Multisite RCT of STEP-Home: A transdiagnostic skill-based community reintegration workshop

9/11事件后，来自持久自由和伊拉克自由行动(OEF/OIF)的退伍军人代表了一种临床 需要非污名化和多学科干预的复杂群体，有效地针对他们的 许多与轻度脑外伤和创伤后应激障碍相关的合并症。研究表明， 大多数退伍军人在退役后很难适应平民生活 包括关系困难、冲动和危险行为、更多的药物使用和 愤怒控制问题。心理健康问题经常被认为是导致这些困难的原因。不幸的是， 这群退伍军人也被证明对心理健康治疗和 难以聘用，表现出很高的缺席率和日程安排困难。我们建议这样做 越来越多的退伍军人需要综合的、跨诊断的(跨诊断)干预措施 适合他们所面临的一系列治疗挑战，同时也是可口的和吸引人的。至 为了解决这一待遇差距，我们为归国的退伍军人和 在最近完成的RR&D尖顶奖中展示了其可行性和初步效果(2014- 2016)。在这份功绩审查建议中，我们建议在这些调查结果的基础上，推动 步入家庭重返社会研讨会在多点随机对照试验中进入疗效阶段。步进- Home是一个为期12周、每周2小时的重返社会讲习班，旨在帮助所有9/11事件后的退伍军人(与和 没有精神病学和/或神经学诊断史)，并发展技能以提高他们的 控制愤怒/冲动，并协助他们在退伍后重返平民和工作生活。核心技能和 该计划的内容在集体使用方面是新颖的，并且以前没有应用于退伍军人群体 我们的尖顶可行性研究。我们将进行多地点(区域波士顿；区域休斯顿)，随机 第二阶段家庭对照试验(26个车间；8个退伍军人/车间；总数=208)。我们有两个主要目标 这项提议。首先，我们将检验家庭护理对主要结局的治疗效果。 主动控制状态(目前的中心团体疗法)。第二，我们将评估维护 对我们的主要结果的治疗效果。作为一个探索性的目标，我们将检查STEP的治疗效果。 关于心理健康、功能和职业状况以及认知次级结果的测量 间接针对研讨会的目标。最后，在第二个探索性目标中，我们将确定 对主要结果的治疗是通过获得核心技能/关键成分(问题 解决问题、情绪调节、注意力训练)。成功完成所建议的目标，将会带来 有可能显著提高技能，以促进9/11事件后退伍军人重新融入平民社会。此外， Step-Home尖顶可行性研究表明，该车间也是退伍军人的门户 他们不愿参与传统的心理健康治疗，以促进开放和参与 额外的、急需的退伍军人事务部服务。鉴于这一队列中的高耐药率，正在开发 可接受的干预措施，促进治疗参与度和保留率，并为未来的退伍军人管理局打开大门 护理，对于改善功能状态和降低未经治疗的精神病人的长期医疗费用是必要的 健康疾病。

Post-9/11 Veterans from Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) represent a clinically complex group who require non-stigmatizing and multidisciplinary interventions that effectively target their many comorbidities associated with mild TBI and posttraumatic stress disorder. Research indicates that a majority of combat Veterans experience difficulty in readjusting to civilian life after returning from combat including relationship difficulties, impulsive and dangerous behavior, increased substance use, and increased anger control problems. Mental health problems are frequently cited as driving these difficulties. Unfortunately, this group of Veterans has also been demonstrated to be highly resistant to mental health treatment and difficult to engage, showing high rates of appointment no-shows and scheduling difficulties. We propose this growing group of Veterans requires integrative, transdiagnostic (across diagnoses) interventions that will be appropriate for the range of treatment challenges they present while also being palatable and engaging. To address this treatment gap, we have developed the STEP-Home workshop for returning Veterans and demonstrated its feasibility and preliminary effectiveness in a recently completed RR&D SPiRE award (2014- 2016). In this Merit Review proposal, we propose to build on those findings and advance the development of the STEP-Home reintegration workshop to the efficacy stage in a multisite randomized controlled trial. STEP- Home is a 12-week, 2 hour/week reintegration workshop designed to assist all post-9/11 Veterans (with and without a history of psychiatric and/or neurologic diagnoses) with developing skills to improve their anger/impulse control and assist their reintegration to civilian and work life after the military. The core skills and content of the program are novel in their collective use and have not been applied to a Veteran population prior to our SPiRE feasibility study. We will conduct a multisite (TRACTS Boston; TRACTS Houston), randomized controlled trial of STEP-Home (26 workshops; 8 Veterans/workshop; total=208). We have two primary aims in this proposal. First, we will examine the treatment effects of STEP-Home on primary outcomes relative to an active control condition (Present Centered Group Therapy). Second, we will assess the maintenance of treatment effects for our primary outcomes. As an exploratory aim, we will examine treatment effects of STEP- Home on measures of mental health, functional and vocational status and cognitive secondary outcomes targeted indirectly in the workshop. Last, in a second exploratory aim, we will determine if the effect of treatment on the primary outcomes is mediated by the acquisition of core skills/key ingredients (problem solving, emotional regulation, attention training). The successful completion of the aims proposed has the potential to significantly improve skills to foster civilian reintegration in post-9/11Veterans. Furthermore, the STEP-Home SPiRE feasibility study demonstrated that the workshop also serves as a gateway for Veterans who are hesitant to participate in traditional mental health treatments to promote openness and engagement in additional, critically needed, VA services. Given the high rate of treatment resistance in this cohort, developing acceptable interventions that promote treatment engagement and retention, and open the door to future VA care, is necessary to improve functional status and to reduce long-term healthcare costs of untreated mental health illnesses.