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IIR 13-317 – HSR&D Study

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IIR 13-317
Group Motivational Interviewing (GMI) For Homeless Veterans In VA Services
Elizabeth J. Santa Ana PhD MA BA
Ralph H. Johnson VA Medical Center, Charleston, SC
Charleston, SC
Funding Period: February 2015 - December 2019

BACKGROUND/RATIONALE:
There is a significant need for 'wraparound' treatment services in VA housing for addressing SUDs. Homeless Veterans with SUDs are vulnerable to treatment dropout, rendering them susceptible to relapse, while their continuation in outpatient care during their participation in VA housing leads to improved clinical outcomes. According to systematic reviews, individual MI reduces the incidence of SUD, when compared to no treatment, but is labor intensive. As VA moves toward a 'Housing First' paradigm where greater numbers of homeless Veterans will continue to use substances while in VA housing, delivery of GMI (which may be less labor intensive) to these patients will be important for initiating and maintaining their recovery as well as enhancing their psychosocial integration and quality of life. In a prior controlled trial conducted by the PI, GMI resulted in significantly higher outpatient treatment engagement and lower substance use compared to treatment-as-usual among dually diagnosed Veterans.
updated 1/9/2018

OBJECTIVE(S):
Study objectives are consistent with VA housing recommendations focusing on patient recovery, health services promotion, and treatment implementation evaluation. GMI will be compared to a control treatment condition (CT) on (Specific Aim I; Five outcomes: (Primary H1): treatment engagement; (Primary H1): substance use; (Secondary H2): psychosocial integration (e.g., social support, community participation); (Secondary H3) quality of life/psychiatric indices; and (Secondary H4): number of days engaging in structured/productive work activities in the 6-month follow up. Specific Aim II involves a process evaluation for documenting (A) formative (e.g., developmental), (B) process, and (C) summative outcomes; and Specific Aim III involves estimation of cost of intervention in terms of direct costs, indirect costs of staff, costs of capital and workload measures for future implementation and dissemination research.

METHODS:
Randomized controlled trial comparing GMI to CT across five critical outcomes. 186 Veterans in VA housing services (93 per treatment arm) will be enrolled with a diagnosis of alcohol or drug abuse/dependence. Recruitment will take place in Charleston VAMC HUD-VASH & GPD. Participants will be randomly assigned to (1) GMI or (2) CT, each consisting of 4 sessions, will attend a booster session at 2-months, and will be evaluated at 1, 3, and 6 months. Participants with a non-substance related DSM-IV-TR major Axis I disorder (e.g., MDD, PTSD) will be eligible for the study. Analyses will be conducted using generalized linear mixed models (GLMM) approach.

FINDINGS/RESULTS:
None to date. Project is still currently recruiting participants. updated 1/9/2018

IMPACT:
Homeless Veterans with SUDs represent one of the largest and most chronic groups of psychiatric patients treated in the VA Healthcare System. With the ongoing execution of VA's "Plan to End Veteran Homelessness," Veterans entering housing require interventions that can be feasibly implemented with minimal reorganization of existing services. GMI is based on MI, an empirically valid treatment that aligns with Veteran-centered recovery models including Harm Reduction and more traditional treatment philosophies. The investment in GMI for VA housing may be minimal as it requires only a few staff to operate in relatively short time (e.g., 4 sessions, 90-min each) with modest (20 hours) staff training. It can be layered onto existing services with little interruption or reorganization of staff, and it has potential to be offered to larger numbers of Veterans with SUDs in VA housing who would otherwise not receive this intervention. This project impacts Veterans in Myrtle beach and Savannah.

updated 1/9/2018

PUBLICATIONS:

Journal Articles

  1. Jaconis M, Santa Ana EJ, Killeen TK, Badour CL, Back SE. Concurrent treatment of PTSD and alcohol use disorder via telehealth in a female Iraq veteran. The American journal on addictions. 2017 Mar 1; 26(2):112-114.
  2. Santa Ana EJ, LaRowe SD, Armeson K, Lamb KE, Hartwell K. Impact of group motivational interviewing on enhancing treatment engagement for homeless Veterans with nicotine dependence and other substance use disorders: A pilot investigation. The American journal on addictions. 2016 Oct 1; 25(7):533-41.
  3. Gebregziabher M, Voronca D, Teklehaimanot A, Santa Ana EJ. Weibull mixture regression for marginal inference in zero-heavy continuous outcomes. Statistical methods in medical research. 2017 Jun 1; 26(3):1476-1499.
  4. Shorey RC, Martino S, Lamb KE, LaRowe SD, Santa Ana EJ. Change talk and relatedness in group motivational interviewing: a pilot study. Journal of substance abuse treatment. 2015 Apr 1; 51:75-81.
VA Cyberseminars

  1. Santa Ana EJ. Motivational Interviewing for the Case Manager. [Cyberseminar]. 2015 May 1.
Conference Presentations

  1. Santa Ana EJ, LaRowe K, Lamb K, Hartwell K. Impact of group motivational interviewing on enhancing treatment engagement for homeless Veterans with nicotine dependence and other substance use disorders: A pilot investigation. Paper presented at: College on Problems of Drug Dependence Annual Meeting; 2016 Jun 11; Palm Springs, CA.
  2. Santa Ana EJ, Gebregziabher MG. Care coordination telehealth In-Home-Messaging-Devices lower alcohol use in dually diagnosed Veterans. Paper presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 8; Philadelphia, PA.
  3. Santa Ana EJ, LaRowe S, Lamb K, Tompkins M, Hartwell K. Impact of Group Motivational Interviewing on Enhancing Treatment Engagement for Homeless Veterans with Nicotine Dependence and other Substance Use Disorders: A Pilot Investigation. Paper presented at: American Academy of Addiction Psychiatry Annual Meeting; 2014 Dec 4; Aventura, FL.
  4. Santa Ana EJ. A brief telehealth intervention for Veterans with alcohol use disorders in VA Primary care: A pilot investigation. Paper presented at: College on Problems of Drug Dependence Annual Meeting; 2014 Jun 14; San Juan, Puerto Rico.


DRA: Mental, Cognitive and Behavioral Disorders
DRE: Treatment - Efficacy/Effectiveness Clinical Trial
Keywords: Cognitive Therapy, Homeless
MeSH Terms: none