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2023 HSR&D/QUERI National Conference Abstract

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1188 — Adapting a family-involved intervention to increase initiation and completion of evidenced-based psychotherapy for posttraumatic stress disorder

Lead/Presenter: Megan Shepherd-Banigan,  COIN - Durham
All Authors: Shepherd-Banigan M (Durham VA Health Care System, Duke University Department of Population Health Sciences, Duke-Margolis Center for Health Policy), Wells SY (Durham VA Health Care System) Falkovic M (Durham VA Health Care System, Duke University Department of Population Health Sciences) Ackland PE (Center for Care Delivery and Outcomes Research - Minneapolis VA Health Care System, Department of Medicine - University of Minnesota) Swinkels C (Durham VA Health Care System) Dedert E (Durham VA Health Care System, Department of Psychiatry & Behavioral Sciences - Duke University School of Medicine) Ruffin R (Durham VA Health Care System) Van Houtven CH (Durham VA Health Care System, Duke University Population of Health Sciences, Duke-Margolis Center for Health Policy) Calhoun PS (Durham VA Health Care System, Department of Psychiatry & Behavioral Sciences- Duke University School of Medicine) Edelman D (Durham VA Health Care System, Division of General Internal Medicine, Department of Medicine- Duke University School of Medicine) Weidenbacher HJ (Durham VA Health Care System) Shapiro A (Durham VA Health Care System) Glynn S (Semel Institute of Neuroscience and Human Behavior- Greater LA VA Health Care System/UCLA)

We present the adaptation of Recovery-Oriented Decisions for Relatives’ Support (REORDER)—a family-based intervention for individuals with serious mental illness— to create Family Support in Mental Health Recovery (FAMILIAR), an intervention that seeks to strengthen family members’ abilities to help Veterans engage in posttraumatic stress disorder (PTSD) therapy.

We applied planned modifications to REORDER to meet needs of Veterans with PTSD and their family members. We used domains from the Framework for Adaptations and Modification (FRAME) to systematically track and describe modifications. Adaptations were informed by a series of discussions with Veterans, family members, clinicians, and VA system leaders. Then, a multi-disciplinary intervention development team met to determine which adaptations would be applied and how. Resulting adaptations made to REORDER included changes in content, structure, and delivery format.

The resulting intervention, FAMILIAR, was 3-4 sessions and applied shared-decision making and motivational interviewing to build knowledge about PTSD, treatment options and treatment expectations, and increase engagement among Veterans and family members. The first session was delivered prior to the start of PTSD evidenced-based program (EBB) therapy and sessions continued through EBP visits 3, 4, or 5. Sessions were designed for maximum flexibility and could be offered in-person or virtually. Sessions involved interactions between the interventionist with the Veteran and family member alone and together.

While feasibility and effectiveness testing is needed, we applied a proactive adaptation approach grounded in diverse stakeholder perspectives. We anticipate this approach will enhance FAMILIAR’s success in addressing patient, clinical, and system considerations of a family approach to increase Veteran engagement in PTSD treatment.

FAMILIAR is a brief intervention for Veterans who want to work with their family member to engage in EBPs, but who do not necessarily wish family members to participate in EBP sessions. Therefore, FAMILIAR is a tool mental health clinicians might use to augment EBP engagement and Veteran treatment outcomes through family support. FAMILIAR is also consistent with newly implemented VHA policies to engage family members to improve mental health outcomes for Veterans and could support VHA efforts to increase Veteran uptake of EBPs for PTSD.