Partnered Implementation Evaluation of a National Sponsorship Program for Transitioning Service Members

对转业军人国家赞助计划的合作实施评估

• 批准号: 10189418
• 负责人: Joseph C. Geraci
• 金额: --
• 依托单位: JAMES J PETERS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10189418
• 关键词: Academia; Acute; Address; Adoption; Caring; Cities; Clinic; Clinical Treatment; Communities; Community Services; Data; Department of Defense; Effectiveness; Elements; Enrollment; Epidemic; Evaluation; Feeling suicidal; Generalized Anxiety Disorder; Geographic Locations; Health; Hybrids; Individual; Intake; Intervention; Interview; Life; Maintenance; Measures; Medical center; Mental Depression; Methods; Military Personnel; Modeling; Modification; Monitor; New York City; Outcome; Outcome Measure; Patients; Periodicity; Post-Traumatic Stress Disorders; Prevention; Professional counselor; Program Evaluation; Program Sustainability; Public Health; Publishing; Questionnaires; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Risk; Running; Services; Severities; Site; Social support; Soldier; Suicide; Suicide prevention; Surveys; Texas; Time; United States; United States Department of Veterans Affairs; Veterans; Work; aged; base; community organizations; control trial; design; effectiveness evaluation; effectiveness implementation trial; experience; expiration; formative assessment; implementation evaluation; improved; interest; post 9/11; primary outcome; programs; psychological distress; recruit; routine care; service member; service utilization; stressor; suicidal behavior; suicidal morbidity; suicidal risk; suicide rate; treatment effect; trend

Problem in VA Proposal is Addressing. The United States is currently experiencing a national epidemic of suicide for its youngest Service Members (SMs) still serving in the Department of Defense (DOD, 2019) and those that have already transitioned out of the military. For example, the rate of suicide for Veterans aged 18- 34 years old having more than doubled from approximately 22 suicide deaths per 100,000 in 2006 to 45 per 100,000 in 2016 (VA, 2018; VA 2019). It appears that a period of significant risk for these young Veterans is during their first year after separating from the military with recent estimates suggesting an increase of nearly 50% during this period (Kang et al., 2015; Shen, Cunha, & Williams, 2016). As a result of the troubling trends, two executive orders have been issued within the last two years calling for federal organizations to work closer with local, nonprofit and academia organizations to implement a public health approach to suicide prevention. Preventing suicide remains a top priority for the VA with similar sentiments of a public health perspective to suicide prevention being recently published National Strategy for Preventing Suicide (VA, 2018). In this strategy, the VA acknowledged that it must reach out to Servicemembers (SMs) and Veterans in the community before they experience an acute crisis (VA, 2018). Similarly, VISN 17 made a significant commitment to the Expiration Term of Service (ETS) Sponsorship program in order to engage SMs prior to them exiting the military. Preliminary analysis was conducted for a recent randomized control trial with post- 9/11 Veterans in New York City that received the support from ETS Sponsors with the results showing a moderate treatment effect for both reduced transition stressors and improved social support (Geraci, 2018). Aims. We propose a Hybrid Type 2 effectiveness-implementation trial to evaluate the expansion of ETS Sponsorship across six cities from FY 2020 to 2023 in Texas. Aim #1 will determine the effectiveness of the ETS sponsorship program, as evidenced by measures of transition stressors, social support, psychological distress, suicidal ideation and behaviors, and VA/non-VA service utilization. Aim #2 will determine the feasibility and potential utility of implementing the ETS Sponsorship program to six cities in Texas. SMs that transition to cities without an established ETS Sponsorship program will experience their transition from military to civilian life as usual (i.e., services available from the U.S. Army Soldier for Life-Transition Assistance Program). After cities have implemented the ETS Sponsorship program, transitioning SMs will have access to an ETS Sponsor in their city and warm handoffs to community services. Methods. We will use a stepped wedge design while using other cities as controls until they begin implementation. This design will allow us to extend implementation support to the maximal number of cities and enhance the formative evaluation (periodic reflections with key partners and SM interviews). The stepped wedge design also enables us to make efficient use of all data available for within-site and between-site comparisons. For the within-site comparison, cities will act as their own controls in a program evaluation that compares cities pre- versus post- implementation. The comparison examines cities as they cross-over from control to intervention states. The between-site comparison evaluates the intervention period for a city vs. all other intervention and control periods for all cities. Outcomes of interest are measured for all transitioning SMs at each city within the given intervention time period. We randomized at the city level and will use individual SMs as the unit of observation for primary quantitative outcome measures. Six cities will participate in the program evaluation, with two cities allocated to each of the three start dates or steps. Hierarchical models will be run in which SMs are nested within city analyzing the results of the pre-implementation and post- implementation assessments. Hierarchical random effects models examine within- and between-group change across time and by condition.

