Increasing Social Connection Through Crisis Caring Contacts: A Pragmatic Trial

背景：这是一个前所未有的孤独和社会孤立的时代。尤其是寂寞 是自杀意念、自杀企图、功能衰退和死亡的有力预测因子。寂寞可以 并应由卫生系统加以解决。由于孤独的风险和负面的健康结果， 特别令人担忧的是患有内科或精神科共病的老年人 治疗约定。关爱接触是一种干预，可以解决孤独和贫穷问题。 治疗约定。然而，它只在一小部分精神病患者中进行了评估。 患者并未在受新冠肺炎大流行或其他灾难影响的患者中进行检查。 意义：该项目涉及退伍军人管理局临床的首要任务(预防自杀)，这是一个最重要的 研究和发展办公室的优先事项(临床试验)和多种保健服务 研究和开发优先领域，包括健康、老龄化、获得 护理、心理健康、自杀预防和人口/整体健康。这个项目的影响非常大 高，因为它将促进对与机制和 关爱接触的结果，同时也评估了一个及时、务实、低成本和可扩展的 对缺乏社会联系和治疗参与度的退伍军人进行干预。如果有效，它将 将具有适用性，以应对治疗脱离接触和未来的灾难。 创新和影响：我们采取了基于经验的自杀预防干预措施， 使其适用于退伍军人退伍军人在退伍军人退伍军人门诊治疗投入较差的情况。本研究具有创新性。 在测试应对新冠肺炎大流行及其后果的干预措施方面，在使用 以孤独为目标的卫生服务干预战略。干预措施的同行支持部分 是非常新颖的，因为它的资源需求很低，并且具有可伸缩性。 具体目标：该项目的总体目标是评估“危机关怀联系人”(CCC)， 适应关怀联系，以减少流行病背景下的孤独感。要达到 这一目标我们将实现这些目标：1)在治疗参与度较低的老年退伍军人中， 评估危机关怀联系人在减少孤独感方面的有效性，与增强的 日常护理；2)评估危机关怀接触对其他重要成果的影响，包括 治疗参与度和自杀意念；3)探索治疗反应的潜在调节因素 危机关怀接触者；以及4)探讨危机关怀接触者对全因死亡率和 自杀未遂。 方法：我们的方法是进行一项多点、务实的随机对照试验。 我们将针对60岁及以上的退伍军人进行积极的精神病学或医学诊断，这些退伍军人 退伍军人事务部门诊有限的治疗参与度。在CCC治疗臂中的患者将被送往10 由同行支持专家提供的超过10个月的明信片。那些接受强化日常护理的人 (控制)将发送非个性化、一般性的卫生资源信息。我们将检查自我报告 和行政数据结果超过24个月的跟踪调查。 下一步/实施：我们将从我们的研究网站收集实施前的数据并分享 这与我们的业务合作伙伴--心理健康和自杀预防办公室(OMHSP)合作。危机 关怀联系非常适合未来的实施，因为它具有可扩展性，易于创建 确定哪些退伍军人可以接受干预的操作仪表板，以及添加研究的能力 为退伍军人管理局关怀接触干预措施提供实施工具包的材料。

Background: This is a time of unprecedented loneliness and social isolation. Loneliness in particular is a powerful predictor of suicidal ideation, suicide attempts, functional decline, and death. Loneliness can and should be addressed by health systems. Due to risk for loneliness and negative health outcomes, a group of particular concern is older adults with medical or psychiatric comorbidity who have limited treatment engagement. Caring Contacts is an intervention that can address loneliness and poor treatment engagement. However, it has only been evaluated in a narrow population of psychiatric patients and not examined amongst patients impacted by the COVID-19 pandemic or other disasters. Significance: This project addresses VA’s top clinical priority (suicide prevention), an overarching priority of the Office of Research and Development (clinical trials), and multiple Health Service Research and Development priority areas, including social determinants of health, aging, access to care, mental health, suicide prevention, and population/whole health. The impact of this project is very high because it will advance scientific understanding of key gaps related to the mechanisms and outcomes of Caring Contacts, while also evaluating a timely, pragmatic, low-cost, and scalable intervention for Veterans affected by lack of social connection and treatment engagement. If effective, it will have applicability as a response to treatment disengagement and future disasters. Innovation and Impact: We have taken an empirically-grounded suicide prevention intervention and adapted it for Veterans with poor treatment engagement in VA outpatient care. This study is innovative in testing an intervention responsive to the COVID-19 pandemic and its aftermath, and unique in using a health services intervention strategy to target loneliness. The intervention’s peer support component is highly novel for its low resource demands and potential for scalability. Specific Aims: The overarching objective of this project is to evaluate “Crisis Caring Contacts” (CCC), an adaptation of Caring Contacts tailored to reduce loneliness in the context of the pandemic. To reach this objective we will achieve these aims: 1) Among older Veterans with poor treatment engagement, evaluate the effectiveness of Crisis Caring Contacts in decreasing loneliness, compared to enhanced usual care; 2) Evaluate the effect of Crisis Caring Contacts on other important outcomes, including treatment engagement and suicidal ideation; 3) Explore potential moderators of treatment response to Crisis Caring Contacts; and 4) Explore the effect of Crisis Caring Contacts on all-cause mortality and suicide attempts. Methodology: Our approach is to conduct a multisite, pragmatic randomized controlled trial of CCC. We will target Veterans age 60 and over with active psychiatric or medical diagnoses who have had limited treatment engagement in VA outpatient care. Those in the CCC treatment arm will be sent 10 postcards over 10 months by a Peer Support Specialist. Those in the enhanced usual care arm (control) will be sent non-personalized, general health resource information. We will examine self-report and administrative data outcomes over 24 months of follow-up. Next Steps/Implementation: We will collect pre-implementation data from our study sites and share this with our operational partner, the Office of Mental Health and Suicide Prevention (OMHSP). Crisis Caring Contacts is highly suited to future implementation due to its scalability, ease of creating an operational dashboard to identify Veterans who could receive the intervention, and ability to add study materials to an implementation toolkit for VA Caring Contacts interventions.