Development of a Patient Centered Mental Health Intervention for Recent Veterans
Condition: Stress Disorders, Post-Traumatic; Depression; Anxiety; Substance-Related Disorders
MeSH terms: Substance-Related Disorders; Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      Recent Veterans of the OIF/OEF/OND conflicts are presenting in VA care with high rates of:
      PTSD, depression, anxiety, and alcohol abuse, reporting significant difficulties with
      community reintegration, and dropping out of mental health care at high rates. Surveys of
      recent Veterans show that Veterans want the VA to provide mental health care tailored to
      their concerns and reintegration priorities. The VA is committed to providing personalized,
      proactive, patient centered care (PCC); but little research or intervention development has
      been done on PCC in mental health care settings and preliminary research indicates Veterans
      may lack the skills and knowledge to be active partners in PCC. This study aims to examine
      PCC behaviors in VA mental health care and, informed by this data, develop a brief patient
      centered mental health intervention that will help recent Veterans take the lead in their
      care personalization and support their functional recovery. Results from this study will
      demonstrate the acceptability, feasibility, and preliminary efficacy of this intervention.
    

Detailed description: 
      Project Background: The term "recent Veterans" refers to Veterans who served in the military
      operations Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn.
      Almost 60% of recent Veterans who received VA care have been diagnosed with a mental health
      disorder, most commonly posttraumatic stress disorder (32%), depressive disorders (26%),
      anxiety disorders (25%), and substance abuse (13%). The research literature consistently
      confirms that 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).

      Project Objectives: The proposed research will characterize patient centered care in VA
      mental health care and produce a brief patient centered intervention that will empower
      Veterans to lead and personalize their mental health care in support of their functional
      recovery. In Aim 1 of this research the investigators will characterize rates of providers'
      and recent Veterans' (n=30) participation in the four components of PCC, as well as barriers
      and facilitators of each PCC component, to inform development of a brief patient centered
      mental health intervention in Aim 2. In Aim 2 the investigators will develop a brief patient
      centered mental health intervention for recent Veterans experiencing stress-related mental
      health disorders and conduct a pre-pilot demonstration (n=10) to assess acceptability. This
      intervention will be informed by data collected in Aim 1 and developed using an iterative
      process of discussion with and input from recent Veterans, VA mental health providers, peer
      specialists, and researchers. Finally in Aim 3 the investigators will test the feasibility
      and preliminary efficacy of the brief intervention by conducting a randomized controlled
      trial with 48 recent Veterans with stress-related mental health disorders.

      Project Methods: In Aim 1 data will be collected at one time point using surveys and a
      recording of a Veteran provider encounter which will be coded to quantify Veteran and
      provider patient centered care behaviors. Intervention development in Aim 2 will be led by a
      multi-stakeholder Advisory Panel and further developed using Veteran focus groups.
      Acceptability will be demonstrated via qualitative interviews following a pre-pilot
      demonstration project with 10 Veteran participants. In Aim 3 data will be collected at
      baseline, post-RCT participation, and 3 month and 6 month follow-up. Feasibility will be
      assessed with study administration data on engagement and participation in the intervention
      and preliminary efficacy will be evaluated via quantitative analysis of functioning from
      self-report surveys.

      Note: Measure of Patient Centered Care (Patient-centered Communication) was removed as a
      measure. The MPCC requires recording a patient-provider encounter and coding it. When the
      pandemic occurred previous methods of recording encounters and physically bringing an
      approved recording device to the provider's office prior to the session, was no longer
      viable. Investigators had to suspend recording until approved technology guidance was
      provided. When a means was identified it was so cumbersome no providers agreed to record.
    

Intervention name(s): person-centered mental health intervention; health and wellness
Intervention type(s): Behavioral; Behavioral
Intervention description(s): We anticipate that the PCMHI will be comprised of three, one-hour sessions offered over three to six weeks, scheduled at the participants' preference. Sessions will be one-on-one and the peer support specialist interventionist.; The control condition will be an educational health and wellness intervention for stress related disorders that will match the experimental condition for time and attention. The control condition will be three, one hour, individual sessions covering the symptom cycle, managing stress, and identifying social supports.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Veterans; mental health; Patient-Centered Care