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

对退伍军人卫生保健的预期影响：退伍军人的行为健康问题已经增加 认识到迫切需要更可靠、更有效和更容易获得的手段来识别有需要的人， 指导他们提供帮助，并确保他们得到最好的治疗。研究表明， 当建议和教育来自他们能与之相关的人时，人们对这些建议和教育反应最快。 AboutFace是为退伍军人开发、发布和最近更新的同伴教育资源 由国家创伤后应激障碍中心(NCPTSD)基于HSR&D资助的试验数据。AboutFace功能 退伍军人个人故事，旨在提高退伍军人的心理健康治疗参与度 患有创伤后应激障碍和相关并发症的退伍军人。包括NCPTSD在内的研究小组最近 根据HSR&D赠款#PPO 14-360-完成了AboutFace的可用性评估和试点可行性试验 1.这项研究的数据(1)指导改进AboutFace以增加创伤后应激障碍治疗的启动和 (2)证明了拟议研究方法的可行性。如果AboutFace 发现增加退伍军人对创伤后应激障碍治疗的主动性和参与度，研究数据将具有广泛的意义 克服障碍，照顾患有创伤后应激障碍和其他耻辱性疾病的退伍军人的影响。 背景：至少十分之一的退伍军人符合与他们的军事经历有关的创伤后应激障碍标准。治疗 为创伤后应激障碍提供了广泛的机会，国家传播倡议增加了退伍军人获得最佳- 练习干预。然而，寻求治疗的人数仍然惊人地低；大多数患有创伤后应激障碍的退伍军人并不是这样 由于感受到的耻辱和其他障碍，寻求心理健康服务。NCPTSD开发并推出 AboutFace，一项公共意识活动，帮助退伍军人认识创伤后应激障碍并激励他们寻求 循证护理。自发展以来，AboutFace已经获得了三个主要奖项，并获得了数十个奖项 数以千计的访问量。尽管AboutFace具有减少污名、改善态度的巨大潜力 为了寻求心理健康治疗，并增加创伤后应激障碍治疗的启动和参与度，它已经 还有待在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有效性的数据和确定在VHA内有效实施的战略， 这项研究将提供对数字讲故事干预的作用和价值的更多了解 改善对各种污名化疾病的护理机会。 目标：研究的主要目标是检查AboutFace对a)增长的影响 创伤后应激障碍治疗的启动和参与；以及b)减少对精神疾病的耻辱和消极态度 医疗服务。预计处于AboutFace状态的退伍军人将更有可能访问和 比那些接受强化普通护理(EUC)的PTSD患者更全面的治疗。最后，定性的 将与全国各地的主要利益相关者进行访谈，以了解未来的最佳做法 AboutFace的实现。 方法：共有376名退伍军人接受创伤后应激障碍评估，并建议在 查尔斯顿创伤后应激障碍诊所将被纳入这项研究。退伍军人将被随机分配到AboutFace 对阵EUC。所有退伍军人将收到标准的创伤后应激障碍教育材料，其中一半也将是随机的 分配给接收AboutFace。将对治疗参与度的指数进行比较[即， 开始治疗(是/否)，已完成的疗程总数；]；耻辱和对 寻求心理健康治疗；以及创伤后应激障碍症状和生活质量的变化。退伍军人将成为 在基线、1个月、3个月和6个月时对这些指标进行评估。主题采访将是 与来自不同创伤后应激障碍诊所的20-30名退伍军人创伤后应激障碍临床团队主任(即 在规模、地点和做法方面)，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.