Helping Families Help Veterans with PTSD and Alcohol Abuse: An RCT of VA-CRAFT

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DESCRIPTION (provided by applicant): Anticipated Impacts on Veterans Healthcare - VA-Community Reinforcement and Family Training (VA- CRAFT) is a web-based outreach intervention for family members of Veterans suffering from posttraumatic stress disorder (PTSD) or alcohol use disorders (AUDs) that trains them to help Veterans engage in mental health care. Family members represent a primary source of support for Veterans, and while family support and encouragement are powerful facilitators of Veterans' engagement in mental health care, few family-level interventions have been developed. By evaluating the effectiveness of VA-CRAFT, this project will attempt to validate a tool that can be widely disseminated to improve Veteran engagement in mental health services. Background - PTSD and AUDs are highly prevalent psychiatric disorders among combat Veterans that can lead to substantial impairments and disability. Although empirically supported treatments are available, the majority of Veterans suffering PTSD or AUDs do not engage in any mental health care. Data show that encouragement and support by family members play a key role in Veterans' willingness to engage in mental health care. However, many family members may not know how best to help their Veterans engage in mental health care. VA-CRAFT is an innovative adaption of an empirically supported family training intervention (CRAFT) that has been shown to dramatically increase treatment engagement among substance abusing civilian samples. VA-CRAFT was modified to include Veteran-specific content, to focus on PTSD, SUDs, or both, and to make use of interactive web-technology to increase its efficiency and reach. Empirical investigation is needed to test the effectiveness of this adaptation of an existing, efficacious intervention. Objectives -The goal of this project is to conduct a randomized controlled trial (RCT) of VA-CRAFT using an effectiveness-implementation Type 1 hybrid design. Specific aims are to: 1) Determine the effectiveness of VA-CRAFT on Veterans' mental health service utilization; 2) Determine the effectiveness of VA-CRAFT on family members' wellbeing, personal quality of life, perceived relationship quality with Veteran, and communication about treatment seeking; and 3) Conduct a process evaluation to assess the usability, perceived helpfulness, and format of the intervention. Methods -This is a 3-year, single-site, Type 1 hybrid RCT that will recruit participants from a cohort of Veterans and family members enrolled in the Readiness and Resilience in National Guard Soldiers-2 study (RINGS-2; Polusny & Erbes, PIs). Using Veterans' responses to post-deployment RINGS-2 surveys and administrative data, family members of Veterans who screen positive for PTSD, AUDs, or both and have not engaged in mental health care will be identified and recruited to participate in the RCT (anticipated N =184). Veterans of family participants will also be eligible to participate in assessments only. Family member participants will complete baseline questionnaires of perceived Veteran PTSD and AUD symptoms, family functioning and communication, and well-being and will be randomly assigned to VA-CRAFT or Control (no treatment) conditions. Those assigned to the VA-CRAFT condition will complete the online VA-CRAFT course. Progress through VA-CRAFT will be monitored and stepped outreach efforts (emails, phone calls, letters) will be systematically used, as necessary, to ensure completion of the intervention. After completion of VA-CRAFT, family members and Veterans will complete follow-up questionnaires. Primary outcomes will include: 1) Veteran's mental health service utilization during the 6 months following baseline as assessed by VA administrative data and 2) family member self-reports of well-being and quality of life and 3) family and Veteran reports of perceived relationship quality and communication about treatment seeking. Finally, a process evaluation, incorporating data from participants' feedback on VA-CRAFT modules and interviews with 30 family members and Veterans will provide information to inform future implementation efforts.