Lead/Presenter: Karen Seal,
All Authors: Seal KH (San Francisco VA Healthcare System, University of California, San Francisco), Pyne JM (Central Arkansas VA Healthcare System, University of Arkansas Medical School), Koenig CK (San Francisco VA Healthcare System) Zamora K (San Francisco VA Healthcare System) Abraham T (Central Arkansas Veterans Healthcare System, University of Arkansas Medical School) Li Y (San Francisco VA Healthcare System) Manuel J (San Francisco VA Healthcare System) Mesidor M (Central Arkansas Veterans Healthcare System) Uddo M (Southeast Louisiana Veterans Healthcare System) Hamilton M (Southeast Louisiana Veterans Healthcare System)
The aim of this pragmatic randomized controlled trial was to determine the effectiveness of telephone motivational coaching delivered by Veteran peers to improve mental health (MH) treatment engagement among rural Veterans with untreated MH symptoms.
We enrolled eligible Veterans who used CBOCs in Northern California and Louisiana and had screened positive for MH symptoms, but were not receiving MH care. Veterans were randomized to receive MH referrals plus up to 4 sessions of telephone motivational coaching by Veteran peers vs. MH referrals alone. Masked telephone assessments were conducted at baseline, 8, 16 and 32 weeks. The primary outcome was engagement in MH treatment at VA or the community; secondary outcomes were change in MH symptoms and quality of life. Adjusted Cox proportional hazard models assessed MH engagement in the two arms. Descriptive statistics described changes in MH symptoms and quality of life.
Among 272 enrolled Veterans, 16% were women; mean age was 51 years (SD +/- 13); 42% were minorities; 87% screened positive for depression, 68% PTSD; 87% anxiety and 24% alcohol use disorder. During follow-up, 46% of controls and 45% in the intervention arm engaged in MH treatment, indicating no significant differences between the two arms [Hazard Ratio:1.09 (95% CI: 0.76-1.57). In contrast, Veterans randomized to peer coaching achieved reductions across all MH symptom and drug use scores, with significant improvements in depression, PTSD and cannabis use scores (all p-values < 0.04). Quality of life scores in psychological health, social relationships and environmental domains also improved significantly (p-values < 0.005). Qualitative data revealed that Veterans receiving peer coaching found it therapeutic and did not perceive a need to engage in MH treatment.
Among rural Veterans with MH problems, telephone peer motivational coaching did not result in enhanced MH treatment engagement, but instead, improved MH symptoms and QOL indicators.
With more Veteran peers being hired to conduct coaching in VA, we must plan for the possibility that rural Veterans may prefer to engage with Veteran peer coaches in lieu of mental health treatment, such that peers will need additional training in MH risk, motivational coaching, referral and warm hand-offs.