Implementing the Behavioral Activities Intervention (BE-ACTIV) to Reduce Depression among Veterans in Community Living Centers
实施行为活动干预 (BE-ACTIV) 以减少社区生活中心退伍军人的抑郁症
基本信息
- 批准号:10524009
- 负责人:
- 金额:--
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2020
- 资助国家:美国
- 起止时间:2020-03-01 至 2024-09-30
- 项目状态:已结题
- 来源:
- 关键词:AcuteAddressAdoptionAffectAgeBehavior TherapyBehavioralBiteCaringClinicalCollaborationsCommunicationCommunitiesCompetenceComplexDataDiseaseDissemination and ImplementationDocumentationEffectivenessEffectiveness of InterventionsEvidence based interventionFeeling suicidalFosteringGenderGoalsHigh PrevalenceHomeHybridsInterventionLanguageLeadLong-Term CareMaintenanceManualsMeasuresMedicalMental DepressionMental HealthMental Health ServicesMethodsModelingMorbidity - disease rateNursing HomesOutcomePerformancePersonal SatisfactionPersonsPopulationPreparationPrevalencePrimary Health CareProcessProviderPublic HealthQuality of CareResearchResearch PersonnelRisk FactorsSamplingSiteSpottingsStandardizationSubstance abuse problemSuicideSuicide preventionSupport SystemSystemTeleconferencesTelephone InterviewsTestingTimeTrainingVeteransVisitWorkacceptability and feasibilitybasecare burdencare costscommunity livingdepressive symptomsdesigneffectiveness implementation studyevidence basefollow-upfoster homehigh riskimplementation fidelityimplementation frameworkimplementation measuresimplementation strategyimprovedimproved functioninginnovationmalemortalitynursing interventionpost implementationprogramspsychosocialreduce symptomssatisfactionsevere mental illnesssuccesssuicidal risktooluptakewebinar
项目摘要
Background: Despite widespread recognition of its prevalence and consequences, depression in nursing
homes remains a significant public health issue, affecting 15-25% of community nursing home residents and
contributing to increased morbidity, mortality, care burden, and cost of care. In VA Community Living Centers
(CLCs) the prevalence of depression is nearly 40% and within the first six months of discharge, CLC residents
have a substantially higher risk of suicide compared with other age- and gender-matched VA users. In
accordance with VA’s Strategic Priority to prevent suicide, it is critical to explore approaches to reducing
depression that are specific to the CLC population because depression is a major risk factor for suicidality.
Evidence-based psychosocial treatments are not often used in nursing homes and, when used, little is known
about the quality or effectiveness of the interventions. Behavioral Activities Intervention (BE-ACTIV) is a 10-
week evidence-based psychosocial intervention for depression developed using nursing home staff and
resident input to build in feasibility and acceptability. BE-ACTIV is typically delivered by a mental health
therapist in collaboration with recreational therapy to engage residents in personally meaningful pleasant
activities. This type of approach to improving mental health care is in line with VA’s strategic goals to provide
timely and integrated care that emphasizes Veteran’s well-being and independence.
Objectives: Three gaps must be addressed before BE-ACTIV can be used successfully in CLCs: (1) Adapting
it for the short-stay CLC population, is largely male with higher prevalence of serious mental illness and
substance abuse disorders, (2) Developing a delivery strategy that adapts BE-ACTIV’s current in-person
training and oversight processes for the context of a complex, national system of nursing homes, and (3)
Comparing implementation strategies to facilitate regional or national roll out. We will compare onsite and
remote applications of the LOCK implementation framework, which was developed for use in the CLC context.
The four tenets of the LOCK implementation framework are: 1) Look for the bright spots, 2) Observe, 3)
Collaborate in huddles, and 4) Keep it bite-sized.
Methods: This Hybrid Type 2 Implementation-Effectiveness study will use a mixed methods approach. In Aim
1, at two CLCs, researchers will (a) conduct telephone interviews with CLC staff about adaptation of the BE-
ACTIV training materials and implementation guide and (b) test the adapted BE-ACTIV VA training materials
and implementation guide for user comprehensibility with CLC staff. In Aim 2, 6 sites will implement BE-ACTIV
VA, each over a 6-month period. For this, three sites will have onsite training and check-ins for the
implementation and three will have remote training and check-ins. Aim 3 will be dedicated to finalizing the
training materials and implementation guide based on the input received from staff, our advisory panel, and
data collected at the 6 Aim 2 study sites.
