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CDA 13-264 – HSR&D Study

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CDA 13-264
Integration of Peer Support Across the PTSD Continuum of Care
Natalie E Hundt PhD
Michael E. DeBakey VA Medical Center, Houston, TX
Houston, TX
Funding Period: October 2015 - September 2020

BACKGROUND/RATIONALE:
Evidence-based psychotherapies (EBP) for PTSD, such as Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT), are effective, but only a minority of Veterans complete these treatments. Additionally, up to 60% of Veterans continue to meet diagnostic criteria for PTSD after completion, and even those who no longer meet criteria may have remaining psychosocial needs as they rebuild their lives. Peer support programs have the potential to improve patient outcomes by facilitating treatment initiation, engagement, and aftercare. In peer programs, Veterans recovering from PTSD provide emotional support, empathy, and information based upon their own lived experience with PTSD. Guided by social learning theory, peers can model healthy coping behaviors like confronting trauma directly, engaging in therapy, and rebuilding a fulfilling life during the process of recovery. Peer support is well-established for other disorders and is a priority within the VA. It supports treatment initiation, improves functioning and quality of life, reduces utilization of mental health services, and is highly acceptable to Veterans. Despite the recent expansion of peer programs, more research is needed to examine the most effective ways to integrate peers with existing PTSD care to support evidence based treatments.

OBJECTIVE(S):
The goal of this CDA is to refine and pilot test a peer support program for PTSD, with separate components for initiation/engagement of EBP and aftercare.

METHODS:
In Aim 1, through an iterative formative evaluation with stakeholders (Veterans, peer providers, PTSD providers, and national leaders), and based upon the prior needs assessment, we will refine a peer support program that addresses treatment initiation and engagement. In Aim 2, we will conduct an open feasibility pilot for the peer support initiation/ engagement groups to further refine this program, and then test effectiveness in a pilot randomized trial. Primary outcomes will be EBP attitudes, initiation and completion of EBP. These pilot data will support an IIR submission for a Hybrid Type I Effectiveness/Implementation trial in year 3. In Aim 3, we will conduct a formative evaluation to explore stakeholders' opinions of a proposed aftercare peer program for Veterans who complete EBP. In Aim 4, we will pilot feasibility of the peer program as aftercare in two peer support groups and collect qualitative data to guide revisions. Primary outcomes will be functioning and quality of life. In year 5, we will submit an HSR&D Pilot to conduct a pilot randomized trial of peer support as aftercare.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
This research has provided more information about patient and provider related barriers to the full implementation of PE and CPT in the VA.

PUBLICATIONS:

Journal Articles

  1. Hundt NE, Ecker AH, Thompson K, Helm A, Smith TL, Stanley MA, Cully JA. "It didn't fit for me:" A qualitative examination of dropout from prolonged exposure and cognitive processing therapy in veterans. Psychological Services. 2018 Nov 26.
  2. Hundt NE, Smith TL, Fortney JC, Cully JA, Stanley MA. A qualitative study of veterans' mixed emotional reactions to receiving a PTSD diagnosis. Psychological Services. 2018 Jul 30.
  3. Arney J, Thurman K, Jones L, Kiefer L, Hundt NE, Naik AD, Woodard LD. Qualitative findings on building a partnered approach to implementation of a group-based diabetes intervention in VA primary care. BMJ open. 2018 Jan 21; 8(1):e018093.
  4. Hundt NE, Helm A, Smith TL, Lamkin J, Cully JA, Stanley MA. Failure to engage: A qualitative study of veterans who decline evidence-based psychotherapies for PTSD. Psychological Services. 2018 Nov 1; 15(4):536-542.
  5. Hundt NE, Harik JM, Thompson KE, Barrera TL, Miles SR. Increased utilization of prolonged exposure and cognitive processing therapy over time: A case example from a large Veterans Affairs posttraumatic stress disorder clinic. Psychological Services. 2018 Nov 1; 15(4):429-436.
  6. Hundt NE, Harik JM, Barrera TL, Cully JA, Stanley MA. Treatment decision-making for posttraumatic stress disorder: The impact of patient and therapist characteristics. Psychological trauma : theory, research, practice and policy. 2016 Nov 1; 8(6):728-735.
  7. Harik JM, Hundt NE, Bernardy NC, Norman SB, Hamblen JL. Desired Involvement in Treatment Decisions Among Adults with PTSD Symptoms. Journal of traumatic stress. 2016 Jun 1; 29(3):221-8.
Conference Presentations

  1. Hundt NE, Barrera TL, Arney J, Stanley MA. "It's worth it": Veterans' Experiences in Prolonged Exposure and Cognitive Processing Therapy. Poster session presented at: International Society for Traumatic Stress Studies Annual Symposium; 2016 Nov 11; Dallas, TX.
  2. Miles S, Harik JM, Hundt NE, Mignogna J, Pasterek N, Thompson KE. History of traumatic brain injury is associated with increased mental health service use among Veterans with PTSD, depression, and anxiety. Poster session presented at: International Society for Traumatic Stress Studies Annual Symposium; 2015 Nov 6; New Orleans, LA.
  3. Hundt NE, Harik JM, Miles SR, Arney J, Cully J, Stanley MA. Veterans’ Perspectives on Initiating Evidence-based Psychotherapy for PTSD. Poster session presented at: International Society for Traumatic Stress Studies Annual Symposium; 2015 Nov 5; New Orleans, LA.


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