Evaluating the Use of Peer Specialists to Support Suicide Prevention

评估使用同伴专家来支持自杀预防

• 批准号: 10705613
• 负责人: MATTHEW CHINMAN
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10705613
• 关键词: Address; Adult; Area; Attitude; Bipolar Depression; Caring; Case Management; Characteristics; Clinical; Clinical effectiveness; Communities; Community Healthcare; Community Integration; Community Participation; Complex; Connecticut; Data; Development; Effectiveness; Empathy; Enrollment; Feedback; Feeling suicidal; Fostering; Goals; Health Care Visit; Health Promotion; Healthcare; Healthcare Systems; Intervention; Interview; Investigation; Leadership; Life; Literature; Meaning and purpose; Measures; Medical; Medical center; Mental Health; Mentorship; Methods; Modification; Motivation; Nature; Needs Assessment; Outcome; Participant; Patient Self-Report; Patients; Perception; Primary Care; Procedures; Process; Prospective Studies; Provider; Psyche structure; Psychologist; Quality of life; Randomized; Randomized, Controlled Trials; Recovery; Rehabilitation Outcome; Rehabilitation therapy; Research; Research Personnel; Risk Reduction; Role; Self Perception; Services; Social support; Specialist; Suicide; Suicide prevention; System; Testing; Time; Training; Unipolar Depression; Veterans; Veterans Health Administration; Vocational rehabilitation; Work; acceptability and feasibility; behavioral health; clinical care; clinical practice; community living; disability; efficacy trial; eligible participant; experience; follow up assessment; follow-up; functional disability; high risk; implementation context; implementation facilitators; implementation strategy; improved; innovation; intervention mapping; novel; novel strategies; peer; peer support; physical conditioning; pilot test; post intervention; prevent; preventive intervention; programs; psychiatric disability; psychiatric rehabilitation; psychosocial rehabilitation; randomized trial; recruit; reducing suicide; rehabilitative care; self esteem; social; social integration; stem; stressor; suicidal; suicidal behavior; suicidal risk; suicide rate; theories

Preventing suicide is a top priority for the Veterans Health Administration (VHA). Despite ardent and sustained efforts over the last decade, the suicide rate for VHA patients remains significantly higher than civilians and non- VHA using Veterans. Suicide prevention efforts for high risk VHA patients focus on clinical (e.g., mental health) and service use (e.g., case management) factors. What has yet to be tested is an approach that targets factors in community living, which are better conceptualized as rehabilitative in nature. For it is not only mental and physical illnesses that heighten suicide risk in VHA patients, but also struggles with their sense of self-worth, meaning, and social connections in the community. To help patients with high risk of suicide, this application proposes to adapt and test a promising approach called PREVAIL, which uses ‘Peer Specialists’ (i.e., Veterans with psychiatric disabilities who have been trained to help others with similar conditions). Peer Specialists do not devalue clinical care but engage in rehabilitative tasks of building a life of self-respect and connectedness in one’s local community by offering empathy, hope, and advice based personal experience of mental health recovery. PREVAIL is promising, but still has not demonstrated clinical effectiveness and requires adaptation to address the unique characteristics of Veterans and the VA health care system. This project proposes to use Intervention Mapping, a multi-method, systematic approach using diverse stakeholders, to adapt and pilot PREVAIL. The VHA is the single, largest employer of Peer Specialists and research shows that they can enhance standard clinical care in mental health, physical health, and rehabilitative outcomes. However, Peer Specialists have only just begun to be deployed in suicide prevention efforts. The primary aims of this study are to: 1) Use Intervention Mapping to identify which components of PREVAIL require adaptation to reduce suicidal ideation in high risk VHA patients and to identify implementation strategies useful for the VHA system; and 2) Pilot test the feasibility and acceptability of the adapted PREVAIL, rehabilitative measures, and suicide-related outcomes for use in a rigorous prospective study. With guidance from a steering committee comprised of researchers, VHA leadership, and patients, needs assessment interviews with diverse VHA staff, Peer Specialists, and patients will be conducted to inform the adaptation. Based on results from the needs assessment and the literature on suicide prevention, psychiatric rehabilitation, and peer-based approaches, the steering committee will help adapt PREVAIL. Twelve high suicide risk Veterans with unipolar or bipolar depression will participate in a 3-month “pre- pilot” and provide feedback on how the adapted PREVAIL may be revised. After making any necessary modifications to the intervention, a second group of 12 high suicide risk Veterans with unipolar or bipolar depression will be recruited to participate in a formal pilot test to further evaluate the feasibility and acceptability of recruitment, retention, and assessment procedures. Patients will be from the West Haven and Newington Connecticut medical centers. The Peer Specialists will be from VA Connecticut’s Errera Community Care Center, one of VHA’s leading centers of innovation in psychosocial rehabilitation and one of the largest employers of Peer Specialists. All participants will receive standard VHA care from the Connecticut campuses while participating in this study. Participants will be assessed at baseline, post-intervention, and 3-month follow-up in their level of functional impairment and community integration; sense of hope, quality of life, meaning, and purpose; and self-views and social support. Chart reviews will also be completed at 3-month follow-up to assess for changes in health care visits involving suicidal behaviors. If acceptability (> 50% enrollment of eligible participants) and feasibility (> 70% of enrollees complete follow-up assessment) are demonstrated, this study will result in a novel rehabilitation-oriented suicide prevention intervention to test in a fully-powered randomized controlled efficacy trial.

