Group Motivational Interviewing (GMI) For Homeless Veterans In VA Services
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 185
- 试验地点
- 2
- 主要终点
- Standard Ethanol Content Units (SECs) at 1 Month
研究概览
简要总结
Homeless Veterans with substance use disorders (SUDs) are a major group served by VA and are heavily represented in VA housing. VA recently adopted a 'Housing First' approach emphasizing rapid housing placement to initiate recovery without requiring sobriety and will necessitate SUD interventions that are efficient and easily layered onto existing services. The proposed study will investigate the effectiveness, implementation process, and cost estimate of Group Motivational Interviewing (GMI) for Veterans with SUDs in VA housing (Housing Urban Development-VA Support Housing [HUD-VASH] and Grant and per Diem [GPD]). Outcomes will be assessed at multiple time points using a multi-modal approach. The ultimate goal of this research is to establish the basis of a GMI dissemination and implementation course of action for highly vulnerable homeless Veterans in VA housing for achieving their greatest success in attaining housing stability.
详细描述
Anticipated Impacts on Veterans Health Care:
VA set an ambitious goal for ending homelessness among Veterans by 2015. Housing Urban Development-VA Support Housing [HUD-VASH] and Grant and per Diem [GPD] are two primary VA housing programs to help Veterans exit homelessness. Substance abuse among Veterans in VA housing is a major risk factor for worsening psychopathology and housing instability. Despite recent adoption of a Housing First approach, many VA housing programs lack the staff infrastructure to manage substance use disorders (SUDs). This is a significant problem as 60% (conservative estimate) of Veterans in VA housing have SUDs and these Veterans show greater psychopathology compared to their counterparts without SUDs. These issues warrant substantial need for SUD programs in VA housing that are efficient to deploy, easily layered onto existing services, and require minimal staff to operate. The current study addresses this current void in VA treatment services in that it investigates the effectiveness, implementation process, and cost estimate of treatment of an adaptation of motivational interviewing, an empirically supported intervention with strong impact on reducing substance use and enhancing treatment engagement, in a group format, referred to as Group Motivational Interviewing (GMI) for Veterans with SUDs in VA housing. Data from this project, if shown to be promising, will establish the basis of a GMI dissemination and implementation course of action for highly vulnerable homeless Veterans in VA housing for achieving their greatest success in attaining housing stability.
Background:
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 motivational interviewing reduces the incidence of substance use disorders, 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 Principal Investigator, GMI resulted in significantly higher outpatient treatment engagement and lower substance use compared to treatment-as-usual among dually diagnosed Veterans.
Objectives:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Factorial
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 75 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Men and women Veterans currently in Housing Urban Development-VA Support Housing [HUD-VASH] and Grant and per Diem [GPD]), newly entering the program but not yet housed, or Veterans on the HUD-VASH interest (wait) list.
- •Able to comprehend English.
- •Meets DSM-V criteria for a current substance use disorder and have used substances in the 30 days prior to treatment entry. Participants on medications targeting their substance use must be stabilized on medications for at least 2 weeks before therapy initiation.
- •May meet criteria a mood, anxiety or other psychiatric disorder. Participants on maintenance medications for a mood or anxiety disorder must be stabilized on medications for at least 2 weeks before therapy initiation.
- •Able to adequately provide informed consent and function at an intellectual level sufficient to allow accurate completion of all assessment instruments.
- •Willing to commit to 4 group therapy sessions, baseline, 1, 3, and 6 month follow-up assessments.
排除标准
- •Active suicidal or homicidal ideation with a plan as this is likely to require hospitalization or other interventions that could interfere with study participation.
- •Unstable psychiatric condition that is likely to require hospitalization or other interventions that would interfere with study participation.
- •Unstable medical condition or one that may require hospitalization during the course of the study.
结局指标
主要结局
Standard Ethanol Content Units (SECs) at 1 Month
时间窗: 1 month
The 1-month follow-up was conducted 30 days after day 1 of the treatment group. The Timeline Follow-Back (TLFB) calendar was used to assess retrospective self-report of alcohol in the 30 days prior to 1-month follow-up. Amount of alcohol consumption was converted to standard ethanol content units (SECs; or standard drinks) equivalent to 0.5 oz. of ethanol. This measure represents ALL standard drinks consumed within the stated time period.
Standard Ethanol Content Units (SECs) at 3 Months
时间窗: 3 months
The 3-month follow-up was conducted 60 days after the 1-month follow-up. The Timeline Follow-Back (TLFB) calendar was used to assess retrospective self-report of alcohol in the 60 days prior to 3-month follow-up. Amount of alcohol consumption was converted to standard ethanol content units (SECs; or standard drinks) equivalent to 0.5 oz. of ethanol. This measure represents ALL standard drinks consumed within the stated time period.
