Connecting Women to Care: Home-based Psychotherapy for Women with MST Living in Rural Areas

背景-女性退伍军人中的军性创伤(MST)是一个流行病比例问题 与严重的精神健康和功能障碍以及获得护理障碍密切相关。 监测数据表明，每四名女性退伍军人中就有一人在筛查时报告MST。与女性相比 有其他服务相关压力源的退伍军人，经历MST的退伍军人心理健康问题更严重， 更有可能报告在社交、家庭和亲密关系中的运作困难，也更有可能 失业和报告找工作困难的权利。然而，患有MST的女性参与度较低 经常在退伍军人医疗保健方面比其他女性退伍军人。护理障碍包括与专科的距离 服务、经济困难、育儿和家庭责任，以及男性与性别相关的不适-- 主导退伍军人管理局的设施。过去十年的研究确定了妇女的问题和关切 患有MST的退伍军人，但计划满足他们的心理健康需求，并对已确定的障碍做出反应 都是缺乏的。拟议的研究通过评估对性别敏感的循证技能来解决这一差距 通过家庭视频技术提供的培训计划。 具体目标--这项研究将进行一项混合类型1有效性--实施研究，以实现两个目标 目标。第一个是确定HBVT提供的情感调节技能培训的有效性 (阶梯)相对于HBVT提供的非特异性主动比较器，目前的中心治疗(PCT) 患有MST的退伍军人。假设STAIR将在以下方面优于PCT 创伤后应激障碍症状(主要结果)以及感受到的社会支持和社会参与度 (次要结果)。第二个目标是进行多利益攸关方混合方法评估，以告知 未来潜在的实施计划，通过HBVT确定实施楼梯的障碍和促进者 对治疗过程和临床疗效的量化数据进行上下文分析和解释。 研究方法--这是一项为期四年、两个地点的第一类混合型有效性实施研究设计。总计 200名有MST和PTSD症状的女性退伍军人(具有DSM-5创伤后应激障碍筛查截止点)将被登记 走进书房。参赛者将按乡村地位分层，比例代表全国 人口(农村占34%，非农村占66%)。分层将确保资源专门用于招聘 确定了农村妇女的人数。在每一级别的分层中，参与者将被随机分成以下一组 两种治疗条件，楼梯或PCT，每周10次。评估将 在五个时间点进行：基线(第0周)、中期(第5周)、治疗后立即(每周 10)、2个月随访期(第18周)和4个月随访期(第26周)。乡村将作为协变量被包括在内，并且 评估留存和成果等方面的差异，这将有助于为未来的实施提供信息 计划。多利益攸关方关于楼梯和居家分娩使用的混合方法过程评估 服务范围将包括管理员、临床医生和患者利益相关者。预期结果和预期 对退伍军人医疗保健的影响-预计拟议的研究有可能改善 通过建立社会技能干预的有效性来提高退伍军人医疗保健的质量，技能培训 通过家庭视频技术(HBVT)向女性提供情感和人际调节(STAIR) 患有MST的退伍军人，特别是那些生活在农村地区的退伍军人。治疗的同时解决了社会问题 关切和创伤后应激障碍症状，这两者都是经历过的女性退伍军人的确定需求 MST。STAIR已经在社区人群中被证明是有效的，并在妇女中进行了试点数据 患有MST的退伍军人在感受到的社会支持、社会支持、 参与和创伤后应激障碍症状。HBVT的使用有可能增加获得这种治疗的机会 地理上分散且服务不足的人口。

Background – Military Sexual Trauma (MST) among women Veterans is a problem of epidemic proportion associated with significant mental health and functional impairment and substantial access to care barriers. Surveillance data indicate that one in four women Veterans reports MST when screened. Compared to women Veterans with other service-related stressors, those experiencing MST have greater mental health problems, are more likely to report difficulty in functioning in social, family and intimate relationships and are more likely to be unemployed and to report difficulties in finding a job. Nevertheless, women with MST engage less frequently in VA health care than other women Veterans. Barriers to care include distance from specialty services, financial difficulties, childcare and family responsibilities, and gender-related discomfort in male- dominated VA facilities. Research over the past decade has identified the problems and concerns of women Veterans with MST but programs addressing their mental health needs and responsive to identified barriers are lacking. The proposed study addresses this gap by evaluating a gender-sensitive, evidence-based skills training program delivered via home-based video technology. Specific Aims – The study will conduct a Hybrid Type 1 effectiveness-implementation study to accomplish two aims. The first is to determine the effectiveness of the HBVT-delivered, Skills Training in Affective Regulation (STAIR) relative to a HBVT-delivered nonspecific active comparator, Present Centered Therapy (PCT) among women Veterans with MST. It is hypothesized that STAIR will be superior to PCT in regards to improvement in CAPS PTSD symptoms (primary outcome) as well as in perceived social support and social engagement (secondary outcomes). The second aim is to conduct a multi-stakeholder, mixed method evaluation to inform future potential implementation plans by identify barriers and facilitators of implementing STAIR via HBVT and to contextualize and interpret the quantitative data on treatment processes and clinical effectiveness. Methodology – This is a four-year, two-site Hybrid Type 1 effectiveness-implementation study design. A total of 200 women Veterans with MST and PTSD symptoms (with DSM-5 PTSD Screen cut-off > 3) will be enrolled into the study. Participants will be stratified by rurality status in a proportion representative of the national population (34% rural vs. 66% nonrural). Stratification will ensure that resources are dedicated to recruit the identified number of rural women. Within each level of stratification, participants will be randomized into one of two treatments conditions, STAIR or PCT, each of which is comprised of 10 weekly sessions. Assessments will be conducted at five time-points: baseline (week 0), midtreatment (week 5), immediately posttreatment (week 10), 2-month follow-up (week 18) and 4-month follow-up (week 26). Rurality will be included as a covariate and assessed for variations in aspects such as retention and outcome, which will help inform future implementation plans. Multi-stakeholder mixed-method process evaluation concerning STAIR and the use of in-home delivery of services will include administrator, clinician and patient stakeholders. Expected Results and Anticipated Impacts on Veterans Healthcare – It is expected that the proposed study has the potential to improve the quality of VA healthcare by establishing the effectiveness of a social skills intervention, Skills Training in Affective and Interpersonal Regulation (STAIR) delivered via home-based video technology (HBVT) to women Veterans with MST, particularly those living in rural areas. The treatment simultaneously addresses social concerns and PTSD symptoms, both of which are identified needs of women Veterans who have experienced MST. STAIR has been demonstrated as efficacious in community populations and pilot data with women Veterans with MST indicate similar outcomes regarding improvements in perceived social support, social engagement and PTSD symptoms. The use of HBVT has the potential of increasing access to care to this geographically dispersed and underserved population.