Enhancing Delivery of Problem Solving Therapy using SmartPhone Technology

描述(由申请人提供)： 退伍军人获得和参与循证心理治疗是退伍军人健康管理局(VHA)的高度优先事项，特别是农村健康办公室(ORH)和精神健康服务办公室(MHS)。智能手机应用是一项新兴技术，通过增加对提供者和自我管理工具的数字访问，具有巨大的潜力来扩大传统面对面心理治疗的覆盖范围。由于这项技术的发展相对较新，目前还没有关于智能手机提供的心理治疗效果的数据。关于可接受性和满意度的初步数据令人振奋，表明需要进一步研究。国家创伤后应激障碍中心与国家远程健康与技术中心(T2)合作，最近完成了一款名为Moving Forward的应用程序的开发，这是一种适用于老兵的问题解决疗法(PST)，是一种通过初级保健综合诊所(PC-MHI)提供的循证疗法。与卫生部合作，这一拟议的试点项目将收集关于推进的有效性和可接受性的初步数据，并向应用程序创建者提供及时的反馈。参与者将包括40名被诊断患有焦虑或情绪障碍的退伍军人，他们有兴趣在PC-MHI获得心理健康治疗。参与者将被随机分配到6个PST会议，要么是由前移应用程序增强的PST，要么是单独的6个PST会议。参与者将在基线、6周和12周完成评估。我们提出了3个具体的假设。在假设1中，我们预测，与随机接受PST的患者相比，在6周和12周时，随机接受PST加前进APP的患者在PSSU(家庭作业完成)和CSQ8(满意度)上的得分将观察到效果大小e 0.3。在假设2中，我们预测，与随机使用PST的患者相比，在6周和12周时，随机使用PST加向前APP的患者在SPSI(问题解决风格)上的变化分数将观察到e 0.3。在假设3中，我们预测，与随机接受PST的患者相比，在6周和12周时，随机接受PST加前进APP的患者在DASS综合评分(抑郁、焦虑和压力)和SF-12(健康相关生活质量)上的变化分数时，将观察到效应大小e 0.3。关键线人访谈将提供关于前进应用程序的定性反馈，我们将与MHS的合作伙伴分享这些反馈。拟议的项目对于退伍军人特派团改善所有退伍军人，特别是那些在参与传统面对面治疗方面面临障碍的退伍军人来说很重要。这项拟议的研究涉及研究与发展办公室(Access)的三个主要重点领域之一、HSR&D的两个研究重点(Access/农村健康和精神健康)以及新关部长为21世纪提出的三项转型举措，其中包括：1)获得医疗服务，2)精神健康，3)以患者为中心。这项拟议的工作是创新的，因为它侧重于一种快速崛起的移动技术，该技术具有改善提供精神健康服务的机会和参与度的巨大潜力。到目前为止，还没有检查智能手机应用程序提供心理健康服务的随机有效性试验。该项目也是及时的，因为VHA内的应用程序传播暂时暂停(由信息技术办公室实施)，这为在其发布之前研究向前发展提供了机会。在这个项目完成后，我们预计目标1和目标2中提议的工作将突出前进应用程序的临床价值，该应用程序将向退伍军人事务部政策制定者和广大科学界通报智能手机技术在精神卫生保健提供方面的应用。我们还期待Aim 3将为我们在MHS的合作伙伴提供关于推进应用程序设计和未来应用程序开发的有用反馈。

DESCRIPTION (provided by applicant): Access and engagement in evidence-based psychotherapies for Veterans are high priorities for the Veterans Health Administration (VHA), especially the Office of Rural Health (ORH) and the office of Mental Health Services (MHS). SmartPhone applications are an emerging technology with a vast potential to extend the reach of traditional in-person psychotherapy by allowing increased digital access to providers and self- management tools. Due to the relatively recent development of this technology, there are no data on the effectiveness of SmartPhone-delivered psychotherapy. Preliminary data on acceptability and satisfaction are promising, suggesting a need for further research. The National Center for PTSD in collaboration with the National Center for Telehealth & Technology (T2) recently completed the development of an app called Moving Forward, a Veteran-friendly adaptation of Problem Solving Therapy (PST), an evidence based therapy available through Primary Care Integration Clinics (PC-MHI). In partnership with MHS, this proposed pilot project will gather preliminary data on the effectiveness and acceptability of Moving Forward and provide timely feedback to the app creators. Participants will include 40 Veterans diagnosed with an anxiety or mood disorder interested in obtaining mental health treatment in PC-MHI. Participants will be randomly assigned to receive 6 sessions of either PST augmented by the Moving Forward app or 6 session of PST alone. Participants will complete assessments at baseline, 6 weeks and 12 weeks. We propose 3 specific hypotheses. In hypothesis 1, we predict an effect size e 0.3 will be observed when comparing scores on the PSSU (homework completion), and CSQ8 (satisfaction) at 6 and 12 weeks for patients randomized to PST plus the Moving Forward app compared to patients randomized to PST alone. In hypothesis 2, we predict an effect size e 0.3 will be observed when comparing change scores on the SPSI (problem solving style) at 6 and 12 weeks for patients randomized to PST plus the Moving Forward app compared to patients randomized to PST alone. In hypothesis 3, we predict an effect size e 0.3 will be observed when comparing change scores on the DASS composite score (depression, anxiety and stress) and SF-12 (health-related quality of life) at 6 and 12 weeks for patients randomized to PST plus the Moving Forward app compared to patients randomized to PST alone. Key informant interviews will provide qualitative feedback on the Moving Forward app which we will share with our partners at MHS. The proposed project is important to the VA mission to improve access for all Veterans particularly those who face barriers to engagement in traditional face-to-face treatment. The proposed research addresses one of three primary focus areas of the Office of Research and Development (Access), two of HSR&D's research priorities (Access/Rural Health and Mental Health), and three of Secretary Shinseki's Transformational Initiatives for the 21st Century including improving: 1) access to care, 2) mental health, and 3) patient-centeredness. This proposed work is innovative as it focuses on a rapidly emerging mobile technology that has great potential to improve access and engagement in mental health service delivery. To date, there have been no randomized effectiveness trials that have examined SmartPhone apps for mental health service delivery. The project is also timely as there is a temporary moratorium (imposed by the Office of Information Technology) on app dissemination within VHA, presenting an opportunity to study Moving Forward prior to its release. At the completion of this project, we expect that the work proposed in Aim 1 and 2 will highlight the clinical value of the Moving Forward app, which will inform both VA policy makers and the scientific community at large about the utility of SmartPhone technology in mental health care delivery. We also expect that Aim 3 will provide our partners at MHS with helpful feedback on the Moving Forward app design and future app development.