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2015 HSR&D/QUERI National Conference Abstract

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1019 — A Pilot Trial of VA-CRAFT: Online Training to Enhance Family Well-Being and Veteran Mental Health Service Use

Erbes CR, Center for Chronic Disease Outcomes Research, Minneapolis VA HCS; Kuhn E, National Center for PTSD, Palo Alto VA HCS; Gifford E, National Center for PTSD, Palo Alto VA HCS; Spoont M, Center for Chronic Disease Outcomes Research, Minneapolis VA HCS; Meis LA, Center for Chronic Disease Outcomes Research, Minneapolis VA HCS; Polusny MA, Center for Chronic Disease Outcomes Research, Minneapolis VA HCS; Oleson H, Center for Chronic Disease Outcomes Research, Minneapolis VA HCS; Taylor B, Center for Chronic Disease Outcomes Research, Minneapolis VA HCS; Hagel-Campbell E, Center for Chronic Disease Outcomes Research, Minneapolis VA HCS; Wright J, Minneapolis VA HCS

Objectives:
VA-CRAFT is an online adaptation of the Community Reinforcement and Family Training (CRAFT) intervention designed to train family members to effectively encourage their loved ones to enroll in care for PTSD or alcohol problems. This pilot project examined VA-CRAFT's effects on Veteran mental health and substance abuse services and family member well-being.

Methods:
Family members of Veterans who served in Iraq or Afghanistan, screened positive for PTSD or alcohol use disorders, and were not engaged in mental health services were randomly assigned to complete the VA-CRAFT online training (n = 34), or a wait-list condition (n = 32), for 90 days. VA administrative data were used to evaluate Veteran service utilization. Family members completed measures of relationship functioning, individual distress, and caregiver burden before and after the 90 day treatment period. Qualitative interviews were completed by 20 family members assigned to VA-CRAFT to evaluate their experiences of the course.

Results:
Family members in the VA-CRAFT group had a significantly greater decrease in reports of caregiver burden on the Caregiver Burden Scale (from M = 1.92 to M = 1.56) than family members in the control group (from M = 1.81 to M = 1.84, interaction p < .0001). Qualitative interviews suggested that while the majority of family members perceived benefit from the course and would recommend it to others, and many felt they understood their Veteran better and how to communicate with them, family members were not actually engaging in conversations with their Veterans about getting into treatment, even when they believed the Veteran needed such care. There was no statistically significant difference between the two groups on Veteran mental health service utilization.

Implications:
VA-CRAFT is a well-received program that shows initial promise in reducing caregiver burden among family members of Veteran not receiving needed services for PTSD and/or alcohol problems. Further enhancements may be needed to aid family in encouraging Veterans to engage in care.

Impacts:
Family members are an important resource for Veterans who are underutilized in healthcare. Results support revision of VA-CRAFT to provide an efficient, far-reaching on-line tool for helping Veterans through family training.