Motivational Interviewing to Engage Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) Veterans in Mental Health Treatment
| Status: | Completed |
|---|---|
| Conditions: | Depression, Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 5/5/2014 |
| Start Date: | September 2007 |
| End Date: | September 2009 |
| Contact: | Karen H Seal, MD, MPH |
| Email: | karen.seal@va.gov |
| Phone: | 415 221-4810 |
Motivational Interviewing to Engage OEF/OIF Veterans in Mental Health Treatment
The goal of this randomized controlled trial is to evaluate the efficacy of
telephone-administered motivational interviewing (TAMI) to enhance VA mental health
treatment engagement among veterans of Operations Enduring Freedom (OEF) and Iraqi Freedom
(OIF) who screen positive for mental health disorders on telephone assessment. The
investigators will evaluate whether TAMI results in improved mental health treatment
engagement, decreased mental health symptoms and increased quality of life among OEF/OIF
veterans with mental health disorders. The long-term aim of this study is to conduct rapid
assessment and intervention to prevent chronic mental illness and associated disability
among our newest generation of veterans.
telephone-administered motivational interviewing (TAMI) to enhance VA mental health
treatment engagement among veterans of Operations Enduring Freedom (OEF) and Iraqi Freedom
(OIF) who screen positive for mental health disorders on telephone assessment. The
investigators will evaluate whether TAMI results in improved mental health treatment
engagement, decreased mental health symptoms and increased quality of life among OEF/OIF
veterans with mental health disorders. The long-term aim of this study is to conduct rapid
assessment and intervention to prevent chronic mental illness and associated disability
among our newest generation of veterans.
Project Background/Rationale: Recent reports suggest that a substantial proportion of
OEF/OIF veterans suffer from one or more co-occurring mental health disorders, particularly
post-traumatic stress disorder (PTSD), depression, and substance use disorders. Many newly
returning veterans fail to initiate or complete an adequate course of mental health
treatment largely owing to barriers that include inherent features of the mental illness,
practical and logistical concerns, and stigma. Untreated mental illness threatens to
produce functional and occupational disability as occurred with Vietnam-era veterans.
Motivational Interviewing (MI) is an evidence-based, client-centered, therapeutic technique
shown to enhance mental health treatment engagement in high-risk populations by helping
patients explore and resolve barriers to care.
Project Objectives: The aims of this proposal are: (1) to evaluate the efficacy of
telephone-administered motivational interviewing (TAMI) compared to telephone-administered
informational support sessions (Control) to enhance mental health treatment initiation and
retention among OEF/OIF veterans who screen positive for one or more mental health
disorders; (2) to compare change in mental health symptoms and quality of life among
veterans assigned to TAMI versus Control, and (3) to describe barriers to mental health
treatment engagement among OEF/OIF veterans and assess the putative mechanism by which TAMI
increases mental health treatment engagement.
Project Methods: The study is a two-arm randomized controlled trial. We will conduct
telephone-administered psychometric screening for PTSD, depression, high-risk alcohol and
substance use among 1,000 OEF/OIF veterans residing in Northern California. In addition, we
will collect baseline data on sociodemographic and military service-related characteristics,
VA and non-VA mental health treatment experiences, barriers and motivation to initiate
and/or follow-up with VA mental health appointments. Approximately 300 OEF/OIF veterans
screening positive for one or more mental health disorders will receive a referral to mental
health treatment in their area and will be randomly assigned to either an initial TAMI
session followed by two booster TAMI sessions at 1 and 3 months versus three informational
support sessions balanced for time and attention. We will measure outcomes at baseline,
one, three, and six months. We will test the hypotheses that OEF/OIF veterans receiving
TAMI as compared to the Control condition will be more motivated and hence more likely to
overcome barriers to initiate and attend follow-up VA mental health treatment appointments
and will have greater improvements in mental health symptoms and quality of life.
OEF/OIF veterans suffer from one or more co-occurring mental health disorders, particularly
post-traumatic stress disorder (PTSD), depression, and substance use disorders. Many newly
returning veterans fail to initiate or complete an adequate course of mental health
treatment largely owing to barriers that include inherent features of the mental illness,
practical and logistical concerns, and stigma. Untreated mental illness threatens to
produce functional and occupational disability as occurred with Vietnam-era veterans.
Motivational Interviewing (MI) is an evidence-based, client-centered, therapeutic technique
shown to enhance mental health treatment engagement in high-risk populations by helping
patients explore and resolve barriers to care.
Project Objectives: The aims of this proposal are: (1) to evaluate the efficacy of
telephone-administered motivational interviewing (TAMI) compared to telephone-administered
informational support sessions (Control) to enhance mental health treatment initiation and
retention among OEF/OIF veterans who screen positive for one or more mental health
disorders; (2) to compare change in mental health symptoms and quality of life among
veterans assigned to TAMI versus Control, and (3) to describe barriers to mental health
treatment engagement among OEF/OIF veterans and assess the putative mechanism by which TAMI
increases mental health treatment engagement.
Project Methods: The study is a two-arm randomized controlled trial. We will conduct
telephone-administered psychometric screening for PTSD, depression, high-risk alcohol and
substance use among 1,000 OEF/OIF veterans residing in Northern California. In addition, we
will collect baseline data on sociodemographic and military service-related characteristics,
VA and non-VA mental health treatment experiences, barriers and motivation to initiate
and/or follow-up with VA mental health appointments. Approximately 300 OEF/OIF veterans
screening positive for one or more mental health disorders will receive a referral to mental
health treatment in their area and will be randomly assigned to either an initial TAMI
session followed by two booster TAMI sessions at 1 and 3 months versus three informational
support sessions balanced for time and attention. We will measure outcomes at baseline,
one, three, and six months. We will test the hypotheses that OEF/OIF veterans receiving
TAMI as compared to the Control condition will be more motivated and hence more likely to
overcome barriers to initiate and attend follow-up VA mental health treatment appointments
and will have greater improvements in mental health symptoms and quality of life.
Inclusion Criteria:
- Veteran of OEF/OIF with service in Iraq or Afghanistan, or areas surrounding these
combat theaters
- Military service separation date after 9/30/01
- Has a zip code that corresponds to a Northern California address and no plans to
relocate
- May be contacted by telephone
- Must screen positive for one or more of the following: PTSD, depression, high-risk
alcohol and/or illicit substance use to enroll in the randomized controlled trial.
Exclusion criteria:
- Veterans who served post-9/11/01 but who did not serve in Operation Enduring Freedom
or Operation Iraqi Freedom
- In VA or non-VA mental health treatment currently
- Residing more than 60 miles from SFVAMC or a CBOC associated with SFVAMC
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