Peak SEC at 1 Month
时间窗: 1 month
The 1-month follow-up was conducted 30 days after day 1 of the treatment group. The Timeline Follow-Back (TLFB) calendar was used to assess retrospective self-report of alcohol in the 30 days prior to 1-month follow-up. Amount of alcohol consumption was converted to standard ethanol content units (SECs; or standard drinks) equivalent to 0.5 oz. of ethanol. This measure represents the most standard drinks consumed on a single day within the stated time period.
Standard Ethanol Content Units (SECs) Baseline
时间窗: 30 days prior to Baseline
The Timeline Follow-Back (TLFB) calendar was used to assess retrospective self-report of alcohol in the 30 days prior to baseline. Amount of alcohol consumption was converted to standard ethanol content units (SECs; or standard drinks) equivalent to 0.5 oz. of ethanol. This measure represents ALL standard drinks consumed within the stated time period.
Substance Use Disorder Treatment Sessions at Baseline
时间窗: 30 days prior to Baseline
A Treatment Attendance Calendar was used to record the number of objective treatment sessions documented in each participants VA Computerized Patient Record System for the 30 days prior to Baseline. Treatment sessions included the outpatient substance use disorder treatment group sessions and individual sessions.
Twelve-Step Sessions Attended at 3 Months
时间窗: 3 months
A Treatment Attendance Calendar was used to record the number of self-reported 12-step sessions attended 60 days prior to 3-month follow-up.
Times Involved in Community Participation Activities at 6 Months
时间窗: 6 months
A calendar was used to record the number of times a participant participated in an activity in the community (e.g. museum, library, baseball game) in the 90 days prior to 6-month follow-up.
Peak SEC at 3 Months
时间窗: 3 months
The 3-month follow-up was conducted 60 days after the 1-month follow-up. The Timeline Follow-Back (TLFB) calendar was used to assess retrospective self-report of alcohol in the 60 days prior to 3-month follow-up. Amount of alcohol consumption was converted to standard ethanol content units (SECs; or standard drinks) equivalent to 0.5 oz. of ethanol. This measure represents the most standard drinks consumed on a single day within the stated time period.
Peak SEC at 6 Months
时间窗: 6 months
The 6-month follow-up was conducted 90 days after the 3-month follow-up. The Timeline Follow-Back (TLFB) calendar was used to assess retrospective self-report of alcohol in the 90 days prior to 6-month follow-up. Amount of alcohol consumption was converted to standard ethanol content units (SECs; or standard drinks) equivalent to 0.5 oz. of ethanol. This measure represents the most standard drinks consumed on a single day within the stated time period.
Illicit Drug Use Days at 6 Months
时间窗: 6 months
The Timeline Follow-Back (TLFB) calendar was used to assess retrospective self-report of alcohol in the 90 days prior to 6-month follow-up. This measure represents the number of illicit drug use days within the stated time period.
Twelve-Step Sessions Attended at Baseline
时间窗: 30 days prior to Baseline
A Treatment Attendance Calendar was used to record the number of self-reported 12-step sessions attended 30 days prior to Baseline.
Days Involved in Productive Work Activities at 6 Months
时间窗: 6 months
A calendar was used to record the number of times a participant participated in a productive work activity (e.g. volunteered or worked at a job) in the 90 days prior to 6-month follow-up.
Standard Ethanol Content Units (SECs) at 6 Months
时间窗: 6 months
The 6-month follow-up was conducted 90 days after the 3-month follow-up. The Timeline Follow-Back (TLFB) calendar was used to assess retrospective self-report of alcohol in the 90 days prior to 6-month follow-up. Amount of alcohol consumption was converted to standard ethanol content units (SECs; or standard drinks) equivalent to 0.5 oz. of ethanol. This measure represents ALL standard drinks consumed within the stated time period.
Alcohol Drink Days at 1 Month
时间窗: 1 month
The Timeline Follow-Back (TLFB) calendar was used to assess retrospective self-report of alcohol in the 30 days after day 1 of the treatment group. This measure represents the number of days any alcohol was consumed within the stated time period.
Binge Drink Days at 6 Months
时间窗: 6 months
The Timeline Follow-Back (TLFB) calendar was used to assess retrospective self-report of alcohol in the 90 days prior to 6-month follow-up. This measure represents the number of days the participant binge drank (5 or more standard drinks on a single day for males; 4 or more standard drinks on a single day for females) within the stated time period.
Illicit Drug Use Days at Baseline
时间窗: 30 days prior to Baseline
The Timeline Follow-Back (TLFB) calendar was used to assess retrospective self-report of drug use in the 30 days prior to Baseline. This measure represents the number of illicit drug use days within the stated time period.
Illicit Drug Use Days at 1 Month
时间窗: 1 month
The Timeline Follow-Back (TLFB) calendar was used to assess retrospective self-report of alcohol in the 30 days prior to 1-month follow-up. This measure represents the number of illicit drug use days within the stated time period.
