Improving Mental Health for Veterans with Dementia: Provider Training in Caregiver Engagement

改善患有痴呆症的退伍军人的心理健康：护理人员参与方面的提供者培训

• 批准号: 10443594
• 负责人: Mary Frances Wyman
• 金额: --
• 依托单位: WM S. MIDDLETON MEMORIAL VETERANS HOSP
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10443594
• 关键词: Address; Adult; Aging; Anxiety; Behavior Therapy; Caregiver support; Caregivers; Caring; Clinical Research; Clinical Skills; Cognition; Cognitive; Cognitive deficits; Collaborations; Communication; Complement; Data; Data Analyses; Data Collection; Data Set; Data Sources; Dementia; Development; Dimensions; Dissemination and Implementation; Doctor of Philosophy; Educational Curriculum; Educational Intervention; Effectiveness; Elements; Employee Engagement; Environment; Family; Family Caregiver; Feasibility Studies; Funding; Future; Goals; Health Personnel; Health Services Accessibility; Health Services Research; Health and Retirement Study; Healthcare; Impaired cognition; Infrastructure; Intervention; Interview; K-Series Research Career Programs; Knowledge; Lead; Leadership; Learning; Left; Longitudinal Surveys; Medical Care Team; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mentors; Mentorship; Methodology; Methods; Outcome; Patients; Persons; Play; Post-Traumatic Stress Disorders; Procedures; Provider; Qualitative Methods; Qualitative Research; Quality of Care; Randomized; Records; Regression Analysis; Reporting; Research; Research Personnel; Research Training; Role; Self Efficacy; Series; Services; Severities; Structure; Suicide prevention; System; Testing; Training; Training Activity; Universities; Veterans; Veterans Health Administration; Wisconsin; Work; care outcomes; career; career development; caregiver stress; caregiving; cohort; comorbidity; cost effective; design; effective intervention; effectiveness testing; efficacy trial; evidence base; experience; feasibility testing; geriatric mental health; health care availability; health care delivery; health care quality; health care service; health care service utilization; health care settings; health data; health equity; implementation strategy; improved; improved outcome; informal caregiving; innovation; mild cognitive impairment; novel; pilot test; pilot trial; programs; provider intervention; research study; satisfaction; skills; theories; therapy design

Background: This career development proposal is designed to prepare Mary Wyman, PhD for a VA career conducting health services research focused on improving mental health care delivery and access for aging Veterans. Dr. Wyman will accomplish this goal by completing training activities, obtaining expert mentorship, and completing a series of research studies on family caregiver engagement in mental health services for Veterans with dementia. Comorbid mental health conditions (e.g., depression and anxiety) are common in dementia and are associated with worse outcomes if left untreated. To improve care quality and access, it is critical to effectively involve family caregivers in mental health services; however, providers lack the confidence and skills to do so. The primary objectives in this CDA application are 1) to use a qualitative research approach to identify facilitators and barriers to caregiver engagement; 2) develop and test a provider training curriculum to increase skills in engaging caregivers; and 3) use an existing dataset combining longitudinal survey data and VA health care records to explore how caregiving associates to use of mental health services among Veterans with dementia. Significance/Impact: This work has the potential to have significant and meaningful impact on the delivery of mental health care to aging Veterans. Our methodology will support rapid dissemination and implementation of the final, effectiveness-tested intervention, and our findings can inform development of future interventions to address modifiable factors associated with mental health care access and outcomes. This work aligns strongly with VHA and HSR&D priorities, including increased access to care, mental health and suicide prevention, caregiver support, and employee engagement. Innovation: While there are several effective interventions aimed at caregivers, we propose an innovative approach to increasing caregiver involvement in mental health care by training providers in knowledge and skills for effective caregiver engagement. As such, our proposal offers new directions for improving mental health care quality and access for aging Veterans. The resultant systems intervention may be applicable across VHA care settings and could positively impact employee engagement through increased provider self-efficacy. Specific Aims: Objectives will be achieved through three specific aims: 1) Identify patient-, provider-, and system-level factors that support or impede caregiver engagement in mental health care for aging Veterans with dementia; 2) Develop and pilot-test a provider training curriculum and implementation strategy to improve mental health provider engagement of caregivers of Veterans with dementia; 3) Examine associations of intensity of informal caregiving received and cognitive status with MH care utilization by aging Veterans. Methodology: Aim 1 involves semi-structured interviews with Veterans with dementia, their caregivers, and mental health providers and leadership. Aim 2 will use established methodology to develop, refine, and pilot-test a provider training and implementation strategy for the mental health setting. In Aim 3, data from the VA-Health & Retirement Study Aging Veterans Cohort will be analyzed to explore associations between caregiving, cognitive status, and mental health care utilization. Next Steps/Implementation: During the CDA period, a proposal will be submitted to fund an adequately powered “real-world” efficacy trial of the training curriculum. Dr. Wyman will work with local and national VHA dissemination partners to disseminate study results and the final, effectiveness-tested intervention. Embedded in the Madison VA GRECC and the rich environment of the University of Wisconsin, which offers extensive infrastructure to support early stage investigators, Dr. Wyman is in an ideal environment to complete the proposed research and training, allowing her to successfully launch as an independent investigator in VHA.

