Evaluating the Use of Peer Specialists to Deliver Cognitive Behavioral Social Skills Training
| Status: | Recruiting |
|---|---|
| Conditions: | Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 1/31/2019 |
| Start Date: | August 15, 2018 |
| End Date: | March 31, 2022 |
| Contact: | Matthew J Chinman, PhD |
| Email: | matthew.chinman@va.gov |
| Phone: | (412) 360-2438 |
The Veterans Health Administration (VHA) is advocating that Veterans with serious mental
illness (SMI) receive recovery-oriented, rehabilitation approaches that target real-world
functioning. One such approach is Cognitive-Behavioral Social Skills Training (CBSST). Unlike
traditional cognitive-behavioral therapy, CBSST is a more recovery-oriented psychosocial
rehabilitation intervention that teaches Veterans with SMI to correct errors in thinking and
build social skills. While effective, CBSST has only been tested when facilitated by masters-
or doctoral-level therapists, which limits its use in VHA. However, the investigators' pilot
data shows that Peer Specialists-individuals with SMI who are hired and trained to use their
own recovery experience to assist others with SMI-can also provide CBSST (called CBSST-Peer).
Stand-alone social skills training (SST) is also a recovery-oriented program that VHA is
attempting to rollout nationwide for Veterans with SMI. A few Peer Specialists have been
trained to co-lead SST with professionals. However, SST is not widely implemented because
professionals are busy and Peer Specialist delivered SST has not been tested. This study will
evaluate the effectiveness of Peer Specialist-delivered CBSST and SST, which would increase
access Veterans with SMI have to effective treatment. The investigators' aims are: Aim 1
(Effectiveness): To compare the impact of CBSST-Peer on outcomes in Veterans with SMI to
Veterans receiving Peer Specialist-delivered SST groups of equal duration and to treatment as
usual. The investigators will also assess fidelity of SST and CBSST. Aim 2: (Helpfulness of
CBSST/SST--Peer and implementation barriers and facilitators): To use focus groups with
patients and interviews with Peer Specialists and other staff to assess perceptions of SST-
and CBSS Peer and identify potential barriers and facilitators to future implementation.
Methods: This is a randomized, Hybrid 1 trial involving 252 Veterans with SMI (n=126 each
from Pittsburgh, San Diego) comparing 3 treatment arms: CBSST-Peer vs. SST-Peer vs. treatment
as usual. Hybrid 1 trials test the effectiveness of an intervention and collect
implementation data that could inform its future adoption. At each site, across 6 waves (a
wave = 1 CBSST-Peer and 1 SST-Peer group), 2 Peer Specialists will co-lead 12 groups, each
lasting 20 weeks. Peer Specialists will be trained and receive an hour of supervision weekly
by the CBSST developers. Master trainers from the SST rollout will train and supervise Peer
Specialists in each site. All three arms' sessions will be taped and 25% rated for fidelity
on standardized measures. A survey battery that assesses functioning, quality of life,
recovery, and symptoms will be administered to the Veterans in each wave at: baseline,
mid-intervention (10 weeks), end-of-intervention (20 weeks), and follow-up (32 weeks, 3
months post intervention). The investigators will examine all outcomes using Hierarchical
Linear Models (HLM), with treatment condition included as a time-invariant covariate, and
random intercepts for person and random slopes for time. Relevant covariates will include
site, treatment attendance, symptom severity, service use, and demographic variables. The
investigators will evaluate the effect for treatment conditions (CBSST-Peer vs. SST-Peer vs.
treatment as usual group) in the expected direction and the time X group effect. Qualitative
data on SST- and CBSST-Peer helpfulness and implementation factors will be collected from 8
focus groups, audio-recorded from a random sample of Veterans who participated in SST- and
CBSST-Peer. Interviews will be conducted with participating Peer Specialists (n=approximately
8 per site), and key mental health staff (n=3-4 per site). The qualitative interviews and
focus groups will be analyzed using rapid assessment, a team-based, iterative data collection
and analysis approach providing data on the barriers and facilitators to future
implementation of SST- and CBSST-Peer. Innovation: No study has tested peer-delivered SST or
CBSST, or compared the two, in a rigorous trial. Significance/Expected Results: CBSST and SST
are not widely available. If SST- or CBSST-Peer is effective, it could greatly increase the
delivery of evidence-based services Veterans receive and enhance the services by VHA Peer
Specialists.
