Veterans Health Research Institute Of Central New York Inc

NEURAL MECHANISMS OF VISUAL CROWDING

OUTCOMES IN CALLERS TO THE VA'S 24/7 VETERANS CRISIS LINE

USING MINDFULNESS-BASED COGNITIVE THERAPY TO MANAGE PAIN AND MITIGATE SUICIDE RISK IN VETERANS - THE PROPOSED STUDY WILL DEVELOP A MINDFULNESS-BASED COGNITIVE THERAPY (MBCT) MANUAL TO ADDRESS BOTH FUNCTIONAL IMPAIRMENT AND SUICIDE RISK (MBCT-S/P). WE WILL EXAMINE THE FEASIBILITY OF THE STUDY DESIGN AND ASK PARTICIPANTS IF THE FOUND THE TREATMENT TO BE ACCEPTABLE. WE EXPECT THIS SMALLER STUDY WILL PROVIDE CRITICAL INFORMATION FOR A LARGER TRIAL. SUICIDE IS THE 10TH LEADING CAUSE OF DEATH. CHRONIC PAIN IS A LEADING CAUSE OF FUNCTIONAL IMPAIRMENT IN THE UNITED STATES AND IS A RISK FACTOR OF SUICIDE EVEN AFTER ACCOUNTING FOR PSYCHIATRIC DISORDERS. VETERANS ARE A VULNERABLE POPULATION FOR BOTH SUICIDE AND CHRONIC PAIN; HOWEVER, THERE IS LITTLE RESEARCH EXAMINING WAYS TO REDUCE FUNCTIONAL IMPAIRMENT AND SUICIDE RISK IN A COMBINED TREATMENT. THEREFORE, THIS PROPOSAL EXAMINES THE USE OF MBCT AS A NOVEL WAY TO SIMULTANEOUSLY ADDRESS FUNCTIONAL IMPAIRMENT AND SUICIDE RISK. RESEARCH ON PATIENTS AT RISK OF SUICIDE AND ON PATIENTS EXPERIENCING CHRONIC PAIN SUPPORTS THE UTILITY OF MBCT SEPARATELY. HOWEVER, THERE IS LIMITED EVIDENCE INVESTIGATING A COMBINED TREATMENT THAT ADDRESSES BOTH FUNCTIONAL IMPAIRMENT AND SUICIDE RISK. APPLICATION OF MBCT ON VETERANS AT RISK FOR SUICIDE WHO ARE EXPERIENCING FUNCTIONALLY-IMPAIRING CHRONIC PAIN PROVIDES A UNIQUE OPPORTUNITY TO SIMULTANEOUSLY ADDRESS THESE INTERACTIVE FACTORS. THE OVERALL GOAL OF THE BROADER PROGRAM IS TO ENHANCE FUNCTIONING AND TO REDUCE VETERAN SUICIDE, AND THE PROPOSED PROJECT WILL PROVIDE DATA TO GUIDE THE DEVELOPMENT OF A LARGER TRIAL. THE OBJECTIVES OF THE CURRENT PROPOSAL ARE TO (1) COMBINE EXISTING MBCT INTERVENTION PROTOCOLS TO DEVELOP AN MBCT MANUAL AIMED AT ADDRESSING THE UNIQUE NEEDS OF VETERANS EXPERIENCING FUNCTIONAL IMPAIRMENT FROM CHRONIC PAIN WHO ARE AT RISK FOR SUICIDE, (2) EXAMINE IF THE RECRUITMENT, RETENTION, AND TREATMENT DELIVERY IS FEASIBLE AND IF MBCT-S/P ACCEPTABLE TO PARTICIPANTS, AND (3) ASSESS PARAMETERS OF KEY OUTCOMES AMONG PARTICIPANTS RANDOMIZED TO RECEIVE MBCT-S/P VERSUS AN EDUCATION CONTROL TO INFORM A SUBSEQUENT LARGER CLINICAL TRIAL. TO ACHIEVE THESE OBJECTIVES, WE WILL DEVELOP A MANUAL THROUGH AN EVIDENCE-BASED, ITERATIVE PROCESS THEN CONDUCT A RANDOMIZED CLINICAL TRIAL IN VETERANS WITH CHRONIC PAIN REPORTING SUICIDAL IDEATION. WE WILL RANDOMIZE A TOTAL OF 76 PARTICIPANTS TO RECEIVE EITHER MBCT-S/P OR EDUCATION. WE WILL ASSESS PAIN AND SUICIDE RISK OUTCOMES SUCH AS SUICIDAL IDEATION, DEPRESSION, AND INTERPERSONAL FACTORS AT BASELINE AND AFTER THE TREATMENT PERIOD. WE WILL ALSO TRACK PARTICIPANT FLOW, THERAPIST ADHERENCE TO THE MANUAL, PARTICIPANT HOMEWORK COMPLETION AND PARTICIPANT SATISFACTION WITH THE TREATMENT.

