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

STEP-Home 研讨会的混合方法试点试验，旨在改善最近转业的退伍军人重返社会并降低自杀风险

• 批准号: 10748489
• 负责人: Catherine Brawn Fortier
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-10-01 至 2027-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10748489
• 关键词: Address; Caring; Client satisfaction; Clinical; Communities; Data; Department of Defense; Diagnostic; Education; Educational workshop; Enrollment; Evaluation; Event; Exclusion; Face; Feeling suicidal; Focus Groups; Fostering; Future; Healthcare; Home; Intervention; Interview; Life; Measures; Mental Health; Methods; Military Personnel; Modeling; Outcome; Patient-Centered Care; Pilot Projects; Prevention education; Problem Solving; Psychiatric Diagnosis; Public Health; Questionnaires; Randomized, Controlled Trials; Rehabilitation therapy; Reporting; Resistance; Risk; Risk Factors; Role; Safety; Sample Size; Sampling; Services; Social isolation; Social support; Solid; Suicide; Suicide prevention; Target Populations; Traumatic Brain Injury; Veterans; Vocation; Work; acceptability and feasibility; active duty; arm; comorbidity; cost effective; current pandemic; design; emotion regulation; epidemiologic data; evidence base; functional status; implementation facilitators; improved; interest; military service; military veteran; outreach; pilot trial; post intervention; programs; recruit; reducing suicide; repository; service member; skills; social; standard of care; suicidal risk; suicide rate; telehealth; treatment as usual

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.

在从军事生活到平民生活的第一年中，退伍军人面临“致命差距”，可用 精神科服务并增加自杀危险因素。在这个关键的过渡期间，退伍军人自杀率 是活跃的服务成员和一般退伍军人人口的两倍。平均有20名退伍军人死亡 每天自杀，但只有20种使用VA服务。 VA护理参与已被证明减轻 自杀风险；因此，在“致命差距”期间促进参与对于预防自杀至关重要。 过渡退伍军人需要宣传和服务，以便他们在访问VA的情况下为他们提供支持 医疗保健，自杀预防教育以及有效管理其过渡的技能。该提议将 使用阶梯室弥合这一重要的医疗差距。 Step-Home是一个基于循证的经诊断， 视频远程医疗康复研讨会，以改善重新融合，社会支持和功能 临床合并症高的退伍军人。阶级是非临床，具有成本效益和以技巧为中心 最大程度地吸引不参加传统“心理健康”的治疗的退伍军人 诊断为重点的方法。迄今为止，尚未适应 最近过渡退伍军人或增加了预防自杀。该建议将适应并完善逐步 专门用于最近过渡退伍军人并添加预防自杀内容和技能以创建的家园 Step-Home-sp。拟议的试点研究旨在支持预防阶级和自杀的内容 专家对Step-Home-SP的改进和评估。我们将利用VA/国防部 身份存储库（vadir）将招募最近在全国范围内过渡的退伍军人。在AIM 1中，我们将发展 通过调整阶梯式远程医疗干预措施以专门针对最近过渡 退伍军人和扩大研讨会，包括预防自杀。在AIM 2中，我们将进行两臂证明 - 概念可接受性和可行性随机对照试验（RCT）的STEP-HOME SP与增强 通常的护理（EUC =当前的护理标准 +有关自杀风险和与VA护理联系的教育数据包） 最近过渡了退伍军人。最后，我们将探索重返社会状况，VA护理计划和候选人 相对于EUC，STEP-HOME SP的结果为未来的全尺度RCT提供了信息。如果成功，促进社交， 投票和社区联系；建立情绪调节和冲动控制技能；促进安全性 规划;在上游提供教育和获得VA护理的机会应导致自杀风险降低 在这个关键的过渡期间。