Integration of Peer Support Across the PTSD Continuum of Care

在 PTSD 连续护理中整合同伴支持

• 批准号: 8980039
• 负责人: NATALIE E HUNDT
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-10-01 至 2020-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8980039
• 关键词: Address; Address; Aftercare; Aftercare; Ambulatory Care Facilities; Ambulatory Care Facilities; Area; Area; Attitude; Attitude; Caring; Caring; Clinic; Clinic; Cognitive; Communities; Communities; Complex; Complex; Continuity of Patient Care; Continuity of Patient Care; Coping Behavior; Coping Behavior; Data; Data; Dedications; Dedications; Diagnosis; Diagnosis; Diagnostic; Diagnostic; Disease; Disease; Dropout; Drops; Effectiveness; Effectiveness; Emotional; Emotional; Empathy; Empathy; Employment; Employment; Evaluation; Event; Event; Evidence based treatment; Evidence based treatment; Foundations; Fright; Fright; Funding; Funding; Future; Future; Goals; Goals; Gold; Gold; Grant; Grant; Health Resources; Health Resources; Health Services; Health Services; Health Services for the Aged; Health Services for the Aged; Hospitals; Hospitals; Hybrids; Hybrids; Intervention; Intervention; Knowledge; Knowledge; Learning; Learning; Left; Left; Life; Life; Life Experience; Maintenance; Maintenance; Medical center; Medical center; Mental Health; Mental Health; Mental Health Services; Mental Health Services; Mentorship; Mentorship; Methods; Methods; Minority; Minority; Modeling; Modeling; Needs Assessment; Needs Assessment; Outcome; Patient-Focused Outcomes; Patients; Positioning Attribute; Positioning Attribute; Post-Traumatic Stress Disorders; Post-Traumatic Stress Disorders; Preparation; Preparation; Procedures; Procedures; Process; Process; Program Development; Program Development; Provider; Provider; Psychotherapy; Psychotherapy; Quality of life; Quality of life; Randomized; Randomized; Readiness; Readiness; Recovery; Recovery; Relapse; Relapse; Relationship-Building; Research; Research; Research Personnel; Research Personnel; Resources; Resources; Service delivery model; Services; Services; Support Groups; Support Groups; Symptoms; Testing; Testing; Training; Training; Trauma; Trauma; Trust; Trust; Veterans; Veterans; Work; Work; Writing; Writing; base; base; care delivery; care delivery; career; career; cognitive process; design; design; disability; disability; effective therapy; effectiveness trial; effectiveness trial; evidence base; evidence base; experience; experience; formative assessment; health care delivery; implementation trial; implementation trial; improved; improved; improved functioning; improved functioning; instrument; instrument; meetings; novel; novel; peer; peer; peer support; pilot trial; pilot trial; prevent; prevent; primary outcome; primary outcome; programs; programs; psychosocial; psychosocial; public health relevance; public health relevance; randomized trial; randomized trial; reduce symptoms; skills; skills; social; social; social cognitive theory; social cognitive theory; standard care; standard care; suicidal risk; suicidal risk; symposium; symposium; uptake; uptake

 DESCRIPTION (provided by applicant): Background and significance: Evidence-based psychotherapies (EBP) for PTSD, such as Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT), are effective, but only a minority of Veterans initiate and engage in these treatments. Common Veteran concerns about starting these therapies include lack of emotional readiness and skepticism of the treatment rationale. Additionally, up to 60% of Veterans continue to meet diagnostic criteria for PTSD after completion, and even those who no longer meet criteria may have remaining psychosocial needs as they rebuild their lives. Peer support programs have the potential to improve patient outcomes by facilitating treatment initiation, engagement, and aftercare. In peer programs, Veterans recovering from PTSD provide emotional support, empathy, and information based upon their own lived experience with PTSD. Guided by social learning theory, peers can model healthy coping behaviors like confronting trauma directly, engaging in therapy, and rebuilding a fulfilling life during the process of recovery. Peer support is well-established for other disorder and is a priority within the VA. It supports treatment initiation, improves functioning and qualityof life, reduces utilization of mental health services, and is highly acceptable to Veterans. Despite the recent expansion of peer programs in VA, more research is needed to examine the most effective ways to integrate peers with existing PTSD care to support evidence based treatments across the continuum of PTSD care. The goal of this CDA is to refine and pilot test a peer support program for PTSD, with separate components for initiation/engagement of EBP and aftercare. Research Plan: In Aim 1, through an iterative formative evaluation with stakeholders (Veterans, peer providers, PTSD providers, and national leaders), and based upon the prior needs assessment, we will refine a peer support program that addresses treatment initiation and engagement. Because community based outpatient clinics (CBOCs) have fewer resources to support PTSD care, we will target these settings, as well as a VAMC, for the peer program. In Aim 2, we will conduct an open feasibility pilot for the peer support initiation/ engagement groups to further refine this program, and then test effectiveness in a pilot randomized trial. Primary outcomes will be EBP attitudes, initiation and completion of EBP. These pilot data will support an IIR submission for a Hybrid Type I Effectiveness/Implementation trial in year 3. In Aim 3, we will conduct a formative evaluation to explore stakeholders' opinions of a proposed aftercare peer program for Veterans who complete EBP. In Aim 4, we will pilot feasibility of the peer program as aftercare in two peer support groups and collect qualitative data to guide revisions. Primary outcomes will be functioning and quality of life. In year 5, we will submit an HSR&D Pilot to conduct a pilot randomized trial of peer support as aftercare. Career Plan: My career goal is to become an expert in testing and implementing novel care delivery methods for PTSD in VA. My dedication to the VA, research on PTSD, foundational training in HSR, and expertise using nontraditional mental health interventions make me ideally positioned to conduct this research. During the CDA period, training will focus on providing me with advanced health services training, including methods of formative evaluation for program development, methods and analysis of complex effectiveness-implementation designs to test novel delivery models, and skills to obtain HSR funding to continue this program of research. This will occur through academic courses, conferences, experiential training in conducting the proposed research, and serving as a co-investigator on HSR&D projects. Further guidance will be provided by a mentorship team composed of senior health services researchers with expertise in program development, implementation, PTSD and peer support, and qualitative and quantitative methods.