背景：本职业发展计划旨在为玛丽怀曼博士的VA职业生涯做好准备 开展卫生服务研究，重点是改善精神卫生保健的提供和老龄化的可及性 老兵怀曼博士将通过完成培训活动，获得专家指导， 完成一系列关于家庭照顾者参与退伍军人心理健康服务的研究 患有痴呆症共病心理健康状况（例如，抑郁症和焦虑症）在痴呆症中很常见， 如果不及时治疗会导致更严重的后果为了提高护理质量和可及性， 让家庭照顾者参与心理健康服务;然而，提供者缺乏这样做的信心和技能。 本CDA应用程序的主要目标是：1）使用定性研究方法来识别促进者 和障碍，以照顾者的参与; 2）制定和测试提供者培训课程，以提高技能， 参与护理人员;以及3）使用现有的数据集，结合纵向调查数据和VA医疗保健 记录，以探讨如何让同事使用精神卫生服务的退伍军人与痴呆症。 重要性/影响：这项工作有可能对以下方面产生重大和有意义的影响： 老年退伍军人的心理健康我们的方法将支持快速传播和实施 最后，有效性测试干预，我们的研究结果可以为未来干预措施的发展提供信息， 解决与精神卫生保健获得和结果相关的可变因素。这项工作与 与VHA和HSR&D优先事项，包括增加获得护理，心理健康和自杀预防， 护理人员支持和员工参与。 创新：虽然有几种针对护理人员的有效干预措施，但我们提出了一种创新的 通过培训提供者的知识和技能来增加照顾者参与精神卫生保健的方法 有效的护理人员参与。因此，我们的提案为改善精神卫生保健提供了新的方向 为老年退伍军人提供优质服务。由此产生的系统干预可能适用于整个VHA护理 环境，并可以通过提高供应商的自我效能积极影响员工的参与。 具体目标：将通过三个具体目标实现目标：1）确定患者、提供者和 支持或阻碍护理人员参与老年退伍军人心理健康护理的系统级因素 2）开发和试点测试提供者培训课程和实施策略，以改善精神疾病; 健康提供者参与老年痴呆症退伍军人的照顾者; 3）检查 老年退伍军人接受非正式护理和认知状况与MH护理利用。 方法：目标1涉及与痴呆症退伍军人，他们的照顾者， 心理健康提供者和领导力。目标2将使用已建立的方法来开发、完善和试点测试 为心理健康环境提供培训和实施战略。在目标3中，来自VA-健康的数据 和退休研究老龄化退伍军人队列将进行分析，以探讨退休， 认知状况和心理健康护理利用率。 后续步骤/实施：在CDA期间，将提交一份提案， 动力“真实世界”的培训课程的功效试验。怀曼博士将与当地和国家VHA 传播伙伴传播研究结果和经过有效性检验的最终干预措施。嵌入式 在麦迪逊VA GRECC和威斯康星州，它提供了广泛的大学丰富的环境 基础设施，以支持早期阶段的研究人员，怀曼博士是在一个理想的环境，以完成 建议的研究和培训，使她能够成功地推出作为一个独立的调查员在VHA。