Posttraumatic Stress Disorder (PTSD) is a highly prevalent, potentially debilitating
condition afflicting many war Veterans. While efficacious treatments are available, most
individuals with PTSD do not receive any mental health care. VA faces an ongoing
challenge of engaging Veterans with PTSD in effective services. Recognizing the powerful
influence of families on Veteran wellbeing, VA has called for increased involvement of
family members in the care of Veterans with PTSD. In response, VA has created a national
telephone-based support service called Coaching Into Care (CIC) to work with family
members of Veterans with mental health problems who are reluctant to seek treatment.
Program evaluation data show that CIC is highly valued by callers, but that 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 is a test of an innovative approach to
improve outcomes by blending coaching calls with a web-based 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 and supporting their
family members to better care for themselves, more effectively manage their
relationships, and have effective care-seeking conversations with their Veterans.
Preliminary work suggests that VA-CRAFT may be a powerful adjunct for CIC services. In a
prior HSR&D-funded pilot, the investigators' team found that family members who completed
the relatively brief VA-CRAFT course alone (without any 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
loved one due to not believing such a conversation would be successful. The investigators
developed CIC+VA-CRAFT with the goal of capitalizing on the strengths of both approaches
(CIC and VA-CRAFT) and increasing family members' motivation, perceived ability to have
treatment-seeking conversations with the Veteran, and success at engaging their Veterans
in care. Initial findings from a second, NC-PTSD-funded pilot suggest that this brief,
blended intervention is feasible, acceptable, and potentially more effective than CIC
alone in enhancing Veteran mental health treatment initiation.
Primary Objective: The primary objective is to investigate the effectiveness of
CIC+VA-CRAFT in improving Veteran treatment initiation above CIC only