Impact of Veteran Voices & Visions Peer Support Groups on Social Integration for Veterans with SMI/Psychosis

退伍军人声音的影响

• 批准号: 10583907
• 负责人: Ippolytos Andreas Kalofonos
• 金额: --
• 依托单位: VA GREATER LOS ANGELES HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10583907
• 关键词: Address; Alcohol abuse; Belief; COVID-19 pandemic; Caring; Collaborations; Collection; Communities; Country; Curiosities; Data; Dedications; Delusions; Development; Distress; Education; Employment; Enrollment; Feeling suicidal; Fostering; Frequencies; Friendships; Future; Geography; Goals; Grant; Guidelines; Hallucinations; Health Services; Health system; Hearing; Housing; Improve Access; Intervention; Interview; Life; Link; Loneliness; Manuals; Marriage; Measurement; Measures; Mental Health; Mental Health Services; Meta-Analysis; Modeling; Netherlands; Obesity; Occupations; Outcome; Outcome Measure; Participant; Personal Satisfaction; Phase; Population; Process; Property; Protocols documentation; Psychoses; Psychotic Disorders; Public Health; Quality of life; Random Allocation; Recovery; Research; Running; Safety; Self Administration; Self Efficacy; Smoking; Social Functioning; Social isolation; Specialist; Standardization; Support Groups; Surveys; Symptoms; Target Populations; Training; Training Programs; Transportation; Trust; Veterans; Vision; Voice; Vulnerable Populations; Work; acceptability and feasibility; adverse outcome; cohesion; design; efficacy study; empowerment; experience; follow up assessment; health related quality of life; high risk; improved; innovation; insight; internalized stigma; member; mortality; outcome disparities; peer; peer support; pilot trial; post intervention; programs; psychiatric symptom; psychosocial; psychotic symptoms; recruit; remediation; service engagement; severe mental illness; social integration; social movement; social stigma; suicidal risk; symposium; telehealth; videoconference; virtual; virtual platform; whole health

Veterans with Serious Mental Illness (SMI) struggle with social integration - participation in work, housing, and citizenship - due to symptoms, stigma, and psychosocial functioning deficits. This has a tremendous impact on mortality, comparable to that of smoking and greater than obesity and alcohol abuse. Despite considerable VA efforts to provide mental health care to Veterans with SMI, programs that promote social integration are lacking. Veterans with SMI are at especially high risk for poor social integration and suicidal ideation during the COVID-19 pandemic. There is an urgency to advance treatments targeting Veterans' social integration. This project addresses this need with a group-based, peer specialist (PS) co-facilitated psychosocial intervention for Veterans with SMI, called “Veteran Voices and Visions” (VVV). VVV targets Veterans with SMI who experience psychosis, a group particularly in need of support with social integration. Virtual VVV groups are co-led by VA mental health clinicians (MHCs) and PSs via online video conference. VVV is an adaptation of a community-based support group model called the Hearing Voices (HV) approach that was developed over 30 years ago in the Netherlands. It has since spread to over twenty-five countries, representing hundreds of support groups worldwide. The approach facilitates group cohesion around and normalization of the common psychotic symptoms of SMI: hallucinations, delusions, and social isolation. Despite its global scope, this approach has neither been formally adapted nor rigorously studied in public health systems, including the VA. This intervention has the potential to create and foster a supportive community that improves the social integration of participants by reducing their distress and self-stigma, and increasing self-efficacy. These three process outcomes are strongly associated with social integration. This proposal is directly aligned with VA priorities to advance the breadth of existing psychosocial interventions for Veterans with SMI, improve access via telehealth services, and support Veterans' independence, wellbeing, empowerment, and whole health. The goal of this proposal is (1) to develop a manual, training guidelines, and a fidelity scale for VVV, (2) to assess the feasibility and acceptability of VVV, and (3) collect pilot outcome data. The manual, training guidelines, and fidelity scale will be developed by the research team in collaboration with 4 advisory panels: Veterans with SMI, MHCs, PSs, and non-VA experts in HV. Then, 5 MHCs and 5 PSs will be trained to use the new VVV manual, and each MHC-PS pair will conduct a group with the new protocol. Thirty Veterans will be recruited to participate in these 5 groups and assessments will be conducted at baseline, midpoint, and post- intervention. Baseline assessments include measurement of psychiatric symptoms, level of distress from psychosis, internalized self-stigma, self-efficacy, sense of belonging, recovery, and social integration. Follow- up assessments conducted at 10 and at 20 weeks will include these same measurements as baseline, as well as a survey and qualitative interview on intervention acceptability. Feasibility data on numbers approached, enrolled, and retained, and treatment fidelity will be collected. Fidelity will be assessed in two ways: (1) facilitators will complete self-administered reflection worksheets after each session and (2) research team members will rate 5 randomly selected audio-recorded sessions from each group for formal fidelity ratings. The goal of the within-subjects trial evaluating feasibility and acceptability of the manualized VVV protocol for improving self-efficacy, self-stigma and social functioning in Veterans with psychosis. To that end, the study will be run using the full collection of measures that would be included in a subsequent RCT. However, since the study is designed to assess whether the proposed intervention can be successfully implemented in the target population and to evaluate the properties of a candidate set of outcome measures, rather than demonstrate efficacy, most of the analyses will be descriptive. This will lay the groundwork for a future Merit that will support a controlled efficacy study.

患有严重精神疾病（SMI）的退伍军人很难融入社会——参与工作、住房和生活