PRIMARY CARE BASED MINDFULNESS TRAINING FOR VETERANS WITH PTSD

IMPROVING FIDELITY OF PATIENT-CENTERED SUICIDE PREVENTION CARE IN PRIMARY CARE - THIS R34 APPLICATION AIMS TO ADAPT AND CONDUCT PILOT WORK ON THE LEARNING THROUGH INTERACTIVE FEEDBACK AND TRAINING-SUICIDE PREVENTION (LIFT-UP) EDUCATIONAL PROGRAM AS A STRATEGY TO ENHANCE CURRENT IMPLEMENTATION STRATEGIES. WHILE THERE ARE MANY STRATEGIES DESIGNED TO ASSIST PROVIDERS IN SUICIDE PREVENTION, THEY OFTEN FOCUS HEAVILY ON SUPPORTING PROVIDER’S DELIVERY OF CONTENT, SUCH AS LETHAL MEANS (LM) SAFETY, AND IGNORE DEVELOPING PROVIDER’S SKILL FOR HOW TO ASK IN A PATIENT-CENTERED MANNER. IMPROVING THE SKILL BY WHICH PROVIDERS HAVE LM CONVERSATIONS SHOULD IN TURN INCREASE PATIENT’S WILLINGNESS TO DECREASE ACCESS TO LM AND INCREASE FUTURE DISCLOSURE. LIFT-UP, WAS DEVELOPED TO SUPPORT PROVIDER’S BROAD SUICIDE PREVENTION SKILL DEVELOPMENT THROUGH THE UTILIZATION OF AN ALGORITHMIC ASSESSMENT TOOL THAT RATES PROVIDER’S SKILL DURING A VIRTUAL SIMULATION WITH AN ACTOR FOLLOWED BY THE PROVISION OF STRUCTURED CONSTRUCTIVE VERBAL FEEDBACK. UTILIZING RECENT RESEARCH ON PATIENT PERSPECTIVES ON LM COMMUNICATION AND THE THEORY OF PLANNED BEHAVIOR+RISK PERCEPTION, WE AIM TO FURTHER ADAPT LIFT-UP BY: 1) INCORPORATING COMPONENTS ATTENDING TO PATIENT-CENTERED LM COMMUNICATION THROUGH THE ALTERATION OF THE ASSESSMENT TOOL AND 2) ADDRESSING PROVIDER MOTIVATION BY ADDING WRITTEN EXPERT FEEDBACK THAT SHARES BEHAVIORAL STRATEGIES TO IMPROVE, NORMATIVE INFORMATION, AND PATIENT OUTCOME AWARENESS. THEREFORE, AIM 1’S OBJECTIVE IS TO CONTINUE TO REFINE AND OPTIMIZE THE LIFT- UP ASSESSMENT TOOL AND FEEDBACK THROUGH OBTAINING PERSPECTIVES FROM: 1A) 32 DIVERSE PATIENTS (I.E., FIREARM OWNERS, PATIENTS WITH A HISTORY OF INTIMATE PARTNER VIOLENCE, PATIENTS WHO USE OPIATES) ON FACE AND CONCURRENT VALIDITY OF HIGH VS. TOTAL SCORES AND SPECIFIC LM DIMENSIONS USING RECORDED SIMULATIONS AND 1B) 12 HEALTHCARE PROVIDERS ON THE ACCEPTABILITY, APPROPRIATENESS, INFORMATIVENESS, AND ABILITY TO MOTIVATE CHANGE OF THE VERBAL AND WRITTEN