Improving Mental Health for Veterans with Dementia: Provider Training in Caregiver Engagement

背景：这份职业发展提案旨在为退伍军人管理局职业生涯的博士玛丽·怀曼做准备 开展卫生服务研究，重点是改善精神卫生保健的提供和老龄服务的可及性 退伍军人。怀曼博士将通过完成培训活动、获得专家指导以及 完成关于家庭照顾者参与退伍军人心理健康服务的系列研究 患有痴呆症。精神健康状况(如抑郁和焦虑)在痴呆症和 如果不治疗，会导致更糟糕的结果。为了改善护理质量和获得机会，至关重要的是有效地 让家庭照顾者参与精神健康服务；然而，提供者缺乏这样做的信心和技能。 此CDA应用程序的主要目标是1)使用定性研究方法来确定促进者 和护理人员敬业度的障碍；2)开发和测试提供商培训课程，以提高以下方面的技能 吸引照顾者；以及3)使用结合纵向调查数据和退伍军人健康护理的现有数据集 记录，以探索护理助理如何在患有痴呆症的退伍军人中使用心理健康服务。 意义/影响：这项工作有可能对交付产生重大和有意义的影响 为年迈的退伍军人提供心理健康护理。我们的方法将支持快速传播和实施 最后一项经过有效性测试的干预措施，我们的研究结果可以为未来干预措施的发展提供信息 解决与精神卫生保健服务的获得和结果相关的可修改因素。这项工作非常符合 VHA和HSR&D优先事项，包括增加获得护理、心理健康和预防自杀的机会， 护理者支持和员工敬业度。 创新：虽然有几种针对照顾者的有效干预措施，但我们建议 通过培训照顾者的知识和技能来提高照顾者对精神卫生保健的参与度 有效的照顾者参与度。因此，我们的建议为改善精神卫生保健提供了新的方向 老年退伍军人的质量和准入。由此产生的系统干预可能适用于VHA护理 并可通过提高提供商自我效能对员工敬业度产生积极影响。 具体目标：目标将通过三个具体目标来实现：1)确定患者、提供者和 支持或阻碍照顾者参与老年退伍军人心理健康护理的系统因素 痴呆症；2)制定和试行提供者培训课程和实施战略，以改善智力 健康提供者对患有痴呆症的退伍军人照顾者的参与；3)检查强度与 老年退伍军人接受的非正式照护和认知状况与MH照护利用。 方法：目标1包括对患有痴呆症的退伍军人、他们的照顾者和 精神健康提供者和领导层。目标2将使用已建立的方法来开发、改进和试运行 针对心理健康环境的提供者培训和实施战略。在目标3中，来自退伍军人事务部-健康中心的数据 和退休研究老龄化退伍军人队列将被分析，以探索照顾， 认知状态和精神卫生保健利用情况。 下一步/实施：在CDA期间，将提交一份提案，为 实战训练课程试行。怀曼博士将与地方和国家VHA合作 传播伙伴传播研究结果和最终的、经过有效性检验的干预措施。嵌入式 在麦迪逊VA GRECC和威斯康星大学的丰富环境中，它提供广泛的 支持早期调查人员的基础设施，怀曼博士处于理想的环境中完成 拟议的研究和培训，使她能够作为VHA的独立调查员成功启动。

Background: This career development proposal is designed to prepare Mary Wyman, PhD for a VA career conducting health services research focused on improving mental health care delivery and access for aging Veterans. Dr. Wyman will accomplish this goal by completing training activities, obtaining expert mentorship, and completing a series of research studies on family caregiver engagement in mental health services for Veterans with dementia. Comorbid mental health conditions (e.g., depression and anxiety) are common in dementia and are associated with worse outcomes if left untreated. To improve care quality and access, it is critical to effectively involve family caregivers in mental health services; however, providers lack the confidence and skills to do so. The primary objectives in this CDA application are 1) to use a qualitative research approach to identify facilitators and barriers to caregiver engagement; 2) develop and test a provider training curriculum to increase skills in engaging caregivers; and 3) use an existing dataset combining longitudinal survey data and VA health care records to explore how caregiving associates to use of mental health services among Veterans with dementia. Significance/Impact: This work has the potential to have significant and meaningful impact on the delivery of mental health care to aging Veterans. Our methodology will support rapid dissemination and implementation of the final, effectiveness-tested intervention, and our findings can inform development of future interventions to address modifiable factors associated with mental health care access and outcomes. This work aligns strongly with VHA and HSR&D priorities, including increased access to care, mental health and suicide prevention, caregiver support, and employee engagement. Innovation: While there are several effective interventions aimed at caregivers, we propose an innovative approach to increasing caregiver involvement in mental health care by training providers in knowledge and skills for effective caregiver engagement. As such, our proposal offers new directions for improving mental health care quality and access for aging Veterans. The resultant systems intervention may be applicable across VHA care settings and could positively impact employee engagement through increased provider self-efficacy. Specific Aims: Objectives will be achieved through three specific aims: 1) Identify patient-, provider-, and system-level factors that support or impede caregiver engagement in mental health care for aging Veterans with dementia; 2) Develop and pilot-test a provider training curriculum and implementation strategy to improve mental health provider engagement of caregivers of Veterans with dementia; 3) Examine associations of intensity of informal caregiving received and cognitive status with MH care utilization by aging Veterans. Methodology: Aim 1 involves semi-structured interviews with Veterans with dementia, their caregivers, and mental health providers and leadership. Aim 2 will use established methodology to develop, refine, and pilot-test a provider training and implementation strategy for the mental health setting. In Aim 3, data from the VA-Health & Retirement Study Aging Veterans Cohort will be analyzed to explore associations between caregiving, cognitive status, and mental health care utilization. Next Steps/Implementation: During the CDA period, a proposal will be submitted to fund an adequately powered “real-world” efficacy trial of the training curriculum. Dr. Wyman will work with local and national VHA dissemination partners to disseminate study results and the final, effectiveness-tested intervention. Embedded in the Madison VA GRECC and the rich environment of the University of Wisconsin, which offers extensive infrastructure to support early stage investigators, Dr. Wyman is in an ideal environment to complete the proposed research and training, allowing her to successfully launch as an independent investigator in VHA.