illness (SMI) receive recovery-oriented, rehabilitation approaches that target real-world
functioning. One such approach is Cognitive-Behavioral Social Skills Training (CBSST). Unlike
traditional cognitive-behavioral therapy, CBSST is a more recovery-oriented psychosocial
rehabilitation intervention that teaches Veterans with SMI to correct errors in thinking and
build social skills. While effective, CBSST has only been tested when facilitated by masters-
or doctoral-level therapists, which limits its use in VHA. However, the investigators' pilot
data shows that Peer Specialists-individuals with SMI who are hired and trained to use their
own recovery experience to assist others with SMI-can also provide CBSST (called CBSST-Peer).
Stand-alone social skills training (SST) is also a recovery-oriented program that VHA is
attempting to rollout nationwide for Veterans with SMI. A few Peer Specialists have been
trained to co-lead SST with professionals. However, SST is not widely implemented because
professionals are busy and Peer Specialist delivered SST has not been tested. This study will
evaluate the effectiveness of Peer Specialist-delivered CBSST and SST, which would increase
access Veterans with SMI have to effective treatment. The investigators' aims are: Aim 1
(Effectiveness): To compare the impact of CBSST-Peer on outcomes in Veterans with SMI to
Veterans receiving Peer Specialist-delivered SST groups of equal duration and to treatment as
usual. The investigators will also assess fidelity of SST and CBSST. Aim 2: (Helpfulness of
CBSST/SST--Peer and implementation barriers and facilitators): To use focus groups with
patients and interviews with Peer Specialists and other staff to assess perceptions of SST-
and CBSS Peer and identify potential barriers and facilitators to future implementation.
Methods: This is a randomized, Hybrid 1 trial involving 252 Veterans with SMI (n=126 each
from Pittsburgh, San Diego) comparing 3 treatment arms: CBSST-Peer vs. SST-Peer vs. treatment
as usual. Hybrid 1 trials test the effectiveness of an intervention and collect
implementation data that could inform its future adoption. At each site, across 6 waves (a
wave = 1 CBSST-Peer and 1 SST-Peer group), 2 Peer Specialists will co-lead 12 groups, each
lasting 20 weeks. Peer Specialists will be trained and receive an hour of supervision weekly
by the CBSST developers. Master trainers from the SST rollout will train and supervise Peer
Specialists in each site. All three arms' sessions will be taped and 25% rated for fidelity
on standardized measures. A survey battery that assesses functioning, quality of life,
recovery, and symptoms will be administered to the Veterans in each wave at: baseline,
mid-intervention (10 weeks), end-of-intervention (20 weeks), and follow-up (32 weeks, 3
months post intervention). The investigators will examine all outcomes using Hierarchical
Linear Models (HLM), with treatment condition included as a time-invariant covariate, and
random intercepts for person and random slopes for time. Relevant covariates will include
site, treatment attendance, symptom severity, service use, and demographic variables. The
investigators will evaluate the effect for treatment conditions (CBSST-Peer vs. SST-Peer vs.
treatment as usual group) in the expected direction and the time X group effect. Qualitative
data on SST- and CBSST-Peer helpfulness and implementation factors will be collected from 8
focus groups, audio-recorded from a random sample of Veterans who participated in SST- and
CBSST-Peer. Interviews will be conducted with participating Peer Specialists (n=approximately
8 per site), and key mental health staff (n=3-4 per site). The qualitative interviews and
focus groups will be analyzed using rapid assessment, a team-based, iterative data collection
and analysis approach providing data on the barriers and facilitators to future
implementation of SST- and CBSST-Peer. Innovation: No study has tested peer-delivered SST or
CBSST, or compared the two, in a rigorous trial. Significance/Expected Results: CBSST and SST
are not widely available. If SST- or CBSST-Peer is effective, it could greatly increase the
delivery of evidence-based services Veterans receive and enhance the services by VHA Peer
Specialists.
