Impact: Family members are primary sources of support for Veterans struggling with PTSD. While family support and encouragement are powerful facilitators of Veterans? mental health care engagement, few interventions have been developed that capitalize on this support. To address this gap, VA created Coaching Into Care (CIC) ? a national telephone-based coaching service intended to educate, support, and empower family members and friends who are seeking services for a Veteran. While program evaluation data show that CIC is highly valued by callers, only about 25% of callers with Veterans not already in care, report that their Veteran sought care over the next six months. The proposed study tests an innovative approach to improve the effectiveness of CIC by integrating a web program called VA Community Reinforcement and Family Training (VA-CRAFT), which is based on an empirically-validated intervention. The long-term goal is to establish an efficacious, efficient, scalable, and satisfying family outreach intervention that will significantly increase mental health service initiation among a high priority Veteran population while addressing the needs of their primary supporters, their family members. Background: PTSD is a highly prevalent psychiatric disorder among combat Veterans that often results in significant individual impairment and distress for family members. Although evidence-based treatments are available, most Veterans with PTSD do not receive any mental health care. Preliminary work suggests that VA?s Coaching Into Care services could be improved by integrating VA-CRAFT. In a prior HSR&D-funded pilot, our team found that family members who completed the relatively brief VA-CRAFT course alone (without coaching) had greater decreases in caregiver burden than wait-list controls. However, qualitative interviews also suggested that participants often did not raise the issue of treatment with their Veteran due to not believing such a conversation would be successful. Therefore, we developed CIC+VA-CRAFT to leverage the strengths of both approaches to increase family members? motivation, perceived ability to have treatment-seeking conversations with their Veteran, and success at engaging their Veterans in care. Initial findings from an NC- PTSD-funded pilot of CIC+VA-CRAFT suggest that this brief, blended intervention is feasible, acceptable, and potentially more effective than CIC alone in enhancing Veteran mental health treatment initiation. Objectives: This project will employ a two-group randomized controlled trial (RCT) to compare CIC+VA- CRAFT to CIC only (treatment as usual).
Specific aims are to: 1) Determine the effectiveness of CIC+VA- CRAFT in enhancing Veterans? mental health service initiation compared to CIC only; 2) Determine if CIC+VA- CRAFT is non-inferior to CIC only on caller satisfaction, and 3) Conduct a process evaluation to inform potential future implementation of CIC+VA-CRAFT. The project will also explore potential 1) treatment effects on other important family-related outcomes, and 2) mediators and moderators of treatment. This proposal was developed as a collaboration between the VA CIC and VA-CRAFT programs and their leadership, which will facilitate the intervention?s rapid dissemination should the trial prove successful. Methods: This is a four-year RCT that will recruit spouses or intimate partners of Veterans with PTSD using social media advertisements and referrals from CIC. Participating partners will be randomized to the CIC+VA- CRAFT (n = 115) or CIC only (n = 115) condition for up to three months. CIC+VA-CRAFT will include four manualized CIC phone-coaching calls and access to the VA-CRAFT website. CIC participants will receive only CIC services as usual. Assessments will be at baseline, post-intervention (3 months after randomization), and six-month follow-up and will include partner reports of Veteran service utilization, caregiver burden, wellbeing, and relationship functioning. The feasibility and acceptability of implementing CIC+VA-CRAFT will be assessed with interviews of CIC+VA-CRAFT participants, Veterans of participants, and study and CIC phone coaches.
Posttraumatic stress disorder (PTSD) afflicts many war Veterans, but often they are reluctant to seek help despite availability of effective treatments. Family members are key sources of support who can help encourage such Veterans to initiate mental health services. Toward that goal, VA provides telephone coaching to family members through its Coaching Into Care (CIC) program to help get their Veterans into care. While CIC enjoys high caller satisfaction, it has shown only modest success getting Veterans into care. Blended interventions that include professional support and technology-based interventions offer promise for improving effectiveness of services. Therefore, this proposal tests an intervention that blends CIC calls with a web program called VA Community Reinforcement and Family Training (VA-CRAFT). VA-CRAFT is a translation of an empirically-validated model intended to help Veterans by training their family members to effectively promote care-seeking. If successful, this approach will support families and help more Veterans receive needed mental health care for PTSD.
