Patient case: 54-year-old male with malignant hyperthermia; genetic feature: RYR1

Clinical trial: Pilot Study of Peer-Supported Online Problem-Solving Program

Summary: Many Veterans with mental health care needs go without care due to stigma, practical problems with getting services, and a high value on self-sufficiency. VHA has developed online programs aimed at fostering MH that are easy to access and may be more acceptable than psychotherapy. The purpose of this study is to learn whether peer-supported use of an online problem-solving course is acceptable and helpful and whether the study data can be collected online. Results of this pilot study would inform a larger study of the impact on problem-solving and mental health of a non-stigmatizing, online program - with and without peer support. If effective, peer supported online programs would improve the quality of care to Veterans with unmet mental health needs.

Detailed description: Primary care behavioral health team members and primary care physicians at Palo Alto Division and VA Palo Alto Community Based Outpatient Clinics (CBOCs) will invite participation of primary care veterans who screen positive for depression, anxiety, or PTSD, but decline mental health care. The providers will enter veteran name and contact information directly into secure, encrypted REDCap data file. For patients referred this way, the study research assistant will contact veterans referred by providers and conduct screening by phone to determine eligibility and randomize to a group. If Veterans are not sure whether they wish to be contacted about the study, providers can give interested Veterans a study flyer (attached), which will direct the Veteran to a web site with study information and consent information.
  Community veterans will be invited via social media marketing. Ads will link to a study web site. Study web site will link potential participants to REDCap eligibility screening questions. When eligibility is confirmed, REDCap will automatically alert research assistant to enroll participant and randomize.
  Veterans who decide to be in the study will be assigned by chance to one of three groups: An On Your Own group, a Peer Support group, or a Wait group. Veterans assigned to take the Moving Forward course with peer support or on their own will complete the course online and practice the problem-solving skills they learned for six weeks. Finishing the Moving Forward course takes a total of about four hours. Veterans in the peer support group will speak with a Veteran who is experienced with the course on the phone for 15 to 20 minutes once a week during the study about using the ideas and exercises in the course to solve problems. Veterans assigned to the wait group will answer questions online about problem-solving skills and their well-being (at the start and after three and six weeks). They will be able to take the course if they would like to after the six weeks have passed. Veterans in the On Your Own and Peer Support groups will answer questions online at the beginning, middle, and end of the study about problem-solving skills, their opinions about the course and about peer support (if they got it), and their well-being. This will take 10 to 15 minutes each time.

Eligibility: Inclusion Criteria:
  -  A Veteran of one of the U.S. military services, including National Guard and Reserves.
  -  Positive screen (score of 3 or more) on the PHQ-2 or GAD-2.
  -  Access to a phone and to a desktop or laptop computer with internet access.
  -  Willingness to be randomized to one of three conditions.
  -  Willingness to work with a Peer Support Specialist.
  Exclusion Criteria:
  -  An active suicide plan.
  -  Changes in psychoactive medications in the past month.
  -  MH treatment in the past 6 months, including treatment from a PC-MHI team member.

Relevance to patient case: not relevant