Helping Families Help Veterans with PTSD and Alcohol Abuse: An RCT of VA-CRAFT

帮助家庭帮助退伍军人应对创伤后应激障碍 (PTSD) 和酗酒：VA-CRAFT 的随机对照试验

• 批准号: 8395898
• 负责人: Christopher R Erbes
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-10-01 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8395898
• 关键词: Afghanistan; Alcohol abuse; Bibliotherapy; Characteristics; Clinical Research; Communication; Communities; Conflict (Psychology); Data; Disease; Educational Intervention; Educational process of instructing; Effectiveness; Electronic Mail; Enrollment; Ensure; Evaluation; Family; Family member; Feedback; Funding; Future; Goals; Healthcare; Hybrids; Impairment; Individual; Internet; Intervention; Interview; Investigation; Iraq; Lead; Letters; Link; Longitudinal Studies; Mental Health; Mental Health Services; Mental disorders; Methods; Monitor; Online Systems; Outcome; Participant; Patient Self-Report; Perceived quality of life; Personal Satisfaction; Persons; Play; Population; Post-Traumatic Stress Disorders; Process; Psyche structure; Psychological reinforcement; Quality of life; Questionnaires; Randomized; Randomized Controlled Trials; Readiness; Recruitment Activity; Report (document); Reporting; Research; Sampling; Site; Soldier; Source; Substance Use Disorder; Surveys; Symptoms; Technology; Telephone; Testing; Time; Training; Use Effectiveness; Veterans; Visit; War; Work; alcohol use disorder; cohort; combat; design; disability; follow-up; health care service utilization; improved; innovation; novel; operation; outreach; primary outcome; programs; resilience; response; screening; tool; training project; usability; willingness

DESCRIPTION (provided by applicant): Anticipated Impacts on Veterans Healthcare - VA-Community Reinforcement and Family Training (VA- CRAFT) is a web-based outreach intervention for family members of Veterans suffering from posttraumatic stress disorder (PTSD) or alcohol use disorders (AUDs) that trains them to help Veterans engage in mental health care. Family members represent a primary source of support for Veterans, and while family support and encouragement are powerful facilitators of Veterans' engagement in mental health care, few family-level interventions have been developed. By evaluating the effectiveness of VA-CRAFT, this project will attempt to validate a tool that can be widely disseminated to improve Veteran engagement in mental health services. Background - PTSD and AUDs are highly prevalent psychiatric disorders among combat Veterans that can lead to substantial impairments and disability. Although empirically supported treatments are available, the majority of Veterans suffering PTSD or AUDs do not engage in any mental health care. Data show that encouragement and support by family members play a key role in Veterans' willingness to engage in mental health care. However, many family members may not know how best to help their Veterans engage in mental health care. VA-CRAFT is an innovative adaption of an empirically supported family training intervention (CRAFT) that has been shown to dramatically increase treatment engagement among substance abusing civilian samples. VA-CRAFT was modified to include Veteran-specific content, to focus on PTSD, SUDs, or both, and to make use of interactive web-technology to increase its efficiency and reach. Empirical investigation is needed to test the effectiveness of this adaptation of an existing, efficacious intervention. Objectives -The goal of this project is to conduct a randomized controlled trial (RCT) of VA-CRAFT using an effectiveness-implementation Type 1 hybrid design. Specific aims are to: 1) Determine the effectiveness of VA-CRAFT on Veterans' mental health service utilization; 2) Determine the effectiveness of VA-CRAFT on family members' wellbeing, personal quality of life, perceived relationship quality with Veteran, and communication about treatment seeking; and 3) Conduct a process evaluation to assess the usability, perceived helpfulness, and format of the intervention. Methods -This is a 3-year, single-site, Type 1 hybrid RCT that will recruit participants from a cohort of Veterans and family members enrolled in the Readiness and Resilience in National Guard Soldiers-2 study (RINGS-2; Polusny & Erbes, PIs). Using Veterans' responses to post-deployment RINGS-2 surveys and administrative data, family members of Veterans who screen positive for PTSD, AUDs, or both and have not engaged in mental health care will be identified and recruited to participate in the RCT (anticipated N =184). Veterans of family participants will also be eligible to participate in assessments only. Family member participants will complete baseline questionnaires of perceived Veteran PTSD and AUD symptoms, family functioning and communication, and well-being and will be randomly assigned to VA-CRAFT or Control (no treatment) conditions. Those assigned to the VA-CRAFT condition will complete the online VA-CRAFT course. Progress through VA-CRAFT will be monitored and stepped outreach efforts (emails, phone calls, letters) will be systematically used, as necessary, to ensure completion of the intervention. After completion of VA-CRAFT, family members and Veterans will complete follow-up questionnaires. Primary outcomes will include: 1) Veteran's mental health service utilization during the 6 months following baseline as assessed by VA administrative data and 2) family member self-reports of well-being and quality of life and 3) family and Veteran reports of perceived relationship quality and communication about treatment seeking. Finally, a process evaluation, incorporating data from participants' feedback on VA-CRAFT modules and interviews with 30 family members and Veterans will provide information to inform future implementation efforts.

