Helping Families Help Veterans With PTSD and Alcohol Abuse: An RCT of VA-CRAFT
Condition: PTSD; Alcohol Abuse
MeSH terms: Alcoholism
Study type: Interventional

Summary: 
      This project begins to evaluate the effectiveness of a web-based family outreach tool that is
      designed to promote treatment engagement among Veterans with posttraumatic stress disorder
      (PTSD) or alcohol use disorders (AUDs) but who have not yet engaged in mental health care.
      The National Center for PTSD has developed an on-line, Veteran-tailored, interactive web tool
      called VA - Community Reinforcement and Family Training (VA-CRAFT) that trains family members
      to effectively help their Veterans to engage in treatment for PTSD and/or AUDs. This project
      will provide preliminary information about VA-CRAFT's effectiveness.
    

Detailed description: 
      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 adaptation of an empirically supported family training intervention (CRAFT) that
      has been shown to dramatically increase treatment engagement among substance abusing civilian
      samples. VA-CRAFT includes Veteran-specific content, a focus on PTSD, SUDs, or both, and also
      make use of interactive web-technology to increase its efficiency and reach. Pilot research
      is needed to begin to evaluate the effectiveness of this adaptation of an existing,
      efficacious intervention, to provide feedback to VA-CRAFT developers for possible
      modifications to content and delivery, and to inform future studies.

      Objectives Specific aims are to: 1) provide pilot data on the effectiveness of VA-CRAFT on
      Veterans' mental health service utilization; 2) provide pilot data on the effectiveness of
      VA-CRAFT on family members' wellbeing, personal quality of life, perceived relationship
      quality with Veteran, and communication about treatment seeking; 3) obtain pilot data to
      explore possible differences in intervention response between Veterans with AUDs only, PTSD
      only, or both; and 4) provide information regarding potential changes in content and delivery
      as well as mediators and moderators of outcome for VA-CRAFT.

      Methods This is a randomized controlled trial of VA-CRAFT that will obtain preliminary
      information on its effectiveness and pilot information to inform future studies. Participants
      will be drawn from a cohort of Veterans and family members enrolled in the Readiness and
      Resilience in National Guard Soldiers studies (RINGS; Polusny & Erbes, PIs). Using Veterans'
      responses to post-deployment RINGS surveys and administrative data, family members of
      Veterans who screen positive for PTSD or AUDs will be recruited and divided into 1 of 3
      subsamples: 1) family of Veterans with AUDs only (anticipated n = 38), 2) family of Veterans
      with PTSD only (anticipated n = 72), and 3) family of Veterans with both PTSD and AUDs
      (anticipated n = 74; total anticipated N =184 across the 3 subsamples). 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 contacts) will be systematically used, as necessary,
      to promote completion of the intervention. Three months after the baseline assessment, family
      members and Veterans will complete follow-up questionnaires. Primary outcomes will include:
      1) Veteran's mental health service utilization during the 3 months following initiation of
      VA-CRAFT as assessed by VA administrative data and 2) family member self-reports of wellbeing
      and quality of life and 3) family and Veteran reports of perceived relationship quality and
      communication about treatment seeking. Effect sizes will be estimated for each outcome within
      each subsample of participants (AUD only, PTSD only, and comorbid) and, if patterns are
      similar within subsamples, for the sample overall. Following the post-intervention
      questionnaires, qualitative interviews will be conducted with up to 40 family participants to
      examine possible moderators and mediators of treatment responses and to elicit participant
      feedback on VA-CRAFT modules and development to inform future VA-CRAFT development.
    

Intervention name(s): VA-CRAFT; Control
Intervention type(s): Behavioral; Other
Intervention description(s): VA-CRAFT is an on-line training program that teaches family members how to communicate and interact with Veterans to promote their engagement in needed mental health services for PTSD or Alcohol Use Disorders. 12 on-line sessions.; Participants will have the opportunity to complete the VA-CRAFT training program after 3 months; otherwise no intervention
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Keywords: Family Members; Community Outreach; Internet