Cognitive Rehabilitation for Homeless OEF/OIF/OND Veterans

 描述(由申请人提供)： 到2015年结束退伍军人中的无家可归现象是国家的优先事项。尽管无家可归的途径有很多，但无家可归的最终结果往往是计划失败、问题解决失败，或者两者兼而有之。计划和解决问题是依赖于完整的大脑功能的执行功能，高达80%的无家可归者的这些和其他神经认知能力可能受到损害，影响他们的组织、判断、决策和从心理社会康复干预中受益的能力。因此，认知障碍可能是结束无家可归的努力中一个被低估但普遍存在的障碍。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情况相互作用，导致糟糕的住房结果，糟糕的治疗依从性，以及持续无家可归的风险。在无家可归者服务环境中进行认知评估和康复并不常见，到目前为止还没有关于无家可归者认知康复的已知研究。我们有一个在Aspire Center研究退伍军人的黄金机会，Aspire Center是一个有40个床位的住宅康复治疗计划(寄宿)，为有精神健康问题(精神疾病、药物滥用和创伤性脑损伤)的无家可归归来的退伍军人提供服务。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、为期10周的补偿性认知训练(CCT)干预或教育控制条件，以检查这一退伍军人群体中认知康复的效果。CCT旨在通过教学策略来改善前瞻记忆(记得做事情)、注意力、学习/记忆和执行功能，从而提高现实世界的认知表现。减轻压力和改善睡眠的策略也包括在内。CCT已被证明可以改善与精神疾病相关的认知障碍患者和患有脑外伤的退伍军人的认知、功能容量、神经行为症状严重程度和生活质量。在试验期间，评估将在基线、5周、10周和15周进行，每月跟踪电话将在计划出院后评估一年的住房和就业/教育状况。我们期待与有条件现金转移相关的认知和功能技能的改善(共同初等教育结果)和推广，以降低残疾水平，同时改善重新融入社区的结果(更好的住房稳定性和参加工作或学校)。通过关注和治疗这些退伍军人中的许多人将会有的认知障碍，我们可能会改变退伍军人的轨迹，防止未来的无家可归及其负面的健康后果，从而节省医疗成本，提高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.