Dr. Paul King (PI) is a Clinical Research Psychologist at the VA Center for Integrated Healthcare (CIH), and a graduate of a Department of Veterans Affairs (VA) Advanced Fellowship in Mental Illness Research and Treatment (MIRECC). His primary research area is post-deployment health care for Operation Enduring and Iraqi Freedom (OEF/OIF) Veterans in Primary Care-Mental Health Integration (PC-MHI) settings. The short- term objective for this Career Development Award-2 (CDA-2) proposal is to further Dr. King's development as a Rehabilitation Research and Development (RR&D) researcher by meeting specific training goals related to the design and execution of randomized controlled trials (RCTs), and further building skills in mental health (MH) rehabilitation. The career plan comprehensively addresses these goals via mentorship, formal coursework, and professional seminars. The combination of research support, mentorship, and training will provide opportunities for Dr. King to further develop skills, [prepare] him to function as an independent RR&D researcher, and build a Veteran-centered research portfolio in MH and mild traumatic brain injury (mTBI) rehabilitation. Long term, this research aims to improve the accessibility of skills-focused rehabilitative services; to enhance implementation of patient-centered, evidence-based practices (EBPs) for mTBI in VA; and to serve as a cornerstone for Dr. King's VA RR&D research career. Study activities will take place at the VA Western New York Healthcare System (VA WNYHS) at Buffalo, which is a full-service medical, MH, and substance treatment facility with an active research program. Primary care services are delivered on-site across 3 clinics, with licensed MH providers embedded in each. One of 2 CIH sites is located on the VA WNYHS campus (a second site is located at the Syracuse VA Medical Center). As a VA MH Center of Excellence dedicated to improving the care of Veterans via enhancing the integration of primary care and MH services, CIH is home to national experts in PC-MHI research and practice. The research goal of this CDA-2 proposal entitled ?Enhanced Problem-Solving Training (E-PST) to Improve Recovery for mTBI? is to adapt and pilot test an enhanced version of Problem Solving Training for Primary Care (PST-PC) that can be delivered to Veterans with history of mTBI. This goal will be achieved by conducting 3 studies aimed at: 1) gathering stakeholder feedback on E-PST protocol adaptation through interviews with subject matter experts (SMEs) in PST, rehabilitation, and PC-MHI; 2) [examining the acceptability, feasibility, and preliminary clinical effect] of E-PST by conducting an open trial with [10-12] Veterans with history of mTBI; and 3) conducting a pilot RCT of E-PST compared to [an attention] control (n = 19 per arm). Study 1 (Aim 1) will employ a modified Delphi approach to gather SME feedback on the adaptation and refinement of the E-PST treatment manual. The resulting manual will guide the intervention that is delivered in the open trial in Study 2 (Aim 2). Participants in the open trial will complete the adapted 4-6 session E-PST protocol, and provide self-report and interview data at each session on various aspects of the treatment. These data will ensure that relevant Veteran stakeholder feedback is incorporated prior to initiating the pilot RCT in Study 3 (Aim 3). The purpose of the pilot RCT is threefold: a) to estimate a preliminary effect size (ES) for the primary outcome measure; b) to determine the feasibility of [the assessment plan]; and c) to establish the feasibility of recruitment and retention in order to guide the design of a future multisite efficacy trial. All participants in Studies 2-3 will continue with primary care treatment as usual (TAU) for any necessary medical management of symptoms. Data derived from this CDA-2 will be essential in planning a future RR&D Merit proposal designed to formally test E-PST's efficacy.
Mild traumatic brain injury (mTBI) is among the most common injuries sustained by Veterans of Operations Enduring and Iraqi Freedom. It is also highly co-morbid with mental health conditions, such as post-traumatic stress disorder and depression. While mTBI alone is not typically thought to cause lasting deficits in personal functioning or cognitive abilities, Veterans with a history of mTBI nonetheless report chronic psychological distress, as well as subjective difficulties with attention, concentration, poor frustration tolerance, and decision- making. Although current clinical practice guidelines for mTBI emphasize primary care-based symptom management, there are presently no evidence-based interventions to treat mental health symptoms in this setting. This research proposal therefore seeks to adapt and pilot test a brief, primary care-based intervention to reduce psychological distress in Veterans with mTBI by augmenting problem-solving skills, and helping them to develop specific cognitive and behavioral skills to improve upon their self-reported cognitive inefficiencies.
