行专家领导的退伍军人的结局 手动化，目标集中的小组，持续时间相同。我们还将评估SST和CBSST的保真度。目标二： （CBSST/SST的帮助-同行和执行障碍及促进者）：利用重点小组 与患者和同行专家和其他工作人员进行访谈，以评估SST和CBSST的看法， 同行并确定未来实施的潜在障碍和促进因素。方法：这是一个随机， 混合1试验涉及252名患有SMI的退伍军人（n=126，来自匹兹堡和圣地亚哥），比较3种治疗 两组：CBSST-同伴vs. SST-同伴vs.相同持续时间的手动目标集中组。混合1试验测试 评估干预措施的有效性，并收集实施数据，为今后的采用提供信息。在 每个研究中心，6个波（一个波= 1个CBSST-同行，1个SST-同行，1个目标聚焦组），2个同行专家 将共同领导18到20周的小组。与试点一样，同行专家将接受培训，并接受一个小时的超级- CBSST开发人员每周的愿景。来自SST推广的主培训师将培训和监督同行 每个站点的专家。所有三个手臂的会议将被录音，25%的标准化评估的保真度 措施一个调查电池，评估功能，生活质量，恢复和症状将管理- 在每一波中对退伍军人进行了测试：基线、干预中期（10周）、干预结束（20周）， 随访（32周，干预后3个月）。我们将使用HLM检查所有结果， 条件包括作为时不变协变量，以及人的随机截距和时间的随机斜率。 相关协变量包括研究中心、治疗出勤率、症状严重程度、服务使用和人口统计学 变量我们将评估治疗条件的效果（CBSST-同行与SST-同行与目标聚焦 组）在预期的方向和时间X组的效果。关于SST和CBSST的定性数据-同伴帮助- 将从参加的退伍军人中随机抽取一个样本， 在SST和CBSST同行（每个研究中心4个焦点小组）中，参与同行专家（每个研究中心采访n=6-8人） 研究中心）和心理健康管理人员（每个研究中心约3-4人进行访谈）。使用一种改良的接地理论- 采用这种方法，逐字文本将被编码，以确定关于是否有用的答复类别， VHA中SST-和CBSST-Peer的未来实施的障碍和促进因素。创新：没有研究 在一项严格的试验中测试了同行提供的SST或CBSST，或比较了两者。显著性/预期再- 结果：CBSST和SST不能广泛使用。如果SST-或CBSST-Peer是有效的，它可以大大增加 提供基于证据的服务退伍军人接受并加强VHA同行专家的服务。