Cognitive Rehabilitation for Homeless OEF/OIF/OND Veterans

 描述（由申请人提供）： 到2015年结束退伍军人的无家可归现象是国家的优先事项。虽然有许多途径无家可归，无家可归的最终结果往往涉及失败的规划，解决问题，或两者兼而有之。计划和解决问题是依赖于完整的大脑功能的执行功能，这些和其他神经认知能力可能在高达80%的无家可归者中受损，影响他们的组织，判断，决策以及从心理康复干预中受益的能力。因此，认知障碍可能是一个未被充分认识但普遍存在的障碍，努力结束无家可归。无家可归者认知障碍的原因包括创伤性脑损伤、精神疾病、药物滥用和其他医疗条件。认知障碍可能与这些条件相互作用，导致住房状况不佳，治疗依从性差，以及持续无家可归的风险。在无家可归者服务的设置认知评估和康复是不常见的，没有已知的研究，迄今为止的认知康复无家可归的个人。我们有一个千载难逢的机会来解决这些研究差距，通过研究退伍军人在Aspire中心，一个40张病床的住宅康复治疗计划（辅助）服务无家可归的退伍军人返回精神健康状况（精神疾病，药物滥用和创伤性脑损伤）。在一项为期15周的随机对照试验中，有认知或功能障碍的退伍军人将接受基于证据的10周补偿性认知训练（CCT）干预或教育对照条件，以检查认知康复对退伍军人人群的影响。CCT旨在通过教学策略来改善前瞻性记忆（记住要做的事情），注意力，学习/记忆和执行功能，以提高现实世界的认知表现。还包括减轻压力和改善睡眠的策略。CCT已被证明可以改善认知、功能能力、神经行为症状严重程度和与精神疾病相关的认知障碍个体和TBI退伍军人的生活质量。在试验期间，将在基线、5周、10周和15周时进行评估，每月电话随访将评估项目出院后一年的住房和就业/教育状况。我们预计CCT相关的认知和功能技能（共同主要结果）的改善和残疾程度的降低，沿着改善的社区重返社会结果（更好的住房稳定性和参与工作或学校）。通过照顾和治疗这些退伍军人中的许多人将有认知障碍，我们可以潜在地改变退伍军人的轨迹，防止未来无家可归及其负面的健康后果，从而节省医疗费用和改善退伍军人的生活质量。

 DESCRIPTION (provided by applicant): Ending homelessness among Veterans by 2015 is a national priority. Although there are many routes to homelessness, the end result of homelessness frequently involves a failure in planning, problem-solving, or both. Planning and problem-solving are executive functions dependent upon intact brain functioning, and these and other neurocognitive abilities may be impaired in up to 80% of homeless individuals, affecting their organization, judgment, decision-making, and ability to benefit from psychosocial rehabilitation interventions. Thus, cognitive impairment may be an underappreciated yet pervasive barrier to efforts toward ending homelessness. Causes of cognitive impairment in homeless individuals include traumatic brain injury, psychiatric illness, substance abuse, and other medical conditions. Cognitive impairment may interact with these conditions to result in poor housing outcomes, poor treatment adherence, and risk of continued homelessness. Cognitive assessment and rehabilitation in the setting of homeless services is not common, with no known studies to date of cognitive rehabilitation for homeless individuals. We have a golden opportunity to address these research gaps by studying Veterans at the Aspire Center, a 40-bed Residential Rehabilitation Treatment Program (domiciliary) serving homeless returning Veterans with mental health conditions (psychiatric illness, substance abuse, and traumatic brain injuries). In a 15-week randomized controlled trial, Veterans with cognitive or functional impairments will receive an evidence-based, 10-week Compensatory Cognitive Training (CCT) intervention or an education control condition to examine the effects of cognitive rehabilitation in this Veteran population. CCT aims to improve real-world cognitive performance by teaching strategies to improve prospective memory (remembering to do things), attention, learning/memory, and executive functioning. Strategies to reduce stress and improve sleep are also included. CCT has been shown to improve cognition, functional capacity, neurobehavioral symptom severity, and quality of life in individuals with cognitive impairment associated with psychiatric illness and in Veterans with TBI. During the trial, assessments will be administered at baseline, 5 weeks, 10 weeks, and 15 weeks, and monthly follow-up phone calls will assess housing and employment/education status for one year following program discharge. We expect CCT-associated improvements in cognition and functional skills (co-primary outcomes) and generalization to reduced levels of disability, along with improved community reintegration outcomes (better housing stability and participation in work or school). By attending to and treating the cognitive impairments that many of these Veterans will have, we can potentially alter the course of the Veterans' trajectories and prevent future homelessness and its negative health consequences, resulting in both healthcare cost savings and improved quality of life for Veterans.