Anticipated Impacts: The result of this work will be an evidence-based standardized manual for BE-ACTIV
VA to reduce depression among CLC residents and an implementation guide to incorporate BE-ACTIV VA into
the usual routines for resident assessment, care planning, and preparation for discharge. As an evidence-
based intervention developed for use in community nursing homes, BE-ACTIV VA has a high likelihood of
success if implemented effectively. Identifying a successful implementation strategy using the LOCK
framework will allow for wider dissemination of BE-ACTIV VA in CLCs nationally and create opportunities to
implement the intervention in other VA community-based long-term care programs (e.g., home-based primary
care, medical foster homes, State Veterans Homes, etc.). We will use the findings from this research to work
with our VACO partners and other communication channels to disseminate BE-ACTIV VA.
背景:尽管抑郁症的患病率和后果得到了广泛的认可,
家庭仍然是一个重大的公共卫生问题,影响到15-25%的社区养老院居民,
导致发病率、死亡率、护理负担和护理成本增加。在VA社区生活中心
(CLC)抑郁症患病率接近40%,在出院后的前六个月内,CLC居民
与其他年龄和性别匹配的VA使用者相比,自杀风险要高得多。在
根据退伍军人事务部预防自杀的战略重点,探索减少自杀的方法至关重要。
抑郁症是CLC人群特有的,因为抑郁症是自杀的主要危险因素。
疗养院不常使用循证心理社会治疗,而且在使用时也知之甚少
干预措施的质量或有效性。行为活动干预(BE-ACTIV)是一项10-
一周的循证心理干预抑郁症开发使用疗养院的工作人员和
居民的意见,建立在可行性和可接受性。BE-ACTIV通常由心理健康专家提供,
治疗师与娱乐治疗合作,使居民参与个人有意义的愉快
活动这种改善精神卫生保健的方法符合VA的战略目标,
及时和综合的护理,强调退伍军人的福祉和独立性。
目的:BE-ACTIV在CLC中成功应用前必须解决三个差距:(1)适应性
在短期逗留的CLC人群中,主要是男性,严重精神疾病的患病率较高,
药物滥用障碍,(2)制定一个交付战略,适应BE-ACTIV目前的人
培训和监督过程的背景下,一个复杂的,国家系统的养老院,和(3)
比较执行战略,以促进区域或国家的推广。我们将现场比较,
远程应用的可持续发展执行框架,这是开发用于CLC的背景下。
可持续发展实施框架的四个原则是:1)寻找亮点,2)观察,3)
在小圈子里合作,4)保持它的大小。
方法:本混合2型实施-有效性研究将使用混合方法。在Aim中
1.在两个CLC,研究人员将(a)与CLC工作人员进行电话访谈,了解BE的适应情况,
ACTIV培训材料和实施指南,以及(B)测试经改编的BE-ACTIV VA培训材料
与CLC工作人员一起编写用户可理解性的实施指南。在目标2中,6个研究中心将实施BE-ACTIV
VA,每个超过6个月。为此,三个站点将提供现场培训和登记,
目标3将致力于最终确定
根据工作人员、我们的咨询小组的意见编写培训材料和实施指南,
在6个Aim 2研究中心收集的数据。
预期影响:这项工作的结果将是BE-ACTIV的循证标准化手册
VA,以减少CLC居民的抑郁症和实施指南,将BE-ACTIV VA纳入
住院医师评估、护理计划和出院准备的常规程序。作为证据-
基于开发用于社区疗养院的干预措施,BE-ACTIV VA有很高的可能性,
如果有效实施,成功。利用可持续发展战略确定成功的实施战略
框架将允许在全国社区学习中心更广泛地传播BE-ACTIV VA,并创造机会,
在其他VA社区长期护理计划中实施干预措施(例如,家庭小学
护理、医疗寄养家庭、州退伍军人之家等)。我们将利用这项研究的结果来工作,
与我们的VACO合作伙伴和其他沟通渠道一起传播BE-ACTIV VA。
项目成果
期刊论文数量(0)
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专利数量(0)
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Whitney L Mills的其他文献
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{{ truncateString('Whitney L Mills', 18)}}的其他基金
Improving Veteran Transitions from VA Community Living Centers to the Community
改善退伍军人从退伍军人事务部社区生活中心到社区的过渡
- 批准号:
8782758 - 财政年份:2014
- 资助金额:
-- - 项目类别:
Improving Veteran Transitions from VA Community Living Centers to the Community
改善退伍军人从退伍军人事务部社区生活中心到社区的过渡
- 批准号:
9360882 - 财政年份:2014
- 资助金额:
-- - 项目类别:
Improving Veteran Transitions from VA Community Living Centers to the Community
改善退伍军人从退伍军人事务部社区生活中心到社区的过渡
- 批准号:
8926245 - 财政年份:2014
- 资助金额:
-- - 项目类别:
Improving Veteran Transitions from VA Community Living Centers to the Community
改善退伍军人从退伍军人事务部社区生活中心到社区的过渡
- 批准号:
9757612 - 财政年份:2014
- 资助金额:
-- - 项目类别:
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