STEP-Home: Cognitive, emotional and vocational reintegration for OEF/OIF veterans

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Veterans from Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) represent a clinically complex and growing group who require non-stigmatizing and multidisciplinary interventions that effectively target their many comorbidities that may be associated with mTBI and PTSD. The purpose of this SPiRE pilot proposal is to develop a reintegration workshop, STEP-Home, for use in OEF/OIF Veterans to aid in their transition from military to civilian life (transitioning "Home"), and to evaluate the feasibility of this program in a small pilot investigation. Our research indicates that 50% of participants enrolled in the VA RR&D supported TBI Center of Excellence, the Translational Research Center for TBI and Stress Disorders (TRACTS), report significant difficulty in functional status, which will be targeted by STEP-Home. This cohort suffers from high co-prevalence rates of emotional (e.g., posttraumatic stress disorder, depression, substance abuse) and physical (e.g., traumatic brain injury, chronic pain) wounds. Problems with memory, concentration, sleep, headaches, increased anxiety and irritability are common hallmarks of such wounds. Research indicates that a majority of combat veterans experience difficulty in readjusting to civilian life after returning from combat, and mental health problems are frequently cited as driving this difficulty. Unfortunately, this group of veterans has also been demonstrated to be highly resistant to psychological treatment and difficult to engage, showing particularly high rates of appointment no-shows and scheduling difficulties. STEP-Home hopes to address this by offering an alternative non-stigmatizing, skills-based workshop available to all OEF/OIF veterans regardless of clinical diagnosis. The STEP-Home workshop is based on the evidence-based rehabilitation program "STEP" that has been shown to be effective in ameliorating cognitive and emotional deficits following mild traumatic brain injury (mTBI) in civilians (Short-Term Executive Plus, STEP). We will target the specific needs of OEF/OIF veterans by focusing the content of the civilian STEP program on reintegration issues commonly faced after return home from combat (Veteran-specific program components). We have four primary aims in this proposal. First, we will develop the STEP-Home intervention including condensing and adapting the validated STEP program, creating a STEP-Home manual, developing a therapist training plan, and identifying assessment tools. Second, we will develop a fidelity monitoring plan to monitor and enhance the reliability and validity of STEP-Home. Third, we will pilot a small trial to examine feasibility and acceptability (tolerability/adherence) of STEP-Home. This STEP-Home pilot study will be offered to approximately 24 individuals returning from OEF/OIF, regardless of clinical diagnosis, who are enrolled in the VA RR&D supported TBI Center of Excellence, TRACTS. Fourth, we will evaluate the promise of our adapted intervention. The successful completion of the aims proposed has the potential to significantly improve the quality of life for all OEF/OIF veterans through this intervention aimed at readjustment to the civilian setting.