Motivational Coaching to Enhance Mental Health Engagement in Rural Veterans (CREATE)
The purpose of this study is to investigate combat-related health problems among rural veterans. The research project also aims to test a new telephone-based approach for helping veterans who need treatment connect with the appropriate care. This study will help us to better understand the kinds of problems recently returned veterans experience. The study will also help us to find better ways to help veterans get the help they may need.
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Outcomes Assessor)
Primary Purpose: Health Services Research
|Official Title:||Motivational Coaching to Enhance Mental Health Engagement in Rural Veterans|
- Mental Health (MH) Treatment Engagement [ Time Frame: 26 months ] [ Designated as safety issue: No ]Motivational Coaching (vs. Control) on MH treatment initiation. This will be measured by self-report and by checking the subjects medical record. We will adjust by clustering for CBOC and region as well as potential confounding by other covariates
- Mental Health (MH) Treatment Retention [ Time Frame: 26 months ] [ Designated as safety issue: No ]Motivational Coaching (vs. Control) on MH treatment retention. This will be measured by self-report and by checking the subjects medical record. We will adjust by clustering for CBOC and region as well as potential confounding by other covariates
|Study Start Date:||April 2015|
|Estimated Study Completion Date:||March 2018|
|Estimated Primary Completion Date:||April 2017 (Final data collection date for primary outcome measure)|
Experimental: Motivational Coaching
Telephone based Motivational Coaching sessions
Behavioral: Motivational Coaching
Telephone-based Motivational Interviewing aimed at getting Veterans to engage or retain mental health treatment
No Intervention: Referral alone
This is the current standard of care
Project Background: One in five OEF/OIF/OND veterans resides in rural areas and primarily receives care from VA CBOCs. Compared to their urban counterparts, rural veterans experience a significantly greater MH burden and poorer outcomes. Nevertheless, less than 10% of OEF/OIF/OND veterans with a new PTSD diagnosis attend a minimum number of sessions required for evidence-based treatment, with rurality being one of the strongest predictors of poor engagement. Our pilot study in urban OEF/OIF/OND veterans demonstrated that telephone Motivational Interviewing (MI) delivered by research staff significantly improved MH treatment initiation and retention in care. However, we do not know whether telephone MI will have as strong an effect on MH treatment engagement when implemented by VA staff in CBOCs serving rural veterans.
Project Objectives: As a part of the CeMOHR CREATE application to improve rural veterans' access to evidence-based mental healthcare (Fortney, PI), the overall goal of this project is to adapt, implement and test an MI-based coaching intervention to improve MH services engagement at CBOCs serving rural veterans. The specific aims of this project are: (1) Conduct a developmental formative evaluation of perceived barriers to MH treatment engagement and adapt the MI-based treatment engagement intervention and implementation strategy to the needs of stakeholders; (2) Conduct a randomized multi-site pragmatic effectiveness trial comparing MH Referral alone with MH Referral plus MI-based coaching; and (3) Conduct an implementation-focused formative evaluation and use this information to make mid-course corrections to the implementation strategy based on stakeholder and key informant input.
Methods: We will conduct the pragmatic effectiveness trial of the telephone motivational coaching intervention to determine whether, in comparison to MH Referral alone, telephone MI coaching improves MH treatment initiation and retention, the use of e-health MH resources, and perceived need and readiness for and access to MH treatment among rural veterans who use CBOCs (Aim 2).
Impact: This research will help close the knowledge gap about barriers to care and preferences for MH services among rural veterans. In addition, information from this project will be used to develop implementation toolkits for MH treatment engagement interventions for rural veterans. Finally, this project will determine the effectiveness of a telephone Motivational Interviewing engagement intervention using e-health adjuncts, thereby filling a gap in the scientific literature about whether novel interventions can be used by VA staff in CBOCs to overcome rural-urban disparities in MH treatment engagement.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01893983
|Contact: Nicole McCamish, MA||(415) 221-4810 ext 4284||Nicole.McCamish@va.gov|
|Contact: Linda Abadjian, PhD||(415) 221-4810 ext firstname.lastname@example.org|
|United States, Arkansas|
|Central Arkansas VHS John L. McClellan Memorial Veterans Hospital, Little Rock, AR||Not yet recruiting|
|Little Rock, Arkansas, United States, 72205-5484|
|Contact: Regina L Stanley, BA 501-257-1730 Regina.Stanley2@va.gov|
|United States, California|
|San Francisco||Not yet recruiting|
|San Francisco, California, United States, 94121|
|Contact: Nicole McCamish, MA 415-221-4810 ext 4284 Nicole.McCamish@va.gov|
|Contact: Linda Abadjian, PhD (415) 221-4810 ext 3975 email@example.com|
|Principal Investigator: Karen H Seal, MD MPH|
|Principal Investigator:||Karen H Seal, MD MPH||San Francisco|