Development of a Patient Centered Mental Health Intervention for Recent Veterans

对退伍军人医疗保健的预期影响：OIF/OEF/OND冲突的最近退伍军人 退伍军人事务部护理与压力相关的精神健康障碍（创伤后应激障碍，抑郁症， 焦虑和酗酒），报告在社会关系和社区方面存在重大困难 重返社会，并以不可接受的高比率退出VA精神卫生保健。最近的调查 退伍军人表明，退伍军人希望退伍军人事务部提供适合他们的关注的心理健康护理， 重返社会的优先事项，同时VA已承诺提供个性化的，积极主动的，病人 中心护理然而，很少有研究或干预发展已经做了以病人为中心的护理， 专业精神卫生保健机构。这项工作将导致一个简短的退伍军人为目标的发展， 干预，这将教育退伍军人参与合作伙伴在弗吉尼亚州的新病人为中心的护理 模型，并协助他们定制他们的护理，以最好地实现功能康复，从压力相关的心理 健康失调 项目背景：术语“新近退伍军人”是指在军事行动中服役的退伍军人 持久自由行动、伊拉克自由行动和新黎明行动。近60%的 接受VA护理的退伍军人被诊断出患有精神健康障碍，最常见的是在... 创伤应激障碍（32%）、抑郁症（26%）、焦虑症（25%）和药物滥用 (13%).研究文献一致证实，最近的退伍军人与压力相关的心理健康 健康功能领域（克服和管理疾病）受损的障碍，目的 （有意义的日常活动和参与社会）和社区（积极的关系和社会 网络）。 项目目标：拟议的研究将表征VA精神卫生保健中以患者为中心的护理 并产生一个简短的以病人为中心的干预，这将使退伍军人领导和个性化他们的 精神卫生保健，以支持他们的功能恢复。在本研究的目标1中，我们将描述 供应商和最近的退伍军人（n=30）参与PCC的四个组成部分，以及障碍和 每个PCC组成部分的促进者，以告知以患者为中心的简短心理健康的发展 目标2的干预。在目标2中，我们将制定一个简短的以病人为中心的心理健康干预， 经历与压力相关的心理健康障碍的退伍军人，并进行预试点示范（n=10）， 评估可接受性。这一干预措施将以目标1中收集的数据为依据， 与最近的退伍军人，VA心理健康提供者，同行讨论和输入的迭代过程 专家和研究人员。最后，在目标3中，我们将测试简报的可行性和初步功效 通过对48名近期患应激相关精神障碍的退伍军人进行随机对照试验， 健康失调 项目方法：在目标1中，将在一个时间点使用调查和退伍军人记录收集数据， 提供者遭遇，将编码以量化退伍军人和提供者以患者为中心的护理行为。 目标2中的干预措施制定工作将由一个多利益攸关方咨询小组领导，并将得到进一步发展 使用退伍军人焦点小组。可接受性将通过预试点后的定性访谈来证明 有10名老学员参加的示范项目。在目标3中，将在基线、RCT后收集数据 参与，3个月和6个月随访。将使用以下研究给药数据评估可行性： 参与和参与干预和初步疗效将通过编码的退伍军人- 提供者接触和自我报告调查功能的定量分析。

Anticipated Impacts on Veteran Healthcare: Recent Veterans of the OIF/OEF/OND conflicts are presenting in VA care with high rates of stress related mental health disorders (posttraumatic stress disorder, depression, anxiety, and alcohol abuse), reporting significant difficulties with social relationships and community reintegration, and dropping out of VA mental health care at unacceptably high rates. Surveys of recent Veterans show that Veterans want the VA to provide mental health care tailored to their concerns and reintegration priorities while simultaneously the VA has committed to providing personalized, proactive, patient centered care. However, little research or intervention development has been done on patient centered care in specialty mental health care settings. This work will result in the development of a brief Veteran-targeted intervention which will educate Veterans on being engaged partners in the VA's new patient centered care model and assist them in tailoring their care to best achieve functional rehabilitation from stress related mental health disorders. Project Background: The term “recent Veterans” refers to Veterans who served in the military operations Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. Almost 60% of recent Veterans who received VA care have been diagnosed with a mental health disorder, most commonly post- traumatic stress disorder (32%), depressive disorders (26%), anxiety disorders (25%), and substance abuse (13%). The research literature consistently confirms that recent Veterans with stress-related mental health disorders experience impairment in functional domains of health (overcoming and managing disease), purpose (meaningful daily activities and participation in society), and community (positive relationships and social networks). Project Objectives: The proposed research will characterize patient centered care in VA mental health care and produce a brief patient centered intervention that will empower Veterans to lead and personalize their mental health care in support of their functional recovery. In Aim 1 of this research we will characterize rates of providers' and recent Veterans' (n=30) participation in the four components of PCC, as well as barriers and facilitators of each PCC component, to inform development of a brief patient centered mental health intervention in Aim 2. In Aim 2 we will develop a brief patient centered mental health intervention for recent Veterans experiencing stress-related mental health disorders and conduct a pre-pilot demonstration (n=10) to assess acceptability. This intervention will be informed by data collected in Aim 1 and developed using an iterative process of discussion with and input from recent Veterans, VA mental health providers, peer specialists, and researchers. Finally in Aim 3 we will test the feasibility and preliminary efficacy of the brief intervention by conducting a randomized controlled trial with 48 recent Veterans with stress-related mental health disorders. Project Methods: In Aim 1 data will be collected at one time point using surveys and a recording of a Veteran- provider encounter which will be coded to quantify Veteran and provider patient centered care behaviors. Intervention development in Aim 2 will be led by a multi-stakeholder Advisory Panel and further developed using Veteran focus groups. Acceptability will be demonstrated via qualitative interviews following a pre-pilot demonstration project with 10 Veteran participants. In Aim 3 data will be collected at baseline, post-RCT participation, and 3 month and 6 month follow-up. Feasibility will be assessed with study administration data on engagement and participation in the intervention and preliminary efficacy will be evaluated via coded Veteran- provider encounters and quantitative analysis of functioning from self-report surveys.