FEEDBACK. AFTER USING THE INFORMATION IN AIM 2 TO MAKE REFINEMENTS TO LIFT-UP (1C), AIM 2 INVOLVES A PILOT RANDOMIZED CONTROL TRIAL (WITH CROSSOVER) WHERE 50 PRIMARY CARE STAFF WILL BE ASSIGNED TO ONE OF TWO CONDITIONS 1) USUAL CARE (UC) OR 2) UC PLUS LIFT-UP. WE HYPOTHESIZE THAT THE PILOT CLINICAL TRIAL WILL RESULT IN PROVIDERS RATING LIFT-UP WITH HIGH LEVELS OF APPROPRIATENESS AND ACCEPTABILITY AND THAT THEY WILL DEMONSTRATE INCREASED FIDELITY TO PATIENT- CENTERED LM SKILLS, BE WILLING TO PARTICIPATE IN ADDITIONAL LM TRAININGS, AND REPORT HIGHER ADOPTION OF LM SKILLS THAN THOSE WHO ENGAGE IN UC ALONE. RESULTS WILL INFORM FUTURE WORK TOWARDS A LARGE CLUSTER RANDOMIZED CLINICAL TRIAL EXAMINING THE PREDICTIVE VALIDITY OF LIFT-UP’S ASSESSMENT TOOL AND THE EFFECTIVENESS OF LIFT-UP IN ENHANCING IMPLEMENTATION EFFORTS.

A BRIEF, INTEGRATED INTERVENTION FOR WOMEN VETERANS WITH UNHEALTHY ALCOHOL USE IN PRIMARY CARE - UNHEALTHY ALCOHOL USE IS INCREASINGLY PREVALENT AMONG WOMEN, AND WOMEN VETERANS IN PARTICULAR, AND IS ASSOCIATED WITH EXTENSIVE FUNCTIONAL IMPAIRMENT, ESPECIALLY WHEN IT CO-OCCURS WITH PSYCHIATRIC SYMPTOMS (E.G., INSOMNIA). PSYCHOSOCIAL FUNCTIONING CAN IMPROVE INDEPENDENTLY OF ALCOHOL USE, BUT MUCH ALCOHOL TREATMENT RESEARCH EVALUATES PRIMARILY ALCOHOL USE. WOMEN HAVE BEEN LESS INVOLVED IN ALCOHOL TREATMENT RESEARCH, WHICH IS HARMFUL BECAUSE OF KNOWN DIFFERENCES AMONG MEN AND WOMEN RELATED TO ALCOHOL USE, INCLUDING GREATER RISK OF SOME ALCOHOL-RELATED MEDICAL CONDITIONS, MORE COMORBID PSYCHIATRIC SYMPTOMS, AND MORE ALCOHOL-RELATED STIGMA AMONG WOMEN THAN MEN. WOMEN ARE MORE LIKELY THAN MEN TO EXPERIENCE “TELESCOPING,” A PATTERN OF RAPID PROGRESSION FROM INITIATION TO PROBLEMATIC USE THAT NARROWS THE WINDOW FOR INTERVENTION. INTEGRATED PRIMARY CARE (IPC) MAY NARROW THE TREATMENT GAP FOR WOMEN VETERANS. DEVELOPING BRIEF INTERVENTIONS IN IPC IS AN ESTABLISHED AND EFFECTIVE PRACTICE FOR OTHER PSYCHIATRIC SYMPTOMS (E.G., PTSD, INSOMNIA), YET WE DO NOT KNOW OF A COMPARABLE INTERVENTION FOR UNHEALTHY ALCOHOL USE AMONG WOMEN VETERANS. THIS