Randomized Controlled Trial of AboutFace: A Novel Video Storytelling Resource to Improve Access, Engagement, and Utilization of Mental Health Treatment among Veterans with PTSD

对退伍军人医疗保健的预期影响：退伍军人中的行为健康问题已经引起 认识到迫切需要更可靠、更有效和更容易获得的手段来确认那些需要帮助的人， 指导他们提供帮助，并确保他们得到最好的治疗。研究表明 人们对来自与他们有关系的人的建议和教育最有反应。 AboutFace是一个为退伍军人开发、推出和最近更新的同伴教育资源 国家创伤后应激障碍中心（NCPTSD）根据HSR & D资助的试点数据。AboutFace功能 退伍军人的个人故事，旨在提高心理健康治疗的参与， 患有创伤后应激障碍和相关合并症的退伍军人。包括NCPTSD在内的研究小组最近 在HSR & D拨款#PPO 14 - 360下完成了AboutFace的可用性评估和试点可行性试验- 1.本研究的数据（1）指导改善AboutFace以增加PTSD治疗的开始， 参与;及（2）证明拟议研究方法的可行性。如果关于我们 增加退伍军人的启动和参与创伤后应激障碍治疗，研究数据将有广泛的 克服障碍的影响，以照顾退伍军人与创伤后应激障碍和其他污名化的条件。 背景：10名退伍军人中至少有1人符合与其军事经历相关的PTSD标准。治疗 创伤后应激障碍是广泛可用的，国家传播倡议增加了退伍军人获得最好的， 实践干预。然而，寻求治疗的人数仍然非常少;大多数患有创伤后应激障碍的退伍军人 寻求心理健康服务，因为感觉耻辱和其他障碍。制定并启动了国家贸易和可持续发展委员会 AboutFace，一项旨在帮助退伍军人认识PTSD并激励他们寻求 循证护理。自开发以来，AboutFace已经获得了三个主要奖项， 成千上万的访问。尽管AboutFace在减少耻辱感、改善态度 寻求心理健康治疗，并增加创伤后应激障碍治疗的启动和参与， 尚未在VHA实践环境中进行正式评估或有效实施。除了提供 需要关于AboutFace有效性的数据，并确定在VHA内有效实施的战略， 这项研究将使人们更好地理解数字讲故事干预的作用和价值， 改善对各种污名化疾病的护理。 目的：研究的主要目的是检查AboutFace对以下方面的影响：a）增加 创伤后应激障碍治疗的启动和参与;和B）减少对精神疾病的污名化和消极态度， 保健服务预计在AboutFace条件下的退伍军人将更有可能访问和 比那些接受增强型创伤后应激障碍治疗（eUC）的人更完整。最后，定性 将与全国各地的主要利益相关者进行访谈，为未来的最佳做法提供信息。 关于AboutFace。 方法：共有376名退伍军人接受了创伤后应激障碍评估， 查尔斯顿创伤后应激障碍诊所将入组本研究。退伍军人将随机接受AboutFace 对比eUC。所有退伍军人将获得标准的创伤后应激障碍教育材料，一半也将随机 接受AboutFace。将对治疗参与指数进行比较[即， 开始治疗（是/否），完成治疗的总次数;]; 寻求心理健康治疗;以及PTSD症状和生活质量的变化。退伍军人将 在基线、1个月、3个月和6个月时评估这些指数。专题采访将是 与来自各种PTSD诊所的20 - 30名VA PTSD临床团队主管进行（即，测距 在规模、地点和实践方面），以便为今后的实施和传播举措提供信息。

Anticipated Impacts on Veterans Health Care: Behavioral health problems among Veterans have raised awareness of the critical need for more reliable, effective, and accessible means to recognize those in need, direct them to help, and ensure that they receive the best treatment available. Research has suggested that people are most responsive to advice and education when it comes from someone to whom they can relate. AboutFace is a peer education resource for Veterans that was developed, launched, and recently updated by the National Center for PTSD (NCPTSD) based on HSR&D funded pilot data. AboutFace features personal stories of Veterans and is designed to improve mental health treatment engagement among Veterans with PTSD and related comorbidities. The study team, which includes the NCPTSD, recently completed a usability assessment and pilot feasibility trial of AboutFace under HSR&D grant #PPO 14-360- 1. Data from this study (1) guided improvements to AboutFace for increasing PTSD treatment initiation and engagement; and (2) demonstrated the feasibility of the methodology for the proposed study. If AboutFace is found to increase Veterans’ initiation and engagement in PTSD treatment, study data will have broad implications for overcoming barriers to care for Veterans with PTSD and other stigmatized conditions. Background: At least 1 in 10 Veterans meet criteria for PTSD related to their military experience. Treatment for PTSD is widely available, and national dissemination initiatives have increased Veterans’ access to best- practice interventions. However, treatment-seeking remains strikingly low; most Veterans with PTSD do not seek mental health services due to perceived stigma and other barriers. NCPTSD developed and launched AboutFace, a public awareness campaign to help Veterans recognize PTSD and motivate them to seek evidence-based care. Since its development, AboutFace has earned three major awards and has had tens of thousands of visits. Despite the tremendous potential for AboutFace to reduce stigma, improve attitudes toward mental health treatment seeking, and to increase PTSD treatment initiation and engagement, it has yet to be formally evaluated or effectively implemented within VHA practice settings. In addition to providing needed data on the efficacy of AboutFace and identifying strategies for effective implementation within VHA, this study will provide a greater understanding of the role and value of digital storytelling interventions to improve access to care for a wide range of stigmatized conditions. Objectives: The primary objectives of the study are to examine the impact of AboutFace on a) increasing PTSD treatment initiation and engagement; and b) decreasing stigma and negative attitudes toward mental health services. It is anticipated that Veterans in the AboutFace condition will be more likely to access and complete treatment than those receiving enhanced Usual Care (eUC) for PTSD. Finally, qualitative interviews with key stakeholders across the nation will be conducted to inform best practices for future implementation of AboutFace. Methods: A total of 376 Veterans referred for a PTSD assessment and recommended for treatment in the Charleston PTSD clinic will be enrolled in the study. Veterans will be randomized to receive AboutFace versus eUC. All Veterans will receive standard PTSD educational materials, and half will also be randomly assigned to receive AboutFace. Comparisons will be made across indices of treatment engagement [i.e., initiated treatment (yes/no), total number of sessions completed;]; changes in stigma and attitudes toward seeking mental health treatment; and changes in PTSD symptoms and quality of life. Veterans will be assessed on these indices at baseline, 1-month, 3-month, and 6-months. Thematic interviews will be conducted with 20-30 VA PTSD Clinical Team Directors from a diverse range of PTSD clinics (i.e., ranging in size, location, and practice) to inform future implementation and dissemination initiatives.