描述（由申请人提供）： 对退伍军人医疗保健的预期影响-VA-社区强化和家庭培训（VA- CRAFT）是一项基于网络的外展干预措施，针对患有创伤后应激障碍（PTSD）或酒精使用障碍（AUD）的退伍军人家庭成员，培训他们帮助退伍军人从事心理健康护理。家庭成员是退伍军人支持的主要来源，虽然家庭支持和鼓励是退伍军人参与精神卫生保健的有力促进因素，但很少有家庭层面的干预措施。通过评估VA-CRAFT的有效性，该项目将试图验证一种可以广泛传播的工具，以改善退伍军人参与心理健康服务。背景-创伤后应激障碍和AUDs是战斗退伍军人中高度流行的精神疾病，可导致严重的损伤和残疾。虽然有经验支持的治疗方法，但大多数患有PTSD或AUDs的退伍军人不参与任何心理健康护理。数据显示，家庭成员的鼓励和支持在退伍军人参与精神卫生保健的意愿中起着关键作用。然而，许多家庭成员可能不知道如何最好地帮助他们的退伍军人从事精神卫生保健。VA-CRAFT是一种创新的适应经验支持的家庭训练干预（CRAFT），已被证明可以显着增加药物滥用平民样本中的治疗参与。VA-CRAFT被修改为包括退伍军人特定的内容，专注于创伤后应激障碍，SUD，或两者兼而有之，并利用交互式网络技术来提高其效率和影响力。需要进行实证调查，以检验这种对现有有效干预措施的调整的有效性。目标-该项目的目标是使用有效性实施的1型混合设计进行VA-CRAFT的随机对照试验（RCT）。具体目标是：1）确定VA-CRAFT对退伍军人心理健康服务利用的有效性; 2）确定VA-CRAFT对家庭成员的幸福感、个人生活质量、与退伍军人的感知关系质量以及寻求治疗的沟通的有效性; 3）进行过程评估，以评估干预的可用性、感知帮助和形式。方法-这是一项为期3年的单中心1型混合RCT，将从参加国民警卫队士兵准备和恢复力-2研究（RINGS-2; Polusny & Erbes，PI）的退伍军人和家庭成员队列中招募参与者。使用退伍军人对部署后RINGS-2调查和管理数据的反应，将识别并招募PTSD、AUD或两者均呈阳性且未从事精神卫生保健的退伍军人家庭成员参与RCT（预计N =184）。 家庭参与者的退伍军人也将有资格参加评估。家庭成员参与者将完成感知退伍军人PTSD和AUD症状、家庭功能和沟通以及幸福感的基线问卷，并将随机分配至VA-CRAFT或对照（无治疗）条件。那些分配到VA-CRAFT条件将完成在线VA-CRAFT课程。将监测通过VA-CRAFT取得的进展，并在必要时系统地使用逐步外联工作（电子邮件、电话、信函），以确保完成干预。完成VA-CRAFT后，家庭成员和退伍军人将完成后续问卷。主要结果将包括：1）退伍军人在基线后6个月内的心理健康服务利用率，通过VA管理数据进行评估; 2）家庭成员自我报告的幸福感和生活质量; 3）家庭和退伍军人报告的感知关系质量和寻求治疗的沟通。最后，一个过程评价，包括参与者对VA-CRAFT模块的反馈和与30名家庭成员和退伍军人的访谈数据，将提供信息，为今后的执行工作提供信息。