Whole Health in VA Mental Health: A Randomized Controlled Trial of Omnis Salutis

对退伍军人医疗的预期影响：持久自由行动的最新退伍军人 伊拉克自由和新黎明行动(OIF/OEF/OND)冲突出现在退伍军人管理局的护理中，比率很高 与压力有关的精神健康障碍(创伤后应激障碍、抑郁、焦虑和酗酒)， 并报告在社会关系和重新融入社区方面存在严重困难。最近的调查 退伍军人表明，退伍军人希望退伍军人管理局为他们所关心的问题提供量身定做的心理健康护理 重新融入社会的优先事项；同时，退伍军人事务部致力于转变为一名整体健康患者- 以中心为中心的护理体系。在这种背景下，欧姆尼斯·萨卢蒂斯，一个简短的、以退伍军人为重点的整体健康激活 干预是由退伍军人、临床医生和研究人员组成的利益相关者顾问小组共同开发的。 初步研究结果表明，参加欧姆尼斯沙鲁蒂斯与改善身体状况有关， 新近患有应激相关心理健康障碍的退伍军人的心理和社会功能。 项目背景：“新近退伍军人”一词是指在OIF/OEF/OND军队服役的退伍军人 行动。在接受退伍军人管理局护理的最近退伍军人中，近60%(708,062人)被诊断为患有 精神健康障碍，最常见的创伤后应激障碍(56%)，抑郁障碍(45%)， 焦虑症(44%)和物质使用障碍(21%)。患有应激相关心理疾病的退伍军人 健康障碍经历了健康功能领域的损害(克服和管理疾病)， 目的(有意义的日常活动和参与社会)和社区(积极的关系和 社交网络)。Omnis Salutis是一项为期三个疗程的干预活动，退伍军人在其中了解整体健康 并完成简短的个人健康清单，练习创建和交付我的地图 (使命/愿望/目的)始终如一地向他们的提供者和社会团体传达他们的健康使命 支持；并确定支持其健康使命的正式和非正式治疗关系。欧姆尼斯 在先前的小型随机对照试验(n=48)中，Salutis被证明是可接受和可行的。 此外，退伍军人参加欧姆尼斯沙鲁蒂斯与结局的关系分析 兰德36项健康调查发现，对改善身体疼痛有很大效果，对社交媒体的效果中等 功能，身体功能的小影响，情绪健康，精力/疲劳，角色 由于情绪问题和一般健康问题造成的限制。这些结果是非常有希望的，并支持 欧姆尼斯沙鲁提斯的进一步测试。 项目目标：拟议的研究将测试Omennis Salutis的疗效，这是一种简短的、以退伍军人为重点的 全健康激活干预，随机对照试验(n=238)。这项研究的主要目的是 评价欧姆尼斯沙鲁蒂斯改善新近退伍军人身体和社会功能的疗效 患有与压力相关的障碍。第二个目的是评估欧姆尼斯沙鲁蒂斯对增加 从事压力相关疾病护理的老兵。有一个探索性的目标是评估 作为护理投入和功能之间关系的基础的过程。这项研究将提供 支持欧姆尼斯·萨鲁蒂斯作为一种循证做法和更广泛的传播。 项目方法：我们对238名与压力相关的退伍军人进行了随机对照试验。 从马里兰州、华盛顿特区和韦斯特的四个退伍军人医疗中心招募精神健康障碍患者 弗吉尼亚。退伍军人将被随机分配到三次欧姆尼斯沙鲁蒂斯或三次 主动控制、健康和健康干预。这两种情况都将通过AS VA Video Connect交付 (VVC)远程医疗平台或电话。参与者将在基线上完成评估，3个月的随访， 6个月随访，12个月随访时间点。分析将检查随时间变化的差异 在两种干预条件之间。

Anticipated Impacts on Veteran Healthcare: Recent Veterans of the Operation Enduring Freedom, Operation Iraqi Freedom and Operation New Dawn (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), and reporting significant difficulties with social relationships and community reintegration. 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 transforming to a Whole Health patient- centered, system of care. Within this context, Omnis Salutis, a brief, Veteran-focused, Whole Health activation intervention, was developed with a stakeholder advisory panel of Veterans, clinicians, and researchers. Preliminary findings indicate that participation in Omnis Salutis was associated with improvements in physical, mental and social functioning among recent Veterans with stress related mental health disorders. Project Background: The term “recent Veterans” refers to Veterans who served in the OIF/OEF/OND military operations. Almost 60% (708,062) of recent Veterans who received VA care have been diagnosed with a mental health disorder, most commonly post-traumatic stress disorder (56%), depressive disorders (45%), anxiety disorders (44%), and substance use disorders (21%). 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). Omnis Salutis is a three-session intervention in which Veterans learn about Whole Health and complete a brief Personal Health Inventory, practice creating and delivering MY MAP (Mission/Aspiration/Purpose) to communicate their health mission consistently to their providers and social supports; and identify both formal and informal healing relationships that support their health mission. Omnis Salutis was shown to be acceptable to and feasible in a previous small randomized controlled trial (n = 48). Additionally, analyses of the relationship between participation in Omnis Salutis and outcomes on the Veterans RAND 36-Item Health Survey found a large effect for Bodily Pain improvement, medium effect size for Social Functioning, small effect sizes for Physical Functioning, Emotional Well-Being, Energy/Fatigue, Role Limitations due to Emotional Problems, and General Health. These results are very promising and support further testing of Omnis Salutis. Project Objectives: The proposed research will test the efficacy of Omnis Salutis, a brief, Veteran-focused, Whole Health activation intervention, in a randomized controlled trial (n = 238). The primary aim of the study is to evaluate the efficacy of Omnis Salutis for improving the physical and social functioning of recent Veterans with stress-related disorders. The secondary aim is to evaluate the efficacy of Omnis Salutis for increasing Veteran engagement in care for stress-related disorders. There is an exploratory aim to Evaluate the processes that underlie the relationship between engagement in care and functioning. This study will provide support for Omnis Salutis as an evidence-based practice and for broader dissemination. Project Methods: We propose a randomized controlled trial in a sample of 238 Veterans with stress-related mental health disorders recruited from four VA medical centers in Maryland, Washington DC, and West Virginia. Veterans will be randomly assigned to receive three sessions of Omnis Salutis or three sessions of an active control, health, and wellness intervention. Both conditions will be delivered via as VA Video Connect (VVC) telehealth platform or telephone. Participants will complete assessments at baseline, 3-month follow-up, 6-month follow-up, and 12-month follow-up timepoints. Analyses will examine differences in change over time between the two intervention conditions.