PROPOSAL AIMS TO COMBINE EFFECTIVE ELEMENTS OF INTERVENTIONS FOR ALCOHOL AND COMORBID PSYCHIATRIC SYMPTOMS INTO A SINGLE, BRIEF INTERVENTION IN IPC AND EVALUATE THE INTERVENTION WITH RESPECT TO PSYCHOSOCIAL FUNCTIONING. DR. KATHERINE BUCKHEIT IS A CLINICAL PSYCHOLOGIST AT THE VETERANS AFFAIRS (VA) CENTER FOR INTEGRATED HEALTHCARE (CIH), A VA MENTAL HEALTH CENTER OF EXCELLENCE FOCUSED ON IMPROVING HEALTHCARE BY INCORPORATING MENTAL HEALTH TREATMENT INTO MEDICAL SETTINGS. THIS K01 MENTORED RESEARCH SCIENTIST AWARD WILL ENABLE DR. BUCKHEIT’S TRANSITION TO AN INDEPENDENT INVESTIGATOR WITH A LONG-TERM GOAL OF IMPROVING ALCOHOL TREATMENT BY DESIGNING, EVALUATING, AND IMPLEMENTING BRIEF INTERVENTIONS IN MEDICAL SETTINGS. HER SHORT-TERM GOAL AND SPECIFIC FOCUS OF THIS K01 IS TO OBTAIN EXPERT MENTORSHIP AND FORMAL TRAINING AND CONDUCT A SERIES OF RESEARCH PROJECTS TO DEVELOP AND EVALUATE A BRIEF INTERVENTION FOR WOMEN VETERANS WITH UNHEALTHY ALCOHOL USE IN IPC. THIS K01 WILL PROVIDE DR. BUCKHEIT WITH TRAINING IN KEY AREAS: 1) DESIGNING AND EVALUATING BRIEF INTERVENTIONS IN IPC, 2) EVIDENCE-BASED ALCOHOL TREATMENT IN IPC AND SPECIALTY CARE, 3) INTERVENTION DEVELOPMENT AMONG GROUPS WITH UNMET HEALTHCARE NEEDS, AND 4) MIXED-METHODS AND ADVANCED LONGITUDINAL STATISTICAL ANALYSES. SPECIFIC AIMS ARE: 1) COMBINE ELEMENTS OF EVIDENCE-BASED INTERVENTIONS FOR ALCOHOL USE AND CO-OCCURRING SYMPTOMS INTO A SINGLE BRIEF (≤ 6, 30-MINUTE SESSIONS) INTERVENTION THAT INCLUDES CONTENT FOR WOMEN VETERANS. WE WILL ENGAGE SUBJECT MATTER EXPERTS (IPC, SUBSTANCE USE, WOMEN’S HEALTH) TO SOLICIT FEEDBACK AND REFINE THE INTERVENTION. 2) CONDUCT AN OPEN TRIAL (N=10) TO GATHER PATIENT FEEDBACK AND FINALIZE THE INTERVENTION. 3) CONDUCT A PILOT RANDOMIZED CONTROLLED TRIAL (RCT; N=60) TO EVALUATE RESEARCH AND CLINICAL FEASIBILITY, ACCEPTABILITY, AND PRELIMINARY EFFECTIVENESS IN IMPROVING QUALITY OF LIFE, ALCOHOL PROBLEMS, AND ALCOHOL-RELATED FUNCTIONAL IMPAIRMENT COMPARED TO PRIMARY CARE USUAL CARE. RESULTS WILL INFORM AN R01 APPLICATION TO BE SUBMITTED BY THE END OF YEAR 4.