A mixed methods pilot trial of the STEP-Home workshop to improve reintegration and reduce suicide risk for recently transitioned Veterans

退伍军人在从军事生活过渡到平民生活的第一年里面临着一个“致命的鸿沟”，但可用的资源有限 精神科服务和自杀风险因素增加。在这个关键的过渡时期，退伍军人自杀率 是现役军人和普通退伍军人的两倍。平均有20名退伍军人死亡 每天都有自杀的人，但只有6人使用退伍军人管理局的服务。事实证明，退伍军人护理服务可以缓解 自杀风险；因此，在“致命缺口”期间促进参与可能是预防自杀的关键。 正在转型的退伍军人需要外展和服务，为他们获得退伍军人管理局提供支持 医疗保健、自杀预防教育和有效管理他们过渡的技能。这项提议将 使用Step-Home弥合这一重要的医疗差距。Step-Home是一种基于证据的、跨诊断的、 视频远程保健康复讲习班，以改善重返社会、社会支持和功能 临床合并症高的退伍军人。Step-Home是非临床、经济高效且以技能为重点的 最大限度地吸引没有参与治疗的退伍军人，这些退伍军人可能会对传统的“心理健康”产生抵触 专注于诊断的方法。到目前为止，Step-Home还没有针对 最近转变的退伍军人或为防止自杀而增强的。这项建议将调整和完善步骤- 专门为最近过渡的退伍军人提供的家，并添加自杀预防内容和技能以创建 Step-Home-SP。拟议的试点研究旨在支持Step-Home和自杀预防内容 专家们对Step-Home-SP的提炼和评估。我们将利用退伍军人事务部/国防部 身份资料库(VADIR)，在全国范围内招募最近过渡的退伍军人。在目标1中，我们将开发 通过调整Step-Home远程健康干预来特别针对最近转变的对象 并扩大研讨会，将自杀预防纳入其中。在目标2中，我们将进行双臂验证- Step-Home-SP与增强版的概念外可接受性和可行性随机对照试验(RCT) 普通护理(EUC=当前护理标准教育包，关于自杀风险和与退伍军人管理局护理的联系) 最近转变的退伍军人。最后，我们将探讨重返社会状况、退伍军人管理局护理启动和候选人 Step-Home-SP相对于EUC的结果，以通知未来全面的RCT。如果成功，培养社交能力， 职业和社区联系；培养情绪调节和冲动控制技能；促进安全 规划；以及在上游提供教育和退伍军人管理局护理，应该会降低自杀风险 在这一关键过渡期间及以后。

Veterans face a “deadly gap” during their first year of transition from military to civilian life with limited available psychiatric services and increased suicide risk factors. During this critical transition period, Veteran suicide rate is double that of active service members and the general Veteran population. An average of 20 Veterans die from suicide each day, but only 6 of the 20 use VA services. VA care engagement has been shown to mitigate suicide risk; therefore, promoting engagement during the “deadly gap” could be essential to suicide prevention. Transitioning Veterans require outreach and services to provide them with support in their access to VA healthcare, suicide prevention education, and skills to manage their transition effectively. This proposal would bridge this important healthcare gap using STEP-Home. STEP-Home is an evidence-based, transdiagnostic, video telehealth rehabilitation workshop to improve reintegration, social support, and functioning among Veterans with high clinical comorbidity. STEP-Home is non-clinical, cost-effective, and skills-focused to maximally engage Veterans not participating in treatment who may be resistant to traditional “mental health” diagnostically focused approaches. To date, STEP-Home has not been adapted for the unique needs of recently transitioning Veterans or augmented for suicide prevention. This proposal will adapt and refine STEP- Home specifically for recently transitioning Veterans and add suicide prevention content and skills to create STEP-Home-SP. The proposed pilot study is designed to support STEP-Home and suicide prevention content experts in their refinement and evaluation of STEP-Home-SP. We will utilize the VA/Department of Defense Identity Repository (VADIR) to recruit recently transitioned Veterans nationwide. In Aim 1, we will develop STEP-Home-SP by adapting the STEP-Home telehealth intervention to specifically target recently transitioned Veterans and augment the workshop to include suicide prevention. In Aim 2, we will conduct a two-arm proof- of-concept acceptability and feasibility randomized controlled trial (RCT) of STEP-Home-SP versus Enhanced Usual Care (EUC=current standard of care + educational packet on suicide risk and connection to VA care) in recently transitioned Veterans. Lastly, we will explore reintegration status, VA care initiation, and candidate outcomes for STEP-Home-SP relative to EUC to inform a future full-scale RCT. If successful, fostering social, vocational, and community connection; building emotion regulation and impulse control skills; facilitating safety planning; and providing education and access to VA care upstream should result in decreased suicide risk during this critical transition and beyond.