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

退伍军人在从军队过渡到平民生活的第一年面临着“致命的差距”， 精神病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20名退伍军人死亡 自杀的人，但20人中只有6人使用退伍军人管理局的服务。VA护理参与已被证明可以缓解 自杀风险;因此，在“致命间隙”期间促进参与对预防自杀至关重要。 过渡退伍军人需要外展和服务，为他们提供支持，在他们获得VA 医疗保健，自杀预防教育和技能，以有效地管理他们的过渡。这项建议将 使用STEP-Home弥合这一重要的医疗保健差距。STEP-Home是一个基于证据的，跨诊断的， 视频远程保健康复讲习班，以改善 临床合并症高的退伍军人。STEP-Home是一种非临床的、具有成本效益的、以技能为中心的方法， 最大限度地吸引不参加治疗的退伍军人，他们可能对传统的“精神健康”有抵抗力。 以诊断为重点的方法。到目前为止，STEP-Home还没有适应 最近过渡的退伍军人或增加自杀预防。该提案将调整和完善STEP- 主页专门为最近过渡的退伍军人和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进行改进和评估。我们将利用VA/国防部 身份存储库（VARESISTANCE）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远程保健干预措施，专门针对最近过渡的 退伍军人和扩大车间，包括自杀预防。在目标2中，我们将进行双臂证明- STEP-Home-SP与Enhanced的概念可接受性和可行性随机对照试验（RCT） 家庭护理（EUC=现行标准护理+关于自杀风险和与VA护理相关的教育包）， 最近退伍军人。最后，我们将探讨重返社会的地位，VA护理启动，和候选人 STEP-Home-SP相对于EUC的结局，以告知未来的全面RCT。如果成功，培养社交能力， 职业和社区联系;建立情绪调节和冲动控制技能;促进安全 规划;并提供教育和获得VA护理上游应导致自杀风险降低 在这一关键的过渡时期及以后。

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.