The Veterans Health Administration (VHA) is advocating that Veterans with serious mental
illness (SMI) receive recovery-oriented, rehabilitation approaches that target real-world
functioning. One such approach is Cognitive-Behavioral Social Skills Training (CBSST). Unlike
traditional cognitive-behavioral therapy, CBSST is a more recovery-oriented psychosocial
rehabilitation intervention that teaches Veterans with SMI to correct errors in thinking and
build social skills. While effective, CBSST has only been tested when facilitated by masters-
or doctoral-level therapists, which limits its use in VHA. However, our pilot data shows that
Peer Specialists-individuals with SMI who are hired and trained to use their own recovery
experience to assist others with SMI-can also provide CBSST (called CBSST-Peer). Stand-alone
social skills training (SST) is also a recovery-oriented program that VHA is attempting to
rollout nationwide for Veterans with SMI. A few Peer Specialists have been trained to co-lead
SST with professionals. However, SST is not widely implemented because professionals are busy
and Peer Specialist delivered SST has not been tested. This study will evaluate the
effectiveness of Peer Specialist-delivered CBSST and SST, which would increase access
Veterans with SMI have to effective treatment. Our aims are: Aim 1 (Effectiveness): To
compare the impact of CBSST-Peer on outcomes in Veterans with SMI to Veterans receiving Peer
Specialist-delivered SST and Peer Specialist-led manualized groups of equal duration and
treatment as usual. We will also assess fidelity of SST and CBSST. Aim 2: (Helpfulness of
CBSST/SST--Peer and implementation barriers and facilitators): To use focus groups with
patients and interviews with Peer Specialists and other staff to assess perceptions of SST-
and CBSST Peer and identify potential barriers and facilitators to future implementation.
Methods: This is a randomized, Hybrid 1 trial involving 252 Veterans with SMI (n=126 each
from Pittsburgh, San Diego) comparing 3 treatment arms: CBSST-Peer vs. SST-Peer vs. treatment
as usual. Hybrid 1 trials test the effectiveness of an intervention and collect
implementation data that could inform its future adoption. At each site, across 6 waves (a
wave = 1 CBSST-Peer and 1 SST-Peer group), 2 Peer Specialists will co-lead 12 groups, each
lasting 20 weeks. Peer Specialists will be trained and receive an hour of supervision weekly
by the CBSST developers. Master trainers from the SST rollout will train and supervise Peer
Specialists in each site. All three arms' sessions will be taped and 25% rated for fidelity
on standardized measures. A survey battery that assesses functioning, quality of life,
recovery, and symptoms will be administered to the Veterans in each wave at: baseline,
mid-intervention (10 weeks), end-of-intervention (20 weeks), and follow-up (32 weeks, 3
months post intervention). We will examine all outcomes using Hierarchical Linear Models
(HLM), with treatment condition included as a time-invariant covariate, and random intercepts
for person and random slopes for time. Relevant covariates will include site, treatment
attendance, symptom severity, service use, and demographic variables. We will evaluate the
effect for treatment conditions (CBSST-Peer vs. SST-Peer vs. treatment as usual) in the
expected direction and the time X group effect. Qualitative data on SST- and CBSST-Peer
helpfulness and implementation factors will be collected from 8 focus groups, audio-recorded
from a random sample of Veterans who participated in SST- and CBSST-Peer. Interviews will be
conducted with participating Peer Specialists (n=approximately 8 per site), and key mental
health staff (n=3-4 per site). The qualitative interviews and focus groups will be analyzed
using rapid assessment, a team-based, iterative data collection and analysis approach
providing data on the barriers and facilitators to future implementation of SST- and
CBSST-Peer. Innovation: No study has tested peer-delivered SST or CBSST, or compared the two,
in a rigorous trial. Significance/Expected Results: CBSST and SST are not widely available.
If SST- or CBSST-Peer is effective, it could greatly increase the delivery of evidence-based
services Veterans receive and enhance the services by VHA Peer Specialists.
