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CDA 17-006 – HSR&D Study

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CDA 17-006
Increasing mental health services use through enabling resources & family support
Megan Shepherd-Banigan PhD MPH
Durham, NC
Funding Period: April 2019 - March 2024


Megan Shepherd-Banigan, Ph.D., obtained her doctorate in Health Services Research from the University of Washington in 2014 and her M.P.H from the University of Miami in 2006. From July 2015-November 2017, Dr. Shepherd-Banigan was a post-doctoral research fellow at the Durham VA Health Services Research & Development (HSR&D) Center of Innovation (COIN) and is now a VA Health Research Scientist in the COIN. Her long-term professional goal is to grow her career as an independent VA health services researcher who applies a diverse array of methods to evaluate and improve the effectiveness of mental health and family service delivery systems. The short-term objective of this application is to describe and strengthen Veteran and family determinants of mental health service utilization. The proposed CDA research seeks to address scientific gaps related to the low use of psychotherapy among Veterans with PTSD: Aim 1a— Identify Veteran and family determinants that predict initiation and completion of psycho-therapy for PTSD; Aim 1b— Explore mechanisms linking enabling resources, [treatment preparedness], and initiation and completion of PTSD psychotherapy; Aim 2— Refine and test the feasibility of a family-involved treatment preparedness intervention to increase initiation and completion of EBP psychotherapy for PTSD; Aim 3— Analyze whether use of VA supportive services predicts initiation and completion of PTSD psychotherapy by strengthening economic enabling resources. This application is highly innovative and will advance clinical practice by contributing evidence about 1) the role of complex Veteran and family risk factors that inhibit PTSD treatment use and 2) promising, strategies to strengthen these factors, including a family-involved treatment preparedness intervention and VA education and vocational rehabilitation services to increase uptake of PTSD evidenced-based practices (EBPs).21 This project is consistent with VA priorities, such as increased access to care and uptake of EBPs. The research proposed in Aim 1 will employ novel machine learning causal forest methods93 to Caregiver Support Program survey data and VA administrative data to identify Veteran and family predisposing, enabling, and need factors and elucidate how enabling resources (i.e. perceived financial strain, income, education level, family strain) moderate the association between need for treatment and use/completion of psychotherapy. Subsequent qualitative interviews with Veterans and family members will seek to identify the underlying mechanisms between Veteran/family determinants and service use. The goal of Aim 2 is to refine and test the feasibility and acceptability of an existing family engagement strategy74 using a successive cohort design (SCD) among Veterans who were referred to EBP psychotherapy for PTSD. For Aim 3, VHSC, Veteran Benefits Administration, and Caregiver Support Program data will be combined to examine the effect of VA supportive service use on time to use/completion of psychotherapy treatment using Cox proportional hazard models; sequential stratified matching will be applied to minimize baseline differences between treatment groups. By the end of the 3rd year of CDA funding, a merit award application will be submitted to fund a randomized trial of the Aim 2 intervention. To complete the proposed research, the applicant requires additional skills and content expertise in four areas: [1) intervention and implementation science; 2) advanced methods in qualitative and quantitative research; 3) mental health clinical research and context; and 4) professional development and networking.] Specific topics and activities will include courses in machine learning and qualitative research; workshops about randomized clinical trials and implementation methods; clinical shadowing; and academic conferences and workshops.

NIH Reporter Project Information:


Journal Articles

  1. Curry JF, Shepherd-Banigan M, Van Voorhees E, Wagner HR, Kelley ML, Strauss J, Naylor J, Veterans Affairs Mid-Atlantic MIRECC Women Veterans Work Group , Veterans Affairs Mid-Atlantic MIRECC Work Group. Sex differences in predictors of recurrent major depression among current-era military veterans. Psychological Services. 2019 Nov 21.
  2. Shepherd-Banigan M, Sperber N, McKenna K, Pogoda TK, Van Houtven CH. Leveraging institutional support for family caregivers to meet the health and vocational needs of persons with disabilities. Nursing Outlook. 2019 Sep 27.
  3. Shepherd-Banigan M, Kaufman BG, Decosimo K, Dadolf J, Boucher NA, Mahanna EP, Bruening R, Sullivan C, Wang V, Hastings SN, Allen KD, Sperber N, Coffman CJ, Van Houtven CH. Adaptation and Implementation of a Family Caregiver Skills Training Program: From Single Site RCT to Multisite Pragmatic Intervention. Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing. 2019 Sep 9.
  4. Van Houtven CH, Smith VA, Lindquist JH, Chapman JG, Hendrix C, Hastings SN, Oddone EZ, King HA, Shepherd-Banigan M, Weinberger M. Family Caregiver Skills Training to Improve Experiences of Care: a Randomized Clinical Trial. Journal of general internal medicine. 2019 Oct 1; 34(10):2114-2122.
  5. Sperber NR, Boucher NA, Delgado R, Shepherd-Banigan ME, McKenna K, Moore M, Barrett R, Kabat M, Van Houtven CH. Including Family Caregivers In Seriously Ill Veterans' Care: A Mixed-Methods Study. Health affairs (Project Hope). 2019 Jun 1; 38(6):957-963.
  6. Smith VA, Lindquist J, Miller KEM, Shepherd-Banigan M, Olsen M, Campbell-Kotler M, Henius J, Kabat M, Van Houtven CH. Comprehensive Family Caregiver Support and Caregiver Well-Being: Preliminary Evidence From a Pre-post-survey Study With a Non-equivalent Control Group. Frontiers in public health. 2019 May 22; 7:122.
  7. Hughes JM, Freiermuth CE, Shepherd-Banigan M, Ragsdale L, Eucker SA, Goldstein K, Hastings SN, Rodriguez RL, Fulton J, Ramos K, Tabriz AA, Gordon AM, Gierisch JM, Kosinski A, Williams JW. Emergency Department Interventions for Older Adults: A Systematic Review. Journal of the American Geriatrics Society. 2019 Jul 1; 67(7):1516-1525.
  8. Miller KEM, Lindquist JH, Olsen MK, Smith V, Voils CI, Oddone EZ, Sperber NR, Shepherd-Banigan M, Wieland GD, Henius J, Kabat M, Van Houtven CH. Invisible partners in care: Snapshot of well-being among caregivers receiving comprehensive support from Veterans Affairs. Health science reports. 2019 Mar 1; 2(3):e112.
  9. Bruening R, Sperber N, Miller K, Andrews S, Steinhauser K, Wieland GD, Lindquist J, Shepherd-Banigan M, Ramos K, Henius J, Kabat M, Van Houtven C. Connecting Caregivers to Support: Lessons Learned From the VA Caregiver Support Program. Journal of applied gerontology : the official journal of the Southern Gerontological Society. 2019 Jan 18; 733464818825050.
  10. Shepherd-Banigan M, Smith VA, Maciejewski ML, Stechuchak KM, Hastings SN, Wieland GD, Miller KEM, Kabat M, Henius J, Campbell-Kotler M, Van Houtven CH. The Effect of Support and Training for Family Members on Access to Outpatient Services for Veterans with Posttraumatic Stress Disorder (PTSD). Administration and policy in mental health. 2018 Jul 1; 45(4):550-564.
  11. Maciejewski ML, Shepherd-Banigan M, Raffa SD, Weidenbacher HJ. Systematic Review of Behavioral Weight Management Program MOVE! for Veterans. American journal of preventive medicine. 2018 May 1; 54(5):704-714.
  12. Van Houtven CH, Smith VA, Stechuchak KM, Shepherd-Banigan M, Hastings SN, Maciejewski ML, Wieland GD, Olsen MK, Miller KEM, Kabat M, Henius J, Campbell-Kotler M, Oddone EZ. Comprehensive Support for Family Caregivers: Impact on Veteran Health Care Utilization and Costs. Medical care research and review : MCRR. 2019 Feb 1; 76(1):89-114.

  1. Hughes JM, Freiermuth CE, Williams JW, Ragsdale L, Eucker S, Goldstein K, Rodriguez R, Fulton J, Hastings SN, Shepherd-Banigan M, Ramos K, Tabriz AA, Gordon AM, Gierisch JM, Kosinski A, McDuffie J, Van Noord M. Emergency Department Interventions for Older Adults. VA Evidence-based Synthesis Program Reports. Washington (DC): Department of Veterans Affairs (US); 2018 Jun 1.
Government Briefings

  1. Van Houtven CH, Sperber NR, Shepherd-Banigan M, Decosimo KP. Function QUERI and iHI-Fives: Briefing before the VA Deputy Chief Patient Care Services Officer for Care Management and Social Work (Lisa Pape, LISW); Acting Director of Caregiver Support Program (Jennifer Perez, LICSW); 2019 Oct 23; Washington, DC.

DRA: None at this time.
DRE: None at this time.
Keywords: None at this time.
MeSH Terms: None at this time.

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