Impact of Veteran Voices & Visions Peer Support Groups on Social Integration for Veterans with SMI/Psychosis

患有严重精神疾病(SMI)的退伍军人与社会融合作斗争-参与工作、住房和 公民身份--由于症状、耻辱和心理社会功能缺陷。这对 死亡率，与吸烟相当，高于肥胖和酗酒。尽管有相当大的退伍军人 为有SMI的退伍军人提供心理健康护理的努力，促进社会融合的计划是 缺乏。患有重度精神障碍的退伍军人在退伍军人中社会融入不良和有自杀念头的风险特别高 新冠肺炎大流行。目前迫切需要推进针对退伍军人社会融合的治疗。 该项目通过以小组为基础的同行专家(PS)共同促进心理社会来满足这一需求 对患有SMI的退伍军人的干预，称为“退伍军人声音和愿景”(VVV)。VVV通过SMI瞄准退伍军人 他们经历了精神病，这是一个特别需要社会融合支持的群体。虚拟VVV组 由退伍军人精神健康临床医生(MHC)和PSS通过在线视频会议共同领导。VVV是一种适应 基于社区的支持小组模式，称为听力之声(HV)方法，该方法是在 30年前在荷兰。自那以后，它已经传播到超过25个国家，代表着数百个 世界各地的支持团体。该方法促进了共同的群体凝聚力和常态化 SMI的精神病症状：幻觉、妄想和社交孤立。尽管它的范围覆盖全球，但这 包括退伍军人事务部在内的公共卫生系统既没有正式采用这种方法，也没有对其进行严格的研究。 这种干预有可能创造和培育一个支持性的社区，改善社会 通过减少参与者的痛苦和自我羞辱，提高自我效能，使他们融入社会。这三个人 进程成果与社会融合密切相关。该提案直接与退伍军人管理局保持一致 优先推进对患有重度精神障碍的退伍军人的现有心理社会干预的广度，改善获得 通过远程医疗服务，支持退伍军人的独立、福祉、赋权和整体健康。 这项建议的目标是(1)为VVV制定手册、培训指南和保真度量表，(2) 评估VVV的可行性和可接受性，以及(3)收集试点结果数据。手册，培训 准则和保真度量表将由研究小组与4个咨询小组合作制定： 具有SMI、MHC、PSS和非退伍军人协会HV专家的退伍军人。然后，将培训5个MHC和5个PS使用 新的VVV手册，每个MHC-PS对将使用新的协议进行一个小组。三十名退伍军人将成为 招募参加这5个小组，评估将在基线、中点和岗位进行- 干预。基线评估包括精神症状的测量，来自 精神病、内化自我污名、自我效能、归属感、康复和社会融合。以下为- 在10周和20周进行的UP评估也将包括这些与基线相同的测量 作为对干预可接受性的调查和定性访谈。关于接近的数字的可行性数据， 登记、保留和治疗保真度将被收集。忠诚度将通过两种方式进行评估：(1) 辅导员将在每次会议和(2)研究小组之后完成自我管理的反思工作表 成员将从每组中随机选择5个录音会话进行正式的保真度评级。 受试者内试验的目标是评估人工VVV方案的可行性和可接受性 提高精神病退伍军人的自我效能感、自我污名和社会功能。为此，这项研究 将使用将包括在随后的区域风险评估中的所有措施来运行。然而，由于 这项研究旨在评估拟议的干预措施能否在 并评估一组候选结果衡量标准的性质，而不是 证明有效性，大多数分析将是描述性的。这将为未来的功绩奠定基础 这将支持一项受控疗效研究。

Veterans with Serious Mental Illness (SMI) struggle with social integration - participation in work, housing, and citizenship - due to symptoms, stigma, and psychosocial functioning deficits. This has a tremendous impact on mortality, comparable to that of smoking and greater than obesity and alcohol abuse. Despite considerable VA efforts to provide mental health care to Veterans with SMI, programs that promote social integration are lacking. Veterans with SMI are at especially high risk for poor social integration and suicidal ideation during the COVID-19 pandemic. There is an urgency to advance treatments targeting Veterans' social integration. This project addresses this need with a group-based, peer specialist (PS) co-facilitated psychosocial intervention for Veterans with SMI, called “Veteran Voices and Visions” (VVV). VVV targets Veterans with SMI who experience psychosis, a group particularly in need of support with social integration. Virtual VVV groups are co-led by VA mental health clinicians (MHCs) and PSs via online video conference. VVV is an adaptation of a community-based support group model called the Hearing Voices (HV) approach that was developed over 30 years ago in the Netherlands. It has since spread to over twenty-five countries, representing hundreds of support groups worldwide. The approach facilitates group cohesion around and normalization of the common psychotic symptoms of SMI: hallucinations, delusions, and social isolation. Despite its global scope, this approach has neither been formally adapted nor rigorously studied in public health systems, including the VA. This intervention has the potential to create and foster a supportive community that improves the social integration of participants by reducing their distress and self-stigma, and increasing self-efficacy. These three process outcomes are strongly associated with social integration. This proposal is directly aligned with VA priorities to advance the breadth of existing psychosocial interventions for Veterans with SMI, improve access via telehealth services, and support Veterans' independence, wellbeing, empowerment, and whole health. The goal of this proposal is (1) to develop a manual, training guidelines, and a fidelity scale for VVV, (2) to assess the feasibility and acceptability of VVV, and (3) collect pilot outcome data. The manual, training guidelines, and fidelity scale will be developed by the research team in collaboration with 4 advisory panels: Veterans with SMI, MHCs, PSs, and non-VA experts in HV. Then, 5 MHCs and 5 PSs will be trained to use the new VVV manual, and each MHC-PS pair will conduct a group with the new protocol. Thirty Veterans will be recruited to participate in these 5 groups and assessments will be conducted at baseline, midpoint, and post- intervention. Baseline assessments include measurement of psychiatric symptoms, level of distress from psychosis, internalized self-stigma, self-efficacy, sense of belonging, recovery, and social integration. Follow- up assessments conducted at 10 and at 20 weeks will include these same measurements as baseline, as well as a survey and qualitative interview on intervention acceptability. Feasibility data on numbers approached, enrolled, and retained, and treatment fidelity will be collected. Fidelity will be assessed in two ways: (1) facilitators will complete self-administered reflection worksheets after each session and (2) research team members will rate 5 randomly selected audio-recorded sessions from each group for formal fidelity ratings. The goal of the within-subjects trial evaluating feasibility and acceptability of the manualized VVV protocol for improving self-efficacy, self-stigma and social functioning in Veterans with psychosis. To that end, the study will be run using the full collection of measures that would be included in a subsequent RCT. However, since the study is designed to assess whether the proposed intervention can be successfully implemented in the target population and to evaluate the properties of a candidate set of outcome measures, rather than demonstrate efficacy, most of the analyses will be descriptive. This will lay the groundwork for a future Merit that will support a controlled efficacy study.