illness (SMI) receive recovery-oriented, rehabilitation approaches that target real-world
functioning. One such approach is Cognitive-Behavioral Social Skills Training (CBSST). Unlike
traditional cognitive-behavioral therapy, CBSST is a more recovery-oriented psychosocial
rehabilitation intervention that teaches Veterans with SMI to correct errors in thinking and
build social skills. While effective, CBSST has only been tested when facilitated by masters-
or doctoral-level therapists, which limits its use in VHA. However, our pilot data shows that
Peer Specialists-individuals with SMI who are hired and trained to use their own recovery
experience to assist others with SMI-can also provide CBSST (called CBSST-Peer). Stand-alone
social skills training (SST) is also a recovery-oriented program that VHA is attempting to
rollout nationwide for Veterans with SMI. A few Peer Specialists have been trained to co-lead
SST with professionals. However, SST is not widely implemented because professionals are busy
and Peer Specialist delivered SST has not been tested. This study will evaluate the
effectiveness of Peer Specialist-delivered CBSST and SST, which would increase access
Veterans with SMI have to effective treatment. Our aims are: Aim 1 (Effectiveness): To
compare the impact of CBSST-Peer on outcomes in Veterans with SMI to Veterans receiving Peer
Specialist-delivered SST and Peer Specialist-led manualized groups of equal duration and
treatment as usual. We will also assess fidelity of SST and CBSST. Aim 2: (Helpfulness of
CBSST/SST--Peer and implementation barriers and facilitators): To use focus groups with
patients and interviews with Peer Specialists and other staff to assess perceptions of SST-
and CBSST Peer and identify potential barriers and facilitators to future implementation.
Methods: This is a randomized, Hybrid 1 trial involving 252 Veterans with SMI (n=126 each
from Pittsburgh, San Diego) comparing 3 treatment arms: CBSST-Peer vs. SST-Peer vs. treatment
as usual. Hybrid 1 trials test the effectiveness of an intervention and collect
implementation data that could inform its future adoption. At each site, across 6 waves (a
wave = 1 CBSST-Peer and 1 SST-Peer group), 2 Peer Specialists will co-lead 12 groups, each
lasting 20 weeks. Peer Specialists will be trained and receive an hour of supervision weekly
by the CBSST developers. Master trainers from the SST rollout will train and supervise Peer
Specialists in each site. All three arms' sessions will be taped and 25% rated for fidelity
on standardized measures. A survey battery that assesses functioning, quality of life,
recovery, and symptoms will be administered to the Veterans in each wave at: baseline,
mid-intervention (10 weeks), end-of-intervention (20 weeks), and follow-up (32 weeks, 3
months post intervention). We will examine all outcomes using Hierarchical Linear Models
(HLM), with treatment condition included as a time-invariant covariate, and random intercepts
for person and random slopes for time. Relevant covariates will include site, treatment
attendance, symptom severity, service use, and demographic variables. We will evaluate the
effect for treatment conditions (CBSST-Peer vs. SST-Peer vs. treatment as usual) in the
expected direction and the time X group effect. Qualitative data on SST- and CBSST-Peer
helpfulness and implementation factors will be collected from 8 focus groups, audio-recorded
from a random sample of Veterans who participated in SST- and CBSST-Peer. Interviews will be
conducted with participating Peer Specialists (n=approximately 8 per site), and key mental
health staff (n=3-4 per site). The qualitative interviews and focus groups will be analyzed
using rapid assessment, a team-based, iterative data collection and analysis approach
providing data on the barriers and facilitators to future implementation of SST- and
CBSST-Peer. Innovation: No study has tested peer-delivered SST or CBSST, or compared the two,
in a rigorous trial. Significance/Expected Results: CBSST and SST are not widely available.
If SST- or CBSST-Peer is effective, it could greatly increase the delivery of evidence-based
services Veterans receive and enhance the services by VHA Peer Specialists.
Inclusion Criteria:
- Voluntary informed consent (must be able to be given by the patient)
- Primary diagnosis of SMI documented in the medical record
- schizophrenia
- schizoaffective disorder
- bipolar disorder with psychotic features
- Fluent in English so as to be able to complete testing
Exclusion Criteria:
- Medication changes in the prior month
- Current or recent (within the past year) CBSST, CBT, or SST (so any skill knowledge
and any improvement in outcome can be attributed to SST- or CBSST-Peer rather than
participation in other forms of current or recent CBT or SST interventions)
- Level of care at baseline that interferes with outpatient participation
- Current hospitalization for psychiatric, substance use or physical illness
- hospitalized subjects will be invited to participate 1 month after discharge
- Severe and/or unstable mental illness as indicated during informed consent process by
inability to pass the Blessed measure in the first visit
- Cognitive impairment as indicated by inability to pass the 10 item T/F measure about
informed consent
- Women who are pregnant will be excluded from this study
- Incarcerated Veterans will be excluded from this study
- Veterans with impaired decision making capabilities will be excluded from this study
We found this trial at
2
sites
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Pittsburgh, Pennsylvania 15240
Phone: 412-360-2438
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