 描述（由申请人提供）： 背景和意义：针对PTSD的循证心理疗法（EBP），如延长暴露（PE）和认知加工疗法（CPT）是有效的，但只有少数退伍军人开始并参与这些治疗。常见的退伍军人对开始这些治疗的担忧包括缺乏情绪准备和对治疗原理的怀疑。此外，高达60%的退伍军人在完成后继续符合PTSD的诊断标准，即使那些不再符合标准的人在重建生活时也可能有剩余的心理社会需求。同伴支持计划有可能通过促进治疗的启动、参与和善后来改善患者的预后。在同伴项目中，从创伤后应激障碍中恢复的退伍军人提供情感支持，同情和基于他们自己的创伤后应激障碍生活经历的信息。在社会学习理论的指导下，同伴可以在康复过程中塑造健康的应对行为，如直接面对创伤，参与治疗，重建充实的生活。同伴支持是建立在其他障碍，是一个优先事项内的VA。它支持治疗的启动，改善功能和生活质量，减少心理健康服务的利用，并为退伍军人所接受。尽管最近在弗吉尼亚州的同伴计划的扩展，需要更多的研究来研究最有效的方法，以整合同伴与现有的创伤后应激障碍护理，以支持循证治疗的创伤后应激障碍护理的连续性。本CDA的目标是完善和试点测试创伤后应激障碍的同伴支持计划，与EBP和善后的启动/参与单独的组件。研究计划：在目标1中，通过与利益相关者（退伍军人，同伴提供者，PTSD提供者和国家领导人）的迭代形成性评估，并根据先前的需求评估，我们将完善解决治疗启动和参与的同伴支持计划。由于社区门诊诊所（CBOCs）支持创伤后应激障碍护理的资源较少，我们将针对这些设置，以及VAMC，为同行计划。在目标2中，我们将为同伴支持发起/参与小组进行一次开放的可行性试点，以进一步完善该计划，然后在试点随机试验中测试有效性。主要结果将是EBP的态度，开始和完成EBP。这些试点数据将支持第3年混合I类有效性/实施试验的IIR提交。在目标3中，我们将进行形成性评估，以探讨利益相关者对完成EBP的退伍军人的拟议善后同伴计划的意见。在目标4中，我们将在两个同伴支持小组中试行同伴计划作为后续护理的可行性，并收集定性数据以指导修订。主要结果将是功能和生活质量。在第5年，我们将提交一份HSR&D试点，以进行一项关于同伴支持作为善后的试点随机试验。职业规划：我的职业目标是成为一名专家，在测试和实施新的护理提供方法的创伤后应激障碍在弗吉尼亚州。我对退伍军人事务部的奉献，对创伤后应激障碍的研究，HSR的基础培训，以及使用非传统心理健康干预的专业知识，使我成为进行这项研究的理想人选。在CDA期间，培训将侧重于为我提供先进的卫生服务培训，包括项目开发的形成性评估方法，复杂的有效性实施设计的方法和分析，以测试新的交付模式，以及获得HSR资金的技能，以继续这项研究计划。这将通过学术课程，会议，进行拟议研究的经验培训，并作为HSR&D项目的共同研究员。进一步的指导将由一个由高级卫生服务研究人员组成的导师团队提供，该团队在项目开发，实施，创伤后应激障碍和同伴支持以及定性和定量方法方面具有专业知识。