STEP-Home: Cognitive, emotional and vocational reintegration for OEF/OIF veterans

来自持久自由行动和伊拉克自由行动（OEF/OIF）的退伍军人代表了一个临床 需要非污名化和多学科干预的复杂和不断增长的群体， 针对可能与mTBI和PTSD相关的许多合并症。SPiRE试点的目的是 一项建议是开发一个重返社会讲习班，STEP-Home，供“持久自由行动”/“伊拉克自由行动”退伍军人使用， 从军事过渡到平民生活（过渡“家”），并评估这一计划的可行性， 小型试点调查。我们的研究表明，参加VA RR&D的参与者中有50%支持 TBI卓越中心，TBI和应激障碍转化研究中心（TRACTS），报告 功能状态存在显著困难，这将是STEP-Home的目标。这群人患有高 情绪（例如，创伤后应激障碍、抑郁症、药物滥用）和 物理的（例如，创伤性脑损伤、慢性疼痛）伤口。记忆力，注意力，睡眠， 头痛、焦虑增加和易怒是这种伤口的常见特征。研究表明 大多数退伍军人在从战斗中返回后难以适应平民生活， 心理健康问题经常被认为是造成这种困难的原因。不幸的是，这群老兵 也被证明对心理治疗有很强的抵抗力，很难参与， 预约缺席率和日程安排困难率特别高。STEP-Home希望解决 为此，向所有“持久自由行动”/“伊拉克自由行动”的退伍军人提供一个非污名化的、以技能为基础的讲习班， 无论临床诊断。STEP-Home研讨会基于循证康复 计划“步骤”，已被证明是有效的改善认知和情感缺陷， 平民轻度创伤性脑损伤（mTBI）（短期执行加，STEP）。我们将针对具体的 通过将STEP平民计划的内容集中在重返社会问题上，满足“持久自由行动”/“伊拉克自由行动”退伍军人的需求 通常在从战斗中回家后面临（退伍军人特定计划组件）。我们有四 本提案的主要目的。首先，我们将开发STEP-Home干预，包括冷凝和 调整经过验证的STEP程序，创建STEP家庭手册，制定治疗师培训计划， 并确定评估工具。第二，我们将制定一个保真度监测计划，以监测和提高 STEP-Home的信度和效度。第三，我们会进行小型试验，研究可行性， STEP-Home的可接受性（耐受性/依从性）。这项STEP-Home试点研究将提供给 大约24名从“持久自由行动”/“伊拉克自由行动”返回的人，无论临床诊断如何，都参加了 VA RR&D支持TBI卓越中心，TRACTS。第四，我们将评估我们适应的承诺， 干预成功实现拟议目标有可能大大改善 通过这一旨在重新适应平民环境的干预措施，提高“持久自由行动”/“伊拉克自由行动”所有退伍军人的生活质量。

Veterans from Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) represent a clinically complex and growing group who require non-stigmatizing and multidisciplinary interventions that effectively target their many comorbidities that may be associated with mTBI and PTSD. The purpose of this SPiRE pilot proposal is to develop a reintegration workshop, STEP-Home, for use in OEF/OIF Veterans to aid in their transition from military to civilian life (transitioning "Home"), and to evaluate the feasibility of this program in a small pilot investigation. Our research indicates that 50% of participants enrolled in the VA RR&D supported TBI Center of Excellence, the Translational Research Center for TBI and Stress Disorders (TRACTS), report significant difficulty in functional status, which will be targeted by STEP-Home. This cohort suffers from high co-prevalence rates of emotional (e.g., posttraumatic stress disorder, depression, substance abuse) and physical (e.g., traumatic brain injury, chronic pain) wounds. Problems with memory, concentration, sleep, headaches, increased anxiety and irritability are common hallmarks of such wounds. Research indicates that a majority of combat veterans experience difficulty in readjusting to civilian life after returning from combat, and mental health problems are frequently cited as driving this difficulty. Unfortunately, this group of veterans has also been demonstrated to be highly resistant to psychological treatment and difficult to engage, showing particularly high rates of appointment no-shows and scheduling difficulties. STEP-Home hopes to address this by offering an alternative non-stigmatizing, skills-based workshop available to all OEF/OIF veterans regardless of clinical diagnosis. The STEP-Home workshop is based on the evidence-based rehabilitation program "STEP" that has been shown to be effective in ameliorating cognitive and emotional deficits following mild traumatic brain injury (mTBI) in civilians (Short-Term Executive Plus, STEP). We will target the specific needs of OEF/OIF veterans by focusing the content of the civilian STEP program on reintegration issues commonly faced after return home from combat (Veteran-specific program components). We have four primary aims in this proposal. First, we will develop the STEP-Home intervention including condensing and adapting the validated STEP program, creating a STEP-Home manual, developing a therapist training plan, and identifying assessment tools. Second, we will develop a fidelity monitoring plan to monitor and enhance the reliability and validity of STEP-Home. Third, we will pilot a small trial to examine feasibility and acceptability (tolerability/adherence) of STEP-Home. This STEP-Home pilot study will be offered to approximately 24 individuals returning from OEF/OIF, regardless of clinical diagnosis, who are enrolled in the VA RR&D supported TBI Center of Excellence, TRACTS. Fourth, we will evaluate the promise of our adapted intervention. The successful completion of the aims proposed has the potential to significantly improve the quality of life for all OEF/OIF veterans through this intervention aimed at readjustment to the civilian setting.