防止自杀是退伍军人健康管理局(VHA)的首要任务。尽管热情和坚持不懈 在过去十年的努力下，VHA患者的自杀率仍然显著高于平民和非 VHA使用退伍军人。预防高危VHA患者自杀的努力侧重于临床(例如，精神健康) 和服务使用(例如，案例管理)因素。还有待测试的是一种针对因素的方法 在社区生活中，更好地将其概念化为康复性质。因为它不仅是精神上的，而且 增加VHA患者自杀风险的身体疾病，但也与他们的自我价值感作斗争， 意义，以及社区中的社会关系。为了帮助自杀高危患者，此应用程序 建议采用和测试一种很有前途的方法，称为VERVALE，它使用“同行专家”(即，退伍军人 接受过帮助类似情况的其他人的培训的精神残疾患者)。同行专家不会 贬低临床护理，但从事康复任务，建立自尊和联系的生活 通过提供基于个人心理健康体验的同理心、希望和建议 恢复。普罗维尤是有希望的，但仍未显示出临床有效性，需要适应 解决退伍军人和退伍军人医疗保健系统的独特特点。该项目建议使用 干预地图，一种多方法、系统的方法，使用不同的利益相关者来适应和试点 赢定了。VHA是同行专家的单一、最大雇主，研究表明，他们可以提高 心理健康、身体健康和康复结果方面的标准临床护理。然而，同行专家 才刚刚开始用于预防自杀的努力。这项研究的主要目的是：1)使用 干预图谱以确定流行的哪些成分需要适应以减少自杀意念 高危VHA患者，并确定对VHA系统有用的实施策略；以及2)试点测试 适应的流行、康复措施和自杀相关结果的可行性和可接受性 在严格的前瞻性研究中使用。在由研究人员组成的指导委员会的指导下， 领导力和患者，与不同的VHA工作人员、同行专家和患者进行需求评估访谈 将进行通知改编。基于需求评估的结果和关于 自杀预防、精神康复和以同伴为基础的方法，指导委员会将帮助适应 赢定了。12名患有单相或双相抑郁的高自杀风险退伍军人将参加为期3个月的 试点“，并就如何修订改编后的适用办法提供反馈。在做了任何必要的 对干预措施的修改，第二组12名患有单相或双相的高自杀风险退伍军人 抑郁症将被招募参加正式的先导测试，以进一步评估其可行性和可接受性 招聘、留用和评估程序。病人将来自西黑文和纽灵顿 康涅狄格州医疗中心。同行专家将来自弗吉尼亚州康涅狄格州的埃雷拉社区护理中心， VHA在心理社会康复领域的领先创新中心之一，也是 同行专家。所有参与者将接受康涅狄格州校园的标准VHA护理，同时 参与这项研究。参与者将在基线、干预后和3个月的随访中进行评估 他们的功能障碍和社区融合程度；希望、生活质量、意义和 目标；以及自我观点和社会支持。图表审查也将在3个月的跟踪中完成，以评估 关于涉及自杀行为的卫生保健就诊的变化。如果可接受性(&>；50%的合格注册人数 参与者)和可行性(&gt；70%的参与者完成了跟踪评估)，这项研究 将导致一种新的以康复为导向的自杀预防干预措施在完全有效的随机测试中 对照疗效试验。