Comparison of E-health vs. In-person MFG

In the VA Family Psycho-Educational (FPE) is a component of the Uniform Services standard for
care of Veterans with schizophrenia and their family members. FPE includes single family
variants, e.g., Behavioral Family Therapy, which is provided to individual families (consumer
and family members); and multi-family variants, e.g., Multi-Family Group Psycho-Education
(MFG-stands for 'Multi-Family Group'), which is provided to multiple families (consumers and
family members together) in a single treatment group. To promote the availability of FPE to
all Veterans who could benefit, the VA began national trainings of clinicians in FPE. Despite
this training, the proven effectiveness of FPE, and that it is the standard for care, it is
not widely available to Veterans, is underutilized even where available, and can incur
relatively high resistance from Veterans and families. Less than 5% of VA Medical Centers
provide FPE. Further, even where it is available, it reaches a relatively small proportion of
Veterans who could benefit. Barriers to receiving this treatment include the lack of
appropriately trained clinicians, the need for Veterans and family members to travel to
receive these services--this maybe a particularly important hurdle for a treatment that meets
bi-weekly for a minimum of nine months--the tendency to avoid in-person treatment due to the
stigma associated with seeking mental health treatment, and the difficulty of providing
treatments after hours or on weekends when families are more likely be able to attend. It is
important for the VA to have treatment delivery models that maximize the likelihood that all
Veterans in need will receive interventions such as FPE, including Veterans residing in rural
settings, and Veterans who avoid VA settings due to stigma. E-health delivery of services has
been a focus of the VA as a way to overcome these barriers. Specialized web-based approaches
have been studied and found to be successful for people with schizophrenia, and their
families, and can deliver content that is intensive and engaging with reduced requirements
for staff time.

The investigators' previous work has developed a model and guidelines to design e-health
applications for persons with schizophrenia and others with cognitive impairments (e.g.,
Rotondi, VA RR&D D61804R), and developed a highly scalable intervention termed Schizophrenia
On-line Access to Resources (SOAR) (Rotondi, R01 MH63484). SOAR incorporated FPE into a
modernized model that: incorporates web-based delivery; provides the ability of users to
individualize commitment and services to meet varied preferences and needs, in order to
address prominent reasons for resistance to FPE; and is accessible from homes and smart
phones. SOAR was highly successful at reducing illness symptoms for persons with
schizophrenia and improving their and their family members' knowledge of the illness.

The aims of this study are to conduct: 1) To conduct a non-inferiority randomized trial of
DSW vs. in-person MFG vs. Treatment as usual (TAU) that compares changes in severity of
positive and negative psychiatric symptoms, and family psychological burden, during treatment
and 3-months post-treatment 2) exploratory secondary analyses to identify Veteran and family
characteristics that are associated with decreased levels of psychiatric symptoms and
caregiver burden; 3) exploratory qualitative analyses to inform a larger implementation of
SOAR by identifying barriers, facilitators, VA system requirements, etc. from clinicians
providing the treatments, their supervisors, and participants. If successful, SOAR could
substantially increase the options, availability, utilization, appeal, and effectiveness of
FPE for Veterans and their families, thereby improving Veteran well-being, recovery, and
Veteran and family quality of life.

Inclusion Criteria:

Veterans will be included who:

- have a DSM-V diagnosis of schizophrenia or schizoaffective disorder;

- are 18-75 years old; are not in another family treatment,

- and; are able to speak and read English at the 5th grade level.

- The primary support person for the Veteran must be 18 years old

- and able to speak and read English at the 5th grade level.

Exclusion Criteria:

- Unable to speak English

- or use necessary technology.