Depression Clinical Trial
Official title:
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.
Background:
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.
Objectives:
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:
1. Prepare for and initiate a formative evaluation of the Buddy*to*Buddy program in the
Michigan Army National Guard (MI ARNG).
2. 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.
3. 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.
Methods:
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.
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Observational Model: Cohort, Time Perspective: Cross-Sectional
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