National Guard Outreach and Linkage to Treatment
This project will add an evaluation/research component to an existing peer outreach program, now implemented for over 1100 soldiers in the Michigan Army National Guard. Preliminary work will be completed in three areas. We will conduct semi-structured interviews with soldiers, Buddies, and National Guard leadership and develop and pilot test survey items relevant to implementation. Further, we will develop and pretest survey items relevant to determining soldier symptomatic and functional status. We will also conduct a small feasibility study, fielding the newly developed survey to a representative sample of recently returned National Guard members from Michigan and Indiana, to determine response rates and veteran willingness to allow access to linkable PDHA/PDHRA data and health services data. Finally, we will construct a merged, de-identified longitudinal dataset comprised of Post-Deployment Health Assessment and Reassessment data, Military Health System/TRICARE, and VA services data from National Guard soldiers in Michigan and comparison states of Indiana and Ohio. This will allow a longitudinal assessment of services initiation and retention for the entire Guard populations in these states.
|Study Design:||Observational Model: Cohort
Time Perspective: Retrospective
|Official Title:||National Guard Outreach and Linkage to Treatment|
- National Guard Soldier Survey [ Time Frame: Following return from deployment ] [ Designated as safety issue: No ]This was a pilot study. Demonstrated survey acceptablity, completion rates, allowed for larger observational study recently completed. Survey domains included employment, mental health symptoms, substance use, unit cohesions and other characteristics.
|Study Start Date:||January 2010|
|Study Completion Date:||December 2011|
|Primary Completion Date:||December 2010 (Final data collection date for primary outcome measure)|
National Guard leadership, Buddies, and soldiers
Michigan State Army National Guard soldiers who have returned from OEF/OIF deployments starting December 2008
Indiana State Army National Guard soldiers who have returned from OEF/OIF deployments starting December 2008
National Guard members from Michigan, Ohio, and Indiana who returned from OEF/OIF deployments after September 30, 2003
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Soldiers returning from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) commonly experience symptoms of PTSD, depressive disorders, and interpersonal difficulties. Forty-two percent of National Guard (NG) soldiers report symptoms suggesting a need for evaluation. Unfortunately, only half with mental health needs initiate treatment in the VA or elsewhere. Stigma remains an important barrier. Proactive peer outreach may successfully address stigma and facilitate appropriate treatment use. In the recently implemented Michigan Guard Buddy*to*Buddy (B2B) program, all returning MIARNG soldiers are assigned a first-tier "Buddy" from their unit who systematically telephones them to "check in" regarding key areas of functioning and symptoms. Soldiers may also be referred to second-tier Buddies, veterans outside the Guard trained in motivational interviewing and supervised by professional staff. The goal of the program is to identify soldiers in need of evaluation and connect them to care in a timely fashion.
We will conduct preliminary work that will allow us to assess the need for and the feasibility of adding a rigorous evaluation/research component to the B2B program.
Symptoms of PTSD, depressive disorders, and reports of interpersonal difficulties are common among soldiers following their return from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). Forty-two percent of National Guard/Reserve soldiers report mental health issues suggesting a need for evaluation following return from deployments. Unfortunately, many with problematic symptoms do not access care. Important barriers to treatment include soldier beliefs that those who received mental health care are viewed as "weak" and their careers harmed. Initiatives are needed that successfully address stigma and facilitate treatment connection and retention.
The goal of this RRP is to assess the need for AND the feasibility of a larger VA study that would use a strong quasi-experimental design (time series analysis with comparison groups) to examine the impact of the B2B program on returning NG veteran mental health treatment initiation, retention, symptoms, and functional outcomes.
Specific RRP aims are to:
- Prepare for and initiate a formative evaluation of the Buddy*to*Buddy program in the Michigan Army National Guard (MI ARNG).
- Develop and determine the feasibility of a confidential surveys for National Guard veterans in Michigan and Indiana that elicit information regarding B2B processes (in MI ARNG), VA outreach processes, mental health symptoms, substance use, and treatment initiation and retention.
- Construct a de-identified linked dataset consisting of PDHA/PDHRA data, Military Treatment Facility/TRICARE service provider use, and VA service use for MI ARNG and NG soldiers in contiguous states of Indiana and Ohio. Conduct preliminary analyses of these data.
Preliminary work will be completed in two areas. We will begin a formative evaluation of the implementation of the B2B program, using an augmented qualitative RE-AIM Plus framework, multiple data sources and data collection techniques, and conducting field observations and interviews with program stakeholders. Personnel at all levels, including NG leadership, Buddies, and soldiers, will be part of this process.
We will also develop and refine survey items relevant to understanding B2B implementation and soldier symptom and functional status. We will test procedures for fielding this survey in Michigan and a comparison state, assessing response rates, and using data to inform the design of a larger study of soldier outcomes.
This study proposal has been approved by MI ARNG and is currently at the Army Human Research Protection Office for review. Other Human Subjects applications for several Institutional Review Boards (University of Michigan, Michigan State University, and Purdue University) are being completed.
We are reviewing soldier interview transcripts from earlier pilot work to draft and revise our interview topic guideline.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01020981
|United States, Michigan|
|VA Ann Arbor Healthcare System|
|Ann Arbor, Michigan, United States, 48113-0170|
|Principal Investigator:||Marcia T. Valenstein, MD AB||VA Ann Arbor Healthcare System|