Illicit Drug Use Days at 3 Months
时间窗: 3 months
The Timeline Follow-Back (TLFB) calendar was used to assess retrospective self-report of alcohol in the 60 days prior to 3-month follow-up. This measure represents the number of illicit drug use days within the stated time period.
Substance Use Disorder Treatment Sessions at 1 Month
时间窗: 1 month
A Treatment Attendance Calendar was used to record the number of objective treatment sessions documented in each participants VA Computerized Patient Record System for the 30 days prior to 1-month follow-up. Treatment sessions included the outpatient substance use disorder treatment group sessions and individual sessions.
Twelve-Step Sessions Attended at 1 Month
时间窗: 1 month
A Treatment Attendance Calendar was used to record the number of self-reported 12-step sessions attended 30 days prior to 1-month follow-up.
Peak SEC at Baseline
时间窗: 30 days prior to Baseline
The Timeline Follow-Back (TLFB) calendar was used to assess retrospective self-report of alcohol in the 30 days prior to baseline. Amount of alcohol consumption was converted to standard ethanol content units (SECs; or standard drinks) equivalent to 0.5 oz. of ethanol. This measure represents the most standard drinks consumed in a single day within the stated time period.
Binge Drink Days at 1 Month
时间窗: 1 month
The Timeline Follow-Back (TLFB) calendar was used to assess retrospective self-report of alcohol in the 30 days prior to 1-month follow-up. This measure represents the number of days the participant binge drank (5 or more standard drinks on a single day for males; 4 or more standard drinks on a single day for females) within the stated time period.
Binge Drink Days at 3 Months
时间窗: 3 months
The Timeline Follow-Back (TLFB) calendar was used to assess retrospective self-report of alcohol in the 60 days prior to 3-month follow-up. This measure represents the number of days the participant binge drank (5 or more standard drinks on a single day for males; 4 or more standard drinks on a single day for females) within the stated time period.
Alcohol Drink Days at Baseline
时间窗: 30 days prior to Baseline
The Timeline Follow-Back (TLFB) calendar was used to assess retrospective self-report of alcohol in the 30 days prior to Baseline. This measure represents the number of days any alcohol was consumed within the stated time period.
Alcohol Drink Days at 3 Months
时间窗: 3 months
The Timeline Follow-Back (TLFB) calendar was used to assess retrospective self-report of alcohol in the 60 days prior to 3-month follow-up. This measure represents the number of days any alcohol was consumed within the stated time period.
Alcohol Drink Days at 6 Months
时间窗: 6 months
The Timeline Follow-Back (TLFB) calendar was used to assess retrospective self-report of alcohol in the 90 days prior to 6-month follow-up. This measure represents the number of days any alcohol was consumed within the stated time period.
Binge Drink Days at Baseline
时间窗: 30 days prior to Baseline
The Timeline Follow-Back (TLFB) calendar was used to assess retrospective self-report of alcohol in the 30 days prior to Baseline. This measure represents the number of days the participant binge drank (5 or more standard drinks on a single day for males; 4 or more standard drinks on a single day for females).
Substance Use Disorder Treatment Sessions at 3 Months
时间窗: 3 months
A Treatment Attendance Calendar was used to record the number of objective treatment sessions documented in each participants VA Computerized Patient Record System for the 60 days prior to 3-month follow-up. Treatment sessions included the outpatient substance use disorder treatment group sessions and individual sessions.
Substance Use Disorder Treatment Sessions at 6 Months
时间窗: 6 months
A Treatment Attendance Calendar was used to record the number of objective treatment sessions documented in each participants VA Computerized Patient Record System for the 60 days prior to 6-month follow-up. Treatment sessions included the outpatient substance use disorder treatment group sessions and individual sessions.
Twelve-Step Sessions Attended at 6 Months
时间窗: 6 months
A Treatment Attendance Calendar was used to record the number of self-reported 12-step sessions attended in the 90 days prior to 6-month follow-up.
Days Involved in Productive Work Activities at 3 Months
时间窗: 3 months
A calendar was used to record the number of times a participant participated in a productive work activity (e.g. volunteered or worked at a job) in the 60 days prior to 3-month follow-up
Times Involved in Community Participation Activities at Baseline
时间窗: 30 days prior to Baseline
A calendar was used to record the number of times a participant participated in an activity in the community (e.g. museum, library, baseball game) in the 30 days prior to Baseline.
Days Involved in Productive Work Activities at Baseline
时间窗: 30 days prior to Baseline
A calendar was used to record the number of times a participant participated in a productive work activity (e.g. volunteered or worked at a job) in the 30 days prior to Baseline.
