Helping Families Help Veterans with PTSD and Alcohol Abuse: An RCT of VA-CRAFT

描述(由申请人提供)： 对退伍军人医疗的预期影响(简写为VA-社区强化和家庭培训)是一种基于网络的外展干预，面向患有创伤后应激障碍(PTSD)或酒精使用障碍(AUDS)的退伍军人家庭成员，培训他们帮助退伍军人进行心理健康护理。家庭成员是退伍军人的主要支持来源，虽然家庭支持和鼓励是退伍军人参与精神卫生保健的有力推动者，但很少制定家庭一级的干预措施。通过评估VA-CRATE的有效性，该项目将尝试验证一种可以广泛传播的工具，以提高退伍军人对精神健康服务的参与度。背景-创伤后应激障碍和AUDS是退伍军人中非常普遍的精神障碍，可导致实质性的损伤和残疾。尽管有经验支持的治疗方法可用，但大多数患有创伤后应激障碍或AUDS的退伍军人并不从事任何精神卫生保健。数据显示，家庭成员的鼓励和支持对退伍军人从事心理健康护理的意愿起着关键作用。然而，许多家庭成员可能不知道如何最好地帮助他们的退伍军人从事心理健康护理。VA-CRATURE是对有经验支持的家庭培训干预(CREATE)的创新改编，已被证明极大地增加了滥用药物的平民样本的治疗参与度。对VA-Craft进行了修改，以包括特定于退伍军人的内容，专注于创伤后应激障碍、肥皂剧或两者兼而有之，并利用互动网络技术来提高其效率和覆盖范围。需要进行实证调查，以检验这种对现有有效干预措施的适应的有效性。目标-本项目的目标是使用有效性-实施类型1混合设计对VA-CREAT进行随机对照试验(RCT)。具体目标是：1)确定退伍军人心理健康服务利用的有效性；2)确定退伍军人的家庭成员幸福感、个人生活质量、与退伍军人的感知关系质量以及寻求治疗的沟通的有效性；3)进行过程评估，以评估干预的可用性、感知的帮助和形式。方法：这是一项为期3年的单点1型混合随机对照试验，将从参加国民警卫队士兵的准备和复原力-2研究(RING-2；Polusny&Erbes，PI)的退伍军人和家庭成员队列中招募参与者。使用退伍军人对部署后环-2调查和管理数据的反应，筛选出创伤后应激障碍、AUDS或两者均为阳性的退伍军人的家庭成员将被识别并招募参加随机对照试验(预期N=184)。 家庭参与者的退伍军人也将仅有资格参加评估。家庭成员参与者将完成对退伍军人创伤后应激障碍和AUD症状、家庭功能和沟通以及幸福感的基线问卷调查，并将被随机分配到退伍军人管理局或对照组(不接受治疗)。那些被分配到退伍军人工艺条件的人将完成在线退伍军人工艺课程。将监测通过退伍军人方案取得的进展，并在必要时系统地开展逐步的外联工作(电子邮件、电话、信件)，以确保干预工作的完成。退伍军人家属和退伍军人在完成退伍军人培训后，将完成后续问卷调查。主要结果将包括：1)退伍军人在基线后6个月内通过退伍军人管理数据评估的精神卫生服务利用情况；2)家庭成员对幸福和生活质量的自我报告；3)家庭和退伍军人关于感知的关系质量和关于寻求治疗的沟通的报告。最后，进程评估将结合参与者对退伍军人工艺单元的反馈以及对30名家庭成员和退伍军人的访谈，提供信息，为今后的执行工作提供信息。

DESCRIPTION (provided by applicant): Anticipated Impacts on Veterans Healthcare - VA-Community Reinforcement and Family Training (VA- CRAFT) is a web-based outreach intervention for family members of Veterans suffering from posttraumatic stress disorder (PTSD) or alcohol use disorders (AUDs) that trains them to help Veterans engage in mental health care. Family members represent a primary source of support for Veterans, and while family support and encouragement are powerful facilitators of Veterans' engagement in mental health care, few family-level interventions have been developed. By evaluating the effectiveness of VA-CRAFT, this project will attempt to validate a tool that can be widely disseminated to improve Veteran engagement in mental health services. Background - PTSD and AUDs are highly prevalent psychiatric disorders among combat Veterans that can lead to substantial impairments and disability. Although empirically supported treatments are available, the majority of Veterans suffering PTSD or AUDs do not engage in any mental health care. Data show that encouragement and support by family members play a key role in Veterans' willingness to engage in mental health care. However, many family members may not know how best to help their Veterans engage in mental health care. VA-CRAFT is an innovative adaption of an empirically supported family training intervention (CRAFT) that has been shown to dramatically increase treatment engagement among substance abusing civilian samples. VA-CRAFT was modified to include Veteran-specific content, to focus on PTSD, SUDs, or both, and to make use of interactive web-technology to increase its efficiency and reach. Empirical investigation is needed to test the effectiveness of this adaptation of an existing, efficacious intervention. Objectives -The goal of this project is to conduct a randomized controlled trial (RCT) of VA-CRAFT using an effectiveness-implementation Type 1 hybrid design. Specific aims are to: 1) Determine the effectiveness of VA-CRAFT on Veterans' mental health service utilization; 2) Determine the effectiveness of VA-CRAFT on family members' wellbeing, personal quality of life, perceived relationship quality with Veteran, and communication about treatment seeking; and 3) Conduct a process evaluation to assess the usability, perceived helpfulness, and format of the intervention. Methods -This is a 3-year, single-site, Type 1 hybrid RCT that will recruit participants from a cohort of Veterans and family members enrolled in the Readiness and Resilience in National Guard Soldiers-2 study (RINGS-2; Polusny & Erbes, PIs). Using Veterans' responses to post-deployment RINGS-2 surveys and administrative data, family members of Veterans who screen positive for PTSD, AUDs, or both and have not engaged in mental health care will be identified and recruited to participate in the RCT (anticipated N =184). Veterans of family participants will also be eligible to participate in assessments only. Family member participants will complete baseline questionnaires of perceived Veteran PTSD and AUD symptoms, family functioning and communication, and well-being and will be randomly assigned to VA-CRAFT or Control (no treatment) conditions. Those assigned to the VA-CRAFT condition will complete the online VA-CRAFT course. Progress through VA-CRAFT will be monitored and stepped outreach efforts (emails, phone calls, letters) will be systematically used, as necessary, to ensure completion of the intervention. After completion of VA-CRAFT, family members and Veterans will complete follow-up questionnaires. Primary outcomes will include: 1) Veteran's mental health service utilization during the 6 months following baseline as assessed by VA administrative data and 2) family member self-reports of well-being and quality of life and 3) family and Veteran reports of perceived relationship quality and communication about treatment seeking. Finally, a process evaluation, incorporating data from participants' feedback on VA-CRAFT modules and interviews with 30 family members and Veterans will provide information to inform future implementation efforts.