Increasing Social Connection Through Crisis Caring Contacts: A Pragmatic Trial

通过危机关怀接触增加社会联系：一项务实的试验

• 批准号: 10425515
• 负责人: Alan Teo
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10425515
• 关键词: Acute; Address; Affect; Age; Aging; Ambulatory Care; Appointment; Area; COVID-19 impact; COVID-19 pandemic; COVID-19 pandemic effects; Caring; Cessation of life; Clinical; Clinical Trials; Control Groups; Data; Diagnosis; Disasters; Elderly; Feeling suicidal; Funding; Future; Gender; Grant; Health; Health Resources; Health Services; Health Services Accessibility; Health Services Research; Health system; Healthcare; Individual; Intervention; Loneliness; Medical; Mental Health; Mental Health Services; Methodology; Outcome; Outpatients; Overdose; Patient Self-Report; Patients; Pharmaceutical Preparations; Population; Prevention strategy; Primary Health Care; Randomized Controlled Trials; Resources; Risk; Scientific Advances and Accomplishments; Site; Social isolation; Social support; Socioeconomic Status; Specialist; Suicide; Suicide attempt; Suicide prevention; Survival Analysis; Testing; Time; Trust; Veterans; Visit; Work; acceptability and feasibility; arm; care outcomes; coronavirus disease; cost; dashboard; effectiveness evaluation; evidence base; experience; follow-up; functional decline; future implementation; innovation; mortality; novel; older patient; outreach; pandemic disease; patient population; peer; peer support; pragmatic trial; preventive intervention; psychiatric comorbidity; recruit; research and development; response; social; social health determinants; sociodemographics; suicide rate; treatment arm; treatment as usual; treatment response; usual care arm

Background: This is a time of unprecedented loneliness and social isolation. Loneliness in particular is a powerful predictor of suicidal ideation, suicide attempts, functional decline, and death. Loneliness can and should be addressed by health systems. Due to risk for loneliness and negative health outcomes, a group of particular concern is older adults with medical or psychiatric comorbidity who have limited treatment engagement. Caring Contacts is an intervention that can address loneliness and poor treatment engagement. However, it has only been evaluated in a narrow population of psychiatric patients and not examined amongst patients impacted by the COVID-19 pandemic or other disasters. Significance: This project addresses VA’s top clinical priority (suicide prevention), an overarching priority of the Office of Research and Development (clinical trials), and multiple Health Service Research and Development priority areas, including social determinants of health, aging, access to care, mental health, suicide prevention, and population/whole health. The impact of this project is very high because it will advance scientific understanding of key gaps related to the mechanisms and outcomes of Caring Contacts, while also evaluating a timely, pragmatic, low-cost, and scalable intervention for Veterans affected by lack of social connection and treatment engagement. If effective, it will have applicability as a response to treatment disengagement and future disasters. Innovation and Impact: We have taken an empirically-grounded suicide prevention intervention and adapted it for Veterans with poor treatment engagement in VA outpatient care. This study is innovative in testing an intervention responsive to the COVID-19 pandemic and its aftermath, and unique in using a health services intervention strategy to target loneliness. The intervention’s peer support component is highly novel for its low resource demands and potential for scalability. Specific Aims: The overarching objective of this project is to evaluate “Crisis Caring Contacts” (CCC), an adaptation of Caring Contacts tailored to reduce loneliness in the context of the pandemic. To reach this objective we will achieve these aims: 1) Among older Veterans with poor treatment engagement, evaluate the effectiveness of Crisis Caring Contacts in decreasing loneliness, compared to enhanced usual care; 2) Evaluate the effect of Crisis Caring Contacts on other important outcomes, including treatment engagement and suicidal ideation; 3) Explore potential moderators of treatment response to Crisis Caring Contacts; and 4) Explore the effect of Crisis Caring Contacts on all-cause mortality and suicide attempts. Methodology: Our approach is to conduct a multisite, pragmatic randomized controlled trial of CCC. We will target Veterans age 60 and over with active psychiatric or medical diagnoses who have had limited treatment engagement in VA outpatient care. Those in the CCC treatment arm will be sent 10 postcards over 10 months by a Peer Support Specialist. Those in the enhanced usual care arm (control) will be sent non-personalized, general health resource information. We will examine self-report and administrative data outcomes over 24 months of follow-up. Next Steps/Implementation: We will collect pre-implementation data from our study sites and share this with our operational partner, the Office of Mental Health and Suicide Prevention (OMHSP). Crisis Caring Contacts is highly suited to future implementation due to its scalability, ease of creating an operational dashboard to identify Veterans who could receive the intervention, and ability to add study materials to an implementation toolkit for VA Caring Contacts interventions.

背景：这是一个前所未有的孤独和社会孤立的时代。尤其是孤独， 是自杀意念、自杀企图、功能衰退和死亡的有力预测因子。孤独会 应该由卫生系统来解决。由于孤独和负面健康结果的风险， 特别值得关注的群体是患有医学或精神科合并症的老年人， 治疗参与。关怀接触是一种干预，可以解决孤独和贫困 治疗参与。然而，它只在一个狭窄的精神病患者群体中进行了评估。 受COVID-19大流行或其他灾难影响的患者中未接受检查的患者。 意义：该项目解决了VA的首要临床优先事项（自杀预防），一个总体的 研究和开发办公室的优先事项（临床试验），以及多个卫生服务 研究和发展优先领域，包括健康、老龄化、获得 保健、心理健康、自杀预防和人口/整体健康。这个项目的影响是非常 高，因为它将促进对与机制有关的关键差距的科学理解， 结果的关怀联系，同时也评估及时，务实，低成本，可扩展的 对缺乏社会联系和治疗参与的退伍军人进行干预。如果有效，它 将适用于治疗脱离接触和未来的灾难。 创新和影响：我们采取了一种基于实践的自杀预防干预措施， 将其调整为在VA门诊护理中治疗参与度差的退伍军人。本研究具有创新性 在测试应对COVID-19大流行及其后果的干预措施方面， 针对孤独症的健康服务干预策略。干预措施的同伴支持部分 由于其低资源需求和可扩展性的潜力而非常新颖。 具体目标：该项目的总体目标是评估“危机关怀联系人”， 改编的《关怀接触》，旨在减少疫情背景下的孤独感。达成 我们将实现这些目标：1）在治疗参与度差的老年退伍军人中， 评估危机关怀联系人在减少孤独方面的有效性，与加强 2）评估危机关怀联系人对其他重要结果的影响，包括 治疗参与和自杀意念; 3）探索治疗反应的潜在调节因素， 危机关怀接触;以及4）探索危机关怀接触对全因死亡率的影响， 自杀企图 方法：我们的方法是进行一项多中心、实用的CCC随机对照试验。 我们将针对60岁及以上的退伍军人，他们有积极的精神病或医学诊断， VA门诊治疗参与有限。CCC治疗组的患者将被送往10个 10个月以上的明信片由同行支持专家。那些在加强日常护理组的人 （控制）将被发送非个性化的、一般的健康资源信息。我们将检查自我报告 以及24个月随访期间的管理数据结果。 后续步骤/实施：我们将从研究中心收集实施前数据，并分享 这与我们的业务合作伙伴，心理健康和自杀预防办公室（OMHSP）。危机 Caring Contacts非常适合未来的实施，因为它具有可扩展性，易于创建 操作仪表板，以识别可以接受干预的退伍军人，并能够添加研究 为VA关怀联系人干预措施提供实施工具包。