Peer Visitation for OEF/OIF Veterans

Study Overview
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Brief Summary
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The goal of this study was to train OIF/OIF Veterans with multiple injuries to be Peer Visitors, i.e., Volunteers who visit more recently OIF/OEF Veterans and provide support. We evaluated the effectiveness of the training, and any benefits that Volunteer Peer Visitors and the Recipients of Peer Visitors experienced as a result of participating in Peer Visitation.

Detailed Description
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Peer visitation (PV) provides individuals newly dealing with a particular injury/ illness with an opportunity to interact with a peer who has successfully managed a similar condition. Interaction with a successful role model can provide credible social support and information, increase self-efficacy and teach coping strategies, which in turn can engender hope and motivation to engage in treatment and use active coping strategies. In spite of the widespread clinical availability of PV programs, the amount and type of training and clinical/organizational varies widely, and empirical support for their efficacy is limited. The main objective of this project is to test the feasibility of implementing a PV program for OEF/OIF veterans with war-related polytrauma. The proposed study represented a unique opportunity to evaluate three important aspects of peer visitation among OEF/OIF Veterans. Our three hypotheses were: H 1: Veteran Peer Visitors (VPVs) who complete the training will demonstrate successful acquisition of efficacy, knowledge and skills as measured by: (1) pre- and post-tests administered before and after the training; (2) trainer evaluations upon completion of the training, (3) self-evaluation of at least two actual peer visits, and (4) evaluation by two individuals who receive peer visits. H2: VPVs who complete the study will demonstrate increased self-care, improved mood, and increased post-traumatic growth compared to pre-training baseline measures. H 3: Veterans who receive a visit from a VPV will endorse improvement in one or more of the following areas: stress, self-efficacy, activation, mood, ability to make meaning of their experiences, and knowledge of coping options. We used a mixed-methods study to evaluate the feasibility of PV training materials developed in a previous grant to certify 12-18 Veteran Peer Visitors (VPVs). In a prior project, the proposed research team developed the training materials to be tested in this feasibility study, including screening tools to identify appropriate candidates for VPV training, an Instructor manual and a Veteran PV workbook. Two types of participants: Veteran Peer Visitors and Recipients of VPVs were recruited via the Polytrauma Network Site in VISN 20 (Seattle). VPVs were nominated by a clinician to participate and, if enrolled, will undergo 2-day training and will be required to pass a test upon completion of training. Training included a VA Voluntary Services background check, and orientation to the VHA and VA privacy policies. VPVs became official VA volunteers. Each certified VPV was required to provide 1-5 visits to at least two Veterans. Both VPVs and recipients of VPV completed surveys at baseline and upon study completion.

Official Title
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Evaluating a Peer Visitor Program for OIF/OEF Veterans With Polytrauma

Conditions
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Polytrauma, Blast Injuries

Intervention / Treatment
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* Other: Peer Visitation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: For Peer Visitors: eligibility will be determined using a combination of self-assessment, clinician recommendation, and Voluntary Services screening For participants who are interested in receiving a peer visitor: eligibility will be determined by the referring clinical team and the Research Nurse Peer Visitors: To be eligible to participate in the study as a potential Veteran Peer Visitor, Veterans must complete several screening steps. A Veteran must be nominated by a clinician from the Center for Polytrauma Care (CPC) Clinical Team, or they must nominate themselves for the project and seek endorsement from a clinician on the CPC team. To be nominated or endorsed by a clinician, the Veteran must have been observed by the clinical team member to demonstrate the following specific behaviors and characteristics: Reliable and organized about keeping appointments (80% adherence or better) Demonstrate excellent insight into own treatment goals, progress, barriers, treatment rationale Not demonstrate any high-risk behaviors in the previous 12 months, including suicidal ideation or intent, inpatient psychiatric treatment (other than planned, voluntary admission to Evaluation and Brief Treatment Unit), active substance abuse or dependence, uncontrolled psychotic symptoms (e.g., hallucinations, delusions), felonies. Evidence of good social support (i.e., clinician aware of supportive relationships) Engaged in meaningful life goals and activities (e.g., work, school, volunteering, parenting, recreation, church) Able to pass background check for Voluntary Services Must be English Speaking Able to complete pen and paper surveys Exclusion Criteria: Not an OEF/OIF Veteran Under age 18 Non English Speaking Psychiatrically at risk (i.e., uncontrolled psychotic symptoms, active substance abuse or dependence)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Peer Visitation Training (Peer Mentor)<br>Veteran Peer Visitors participated in a 2-day training program and then provide at 1-5 visits to at least 2 recipients. | Other: Peer Visitation<br>* Trained Volunteers will visit OEF/OIF Veterans with Polytrauma Injuries to provide support.<br>|
| Experimental: Peer Visitation<br>Veterans who received at least one visit from a Veteran Peer Visitor. | Other: Peer Visitation<br>* Trained Volunteers will visit OEF/OIF Veterans with Polytrauma Injuries to provide support.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Post Traumatic Growth Inventory | Administered only to Peer Visitors, possible range 0-105, with higher scores indicating greater post-traumatic growth. Post-traumatic growth includes emotional changes such as noticing a stronger sense of self, deepened relationships, increased sense of gratitude or appreciation for life, increased spirituality. | Upon completion of study requirements (i.e., visits) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient Health Questionnaire-9 (Depression Screen) | 9-item depression screen with possible response options ranging from 9-36, with higher numbers indicating greater depression symptom severity. | Upon completion of visits. | 
| Post-Traumatic Stress Disorder Checklist- Military Version (PCL-M) | Measures PTSD symptoms. Possible scores range from 19-95, with higher scores indicating greater symptom severity. | Upon study completion. | 
| Patient Activation Measure | Measures participante self-efficacy, knowledge of and engagement in health care. Possible scores range from 13-52 with higher scores indicating greater efficacy/knowledge/engagement. | Post- Participation | 
| General Anger Level | 5-item scale developed for this study. Assesses level of perceived experienced anger in the past month. Possible scores range from 5-35 with higher scores indicating greater levels of anger. | Post- Participation |