Shepherd-Banigan Megan, Wells Stephanie Y, Falkovic Margaret, Ackland Princess E, Swinkels Cindy, Dedert Eric, Ruffin Rachel, Van Houtven Courtney H, Calhoun Patrick S, Edelman David, Weidenbacher Hollis J, Shapiro Abigail, Glynn Shirley
Durham VA Health Care System, 508 Fulton Street Durham, NC, 27705, USA.
Duke University, Department of Population Health Sciences, 215 Morris Street, Durham, NC, 27701, USA.
SSM Ment Health. 2022 Dec;2. doi: 10.1016/j.ssmmh.2022.100114. Epub 2022 May 18.
Posttraumatic stress disorder (PTSD) is disabling condition among United States Veterans. Training programs for evidenced-based therapies have been rolled out nationally in the Veterans Health Administration (VHA), but provider adoption of these treatments is limited and rates of Veteran dropout are high. Increasing support for mental health therapy within the Veteran's social network would improve treatment engagement. We discuss 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 support partners' abilities to help Veterans engage in therapy. Our goal was to apply modifications to meet the needs of Veterans with PTSD and their support partners. We used input from Veterans, support partners, clinicians and VA system leaders to inform the modifications. Then, a multi-disciplinary intervention development team met to determine which modifications would be applied and how. We used the domains from the Framework for Adaptations and Modification (FRAME) to systematically track and describe modifications. Adaptations made to REORDER included changes in content, structure, and delivery format. The resulting intervention, FAMILIAR, was a 3-4 session intervention beginning prior to EBP initiation and continuing through sessions 3, 4 or 5 of the EBP. Sessions were designed for maximum flexibility and could be offered either in-person or virtually, and sessions involve interactions between the interventionist with the Veteran and support partner alone and together. We learned the importance of including diverse stakeholder perspectives to develop a comprehensive understanding of the needs of the target population and the health system. While feasibility and effectiveness testing is needed, we applied a proactive adaptation approach that we anticipate will make FAMILIAR successful in addressing patient, clinical, and system considerations of a family approach to increase Veteran engagement in PTSD treatment.
创伤后应激障碍（PTSD）在美国退伍军人中是一种致残性疾病。基于循证疗法的培训项目已在退伍军人健康管理局（VHA）全国范围内推出，但医疗服务提供者对这些治疗方法的采用有限，退伍军人退出治疗的比例很高。增加退伍军人社交网络中对心理健康治疗的支持将提高治疗参与度。我们讨论了为亲属支持制定的以康复为导向的决策（REORDER）——一种针对严重精神疾病患者的家庭干预措施——的改编，以创建心理健康康复中的家庭支持（FAMILIAR），这是一种旨在增强支持伙伴帮助退伍军人参与治疗能力的干预措施。我们的目标是进行修改以满足患有创伤后应激障碍的退伍军人及其支持伙伴的需求。我们利用退伍军人、支持伙伴、临床医生和退伍军人事务部系统负责人的意见来指导修改。然后，一个多学科干预开发团队开会确定将应用哪些修改以及如何应用。我们使用改编和修改框架（FRAME）中的领域来系统地跟踪和描述修改。对REORDER所做的改编包括内容、结构和交付形式的改变。由此产生的干预措施FAMILIAR是一个为期3至4节的干预项目，在循证疗法开始之前启动，并持续到循证疗法的第3、4或5节。课程设计具有最大的灵活性，可以面对面或通过虚拟方式提供，课程包括干预者与退伍军人以及支持伙伴单独和一起的互动。我们了解到纳入不同利益相关者观点对于全面理解目标人群和卫生系统需求的重要性。虽然需要进行可行性和有效性测试，但我们采用了一种积极的改编方法，预计这将使FAMILIAR在解决以家庭为方法的患者、临床和系统考虑因素方面取得成功，以提高退伍军人参与创伤后应激障碍治疗的程度。
