Designing veteran-centered strategies to reduce and prevent food insecurity: A veteran and community-partnered approach

背景：粮食不安全的定义是由于家庭经济原因， 限制和影响四分之一的9/11后退伍军人。食物不安全的退伍军人增加了精神疾病的风险 健康状况，如抑郁症和自杀意念。目前减少粮食不安全的方法侧重于 但在解决失业、贫困、失业和失业等潜在因素方面却收效甚微。 获得医疗保健和社会隔离。幸运的是，退伍军人事务部有解决这些基本问题的服务， 贡献者。不幸的是，超过一半的9/11后退伍军人尚未注册或使用VA计划 因为他们缺乏对服务的认识和/或获得服务的机会。社区志愿服务组织是关键的切入点 对于那些尚未与VA服务联系的未满足社会需求的退伍军人。然而，我们对 他们的筛选实践。就像在医疗机构一样，在社区中建立健全的筛查和转诊流程 环境是必要的;否则，很大一部分退伍军人可能继续没有食物。重要性： 拟议的CDA直接响应了VHA HSR & D的研究呼吁，以减轻未满足的社会需求， 老兵越来越多的证据表明，仅仅提供粮食并不能改善粮食安全。我们需要一个 考虑到粮食不安全的根本原因的全面方法。53%的人中， 9/11退伍军人没有参加退伍军人事务处的服务，但与低入伍等级分开和/或是妇女。这些 这些特点使他们面临更大的粮食不安全风险。因此，我们还需要集成鲁棒的 筛选过程，以确定退伍军人谁是粮食不安全的地方，他们在社区;否则， 很大一部分退伍军人可能会继续与未满足的社会需求。创新：需要合作伙伴 与社区组织、VHA和社区卫生组织合作，设计一种干预措施， 贡献者通过同行支持，以减少孤立和导航现有资源的基础上， 在这个CDA中提出的研究。据我所知，我们的研究也将是第一次尝试， 志愿服务组织正在筛查粮食不安全和其他与健康有关的社会需求。目标：长期 职业目标是成为一名VA为基础的独立调查员，因实施创新，社区， 参与解决粮食不安全和健康的其他社会决定因素的解决方案。以我的指导， 导师团队，我的目标是提高参与性研究的熟练程度，扩大干预知识， 设计和评估，并建立实施技能，将证据转化为实践。支持这些 职业目标，在CDA期间，我建议：目标1。设计一个知情的、环绕式的 采取干预措施，帮助9/11后粮食不安全的退伍军人。目标二。进行可行性试验， 知情者知情的，环绕式干预，旨在为粮食不安全的退伍军人提供同行 支持和连接现有的服务，解决粮食不安全的根本原因。目标3. * 审查以社区为基础的粮食不安全和其他与健康有关的社会需求筛查做法， 老兵方法论：我们将使用以人为中心的设计框架来设计一个环绕式的 与关键利益攸关方的干预（例如，退伍军人，社区合作伙伴，VHA社会工作，和社区外展 专家）。然后，我们将对干预措施进行为期12周的可行性和可接受性试验。在第四年， 5，我们将在德克萨斯州的VSO中进行筛查实践的景观调查，并以1：1的比例进行深入调查。 与选定的VSO进行访谈，以进一步探讨促进和阻止VSO筛查的因素。结果 将包括供筛选的知情者流程图。下一步：由此产生的研究 CDA将支持IIR提交，以进行混合1型研究， 在这方面，我们提出了一项干预措施，并提出了在社区环境中启动和/或扩大社会需求筛查的建议。作为一名退伍军人- 基于护士科学家，我将使用的技能，指导，并从我的CDA获得的经验，以产生 这将为实践和政策提供信息，以解决影响退伍军人的复杂社会需求。

Background: Food insecurity is defined as limited or uncertain access to food due to household economic restrictions and affects 1 in 4 post-9/11 Veterans. Food insecure Veterans have increased risk for mental health conditions like depression and suicidal ideation. Current methods to reduce food insecurity focus on immediate food access but do little to address underlying contributors such as such as unemployment, poor access to healthcare, and social isolation. Fortunately, the VA has services that address these underlying contributors. Unfortunately, more than half of post-9/11 Veterans have yet to enroll in, or use, VA programs because they lack awareness of, and/or access to, services. Community-based VSOs are critical entry points for Veterans with unmet social needs who have yet to connect with VA services. However, we know little about their screening practices. Like in healthcare settings, robust screening and referral processes in community settings are imperative; otherwise, a large portion of Veterans may continue to go without food. Significance: The proposed CDA directly responds to the VHA HSR&D’s call for research to mitigate unmet social needs of Veterans. Mounting evidence indicates that food provision alone does not improve food security. We need a comprehensive approach that considers underlying contributors to food insecurity. Many of the 53% of post- 9/11 Veterans not enrolled in VA services separated with low enlistment ranks and/or are women. These characteristics place them at increased risk for food insecurity. Thus, we also need to integrate robust screening processes to identify Veterans who are food insecure where they are—in the community; otherwise, a significant portion of Veterans may continue to go with unmet social needs. Innovation: The need to partner with community-based organizations, VHA, and VBA to design an intervention that will address underlying contributors through peer-support to reduce isolation and navigate existing resources is the basis for the research proposed in this CDA. Our study will also, to my knowledge, be the first attempt to examine how VSOs are screening for food insecurity and other health-related social needs. Specific Aims: My long-term career goal is to be a VA-based independent investigator recognized for implementing innovative, community- engaged solutions that tackle food insecurity and other social determinants of health. With guidance from my mentorship team, I aim to increase proficiency with participatory research, expand knowledge on intervention design and evaluation, and build implementation skills to translate evidence to practice. To support these career objectives, during the CDA I propose to: Aim 1. Design a stakeholder-informed, wrap-around intervention to help post-9/11 Veterans who are food insecure. Aim 2. Conduct a feasibility trial of a stakeholder-informed, wrap-around intervention designed to provide Veterans who are food insecure with peer support and connect to existing services that address underlying contributors to food insecurity. Aim 3. Examine community-based screening practices for food insecurity and other health-related social needs in Veterans. Methodology: We will use the human-centered design framework to design a wrap-around intervention with key stakeholders (e.g., Veterans, community partner, VHA social work, and VBA outreach specialists). We will then conduct a 12-week feasibility and acceptability trial of the intervention. In Year 4 and 5, we will conduct a landscape survey of screening practices among VSOs in Texas and 1:1 in-depth interviews with select VSOs to further explore factors that facilitate and prevent screening in VSOs. Findings will include stakeholder-informed process maps for screening. Next steps: The research generated from this CDA will support an IIR submission to conduct a hybrid type 1 study of the stakeholder-informed, wrap-around intervention and a proposal to initiate and/or expand screening of social needs in community settings. As a VA- based nurse scientist, I will use the skills, mentorship, and experience gained from my CDA to generate research that will inform practice and policy to address complex social needs affecting Veterans.