Times Involved in Community Participation Activities at 1 Month
时间窗: 1 month
A calendar was used to record the number of times a participant participated in an activity in the community (e.g. museum, library, baseball game) in the 30 days prior to 1-month follow-up.
Times Involved in Community Participation Activities at 3 Months
时间窗: 3 months
A calendar was used to record the number of times a participant participated in an activity in the community (e.g. museum, library, baseball game) in the 60 days prior to 3-month follow-up.
Days Involved in Productive Work Activities at 1 Month
时间窗: 1 month
A calendar was used to record the number of times a participant participated in a productive work activity (e.g. volunteered or worked at a job) in the 30 days prior to 1-month follow-up.
次要结局
- Mental Health Treatment Sessions at Baseline(30 days prior to Baseline)
- Addiction Severity Index-Lite (ASI-Lite) at 6 Months for Alcohol Use(6 months)
- Social Support Survey Total Score at Baseline(30 days prior to Baseline)
- Substance Use Disorder and Mental Health Treatment Sessions at Baseline(30 days prior to Baseline)
- Addiction Severity Index-Lite (ASI-Lite) at Baseline for Alcohol Use(30 days prior to Baseline)
- Addiction Severity Index-Lite (ASI-Lite) at 1 Month for Psychiatric Status(30 days)
- Addiction Severity Index-Lite (ASI-Lite) at 6 Months for Psychiatric Status(6 months)
- Social Support Survey Total Score at 1 Month(30 days prior to 1-month follow-up)
- Mental Health Treatment Sessions at 1 Month(1 Month)
- Addiction Severity Index-Lite (ASI-Lite) at 3 Months for Alcohol Use(3 months)
- Addiction Severity Index-Lite (ASI-Lite) at 3 Month for Psychiatric Status(3 months)
- Short Inventory of Problems at 1 Month(1 month)
- Short Inventory of Problems at 3 Months(3 months)
- Social Support Survey Total Score at 6 Months(90 days prior to 6-month follow-up)
- Quality of Life Survey (QOLS) at 3 Months(3 months)
- Quality of Life Survey (QOLS) at 6 Months(6 months)
- Brief Symptom Inventory (BSI-18) at 6 Months(6 months)
- SF-12 Health Survey Mental Summary Score at 1 Month(1 month)
- SF-12 Health Survey Mental Summary Score at 6 Months(6 months)
- Treatment Motivation Questionnaire (TMQ) at 1-month(30 days prior to 1-month follow-up)
- Mental Health Treatment Sessions at 3 Months(3 Months)
- Mental Health Treatment Sessions at 6 Months(6 Months)
- Substance Use Disorder and Mental Health Treatment Sessions at 1 Month(1 Month)
- Substance Use Disorder and Mental Health Treatment Sessions at 3 Months(3 Months)
- Social Support Survey Total Score at 3 Months(60 days prior to 3-month follow-up)
- Quality of Life Survey (QOLS) at Baseline(30 days prior to Baseline)
- Quality of Life Survey (QOLS) at 1 Month(1 month)
- Substance Use Disorder and Mental Health Treatment Sessions at 6 Months(6 Months)
- Addiction Severity Index-Lite (ASI-Lite) at 1 Month for Alcohol Use(1 month)
- Addiction Severity Index-Lite (ASI-Lite) at Baseline for Psychiatric Status(30 days prior to Baseline)
- Short Inventory of Problems at 6 Months(6 months)
- Brief Symptom Inventory (BSI-18) at Baseline(30 days prior to Baseline)
- Brief Symptom Inventory(BSI-18) at 1 Month(1 month)
- Brief Symptom Inventory (BSI-18) at 3 Months(3 months)
- Short Inventory of Problems (SIP) at Baseline(30 days prior to Baseline)
- SF-12 Health Survey Physical Summary Score at 6 Months(6 months)
- Fagerstrom Test for Nicotine Dependence at Baseline(30 days prior to Baseline)
- SF-12 Health Survey Physical Summary Score at 3 Months(3 months)
- Helping Alliance Questionnaire - Total Score(Completed during session 4 of treatment group (i.e. the final treatment session))
- SF-12 Health Survey Physical Summary Score at Baseline(30 days prior to Baseline)
- SF-12 Health Survey Physical Summary Score at 1 Month(1 month)
- SF-12 Health Survey Mental Summary Score at Baseline(30 days prior to Baseline)
- SF-12 Health Survey Mental Summary Score at 3 Months(3 months)
- Treatment Motivation Questionnaire (TMQ) at Baseline(30 days prior to Baseline)
- Treatment Motivation Questionnaire (TMQ) at 6-months(90 days prior to 6-month follow-up)
- Psychiatric Outpatient Satisfaction Scale - Total Score(1 month)
- Treatment Motivation Questionnaire (TMQ) at 3-month(60 days prior to 3-month follow-up)