VA提案中的问题正在解决。美国目前正在经历一场全国性的流行病， 仍在国防部服役的最年轻军人（SM）自杀（国防部，2019年）， 那些已经脱离军队的人。例如，18岁退伍军人的自杀率- 从2006年的每10万人中约有22人自杀死亡增加到2007年的每10万人中有45人自杀死亡， 2016年10万（VA，2018; VA 2019）。看来，一个时期的重大风险，这些年轻的退伍军人是 在他们从军队分离后的第一年，最近的估计表明， 50%（Kang等人，2015; Shen，库尼亚，&威廉姆斯，2016）。由于这些令人不安的趋势， 在过去的两年里，已经发布了两项行政命令，要求联邦组织更密切地合作， 与当地的非营利组织和学术组织合作，实施预防自杀的公共卫生方法。 预防自杀仍然是退伍军人事务部的首要任务，他们对公共卫生的观点有类似的看法， 自杀预防最近发布了《国家预防自杀战略》（弗吉尼亚州，2018年）。在这 根据这一战略，退伍军人管理局承认必须接触到退伍军人和退伍军人。 社区之前，他们经历了严重的危机（VA，2018年）。同样，VISN 17也做出了重大贡献。 承诺遵守服务条款（ETS）赞助计划，以便在 他们退出军队。对最近的一项随机对照试验进行了初步分析， 9/11退伍军人在纽约市，得到了ETS赞助商的支持，结果显示， 对于减少过渡压力源和改善社会支持的中度治疗效果（Geraci，2018）。 目标。我们提出了一个混合型2的有效性实施试验，以评估扩大ETS 从2020财年到2023财年，在德克萨斯州的六个城市提供赞助。目标#1将决定 ETS赞助计划，通过过渡压力源、社会支持、心理 痛苦，自杀意念和行为，以及VA/非VA服务利用。目标#2将决定 在德克萨斯州的六个城市实施ETS赞助计划的可行性和潜在效用。短信， 过渡到没有建立ETS赞助计划的城市，将经历从军事过渡到军事的过渡。 像往常一样的平民生活（即，美国陆军士兵生命过渡援助组织提供的服务 程序）。在城市实施ETS赞助计划后，过渡的SM将可以访问 在他们的城市的ETS赞助商和温暖的社区服务。 方法.我们将使用一个阶梯楔形设计，同时使用其他城市作为对照，直到他们开始 实施.这种设计将使我们能够将实施支持扩展到最大数量的城市 并加强形成性评价（与主要合作伙伴的定期反思和高级管理人员访谈）。阶梯 楔形设计还使我们能够有效地利用场地内和场地间的所有可用数据 比较。对于站点内比较，城市将在项目评估中充当自己的对照， 比较了实施前和实施后的城市。比较检查城市，因为他们跨越从 干预国家的控制。研究中心间比较评价了一个城市与所有城市的干预时间 所有城市的其他干预和控制期。对所有过渡SM的关注结果进行测量 在给定的干预时间段内，每个城市都有。我们在城市一级进行随机化， SM作为主要定量结局指标的观察单位。六个城市将参加 计划评估，三个开始日期或步骤中的每一个都分配了两个城市。分层模型将 在城市内部嵌套SM，分析实施前和实施后的结果， 执行情况评估。分层随机效应模型检查组内和组间变化 跨越时间和条件。

项目成果

Supporting servicemembers and veterans during their transition to civilian life using certified sponsors: A three-arm randomized controlled trial.

使用经过认证的赞助商支持现役军人和退伍军人过渡到平民生活：一项三组随机对照试验。

• DOI: 10.1037/ser0000764
• 发表时间: 2023
• 期刊: Psychological services
• 影响因子: 2.3
• 作者: Geraci,JosephC;Dichiara,Ariana;Greene,Ashley;Gromatsky,Molly;Finley,ErinP;Kilby,Daniel;Frankfurt,Sheila;Edwards,EmilyR;SolomonKurz,A;Sokol,Yosef;Sullivan,SarahR;Mobbs,Meaghan;Seim,RichardW;Goodman,Marianne
• 通讯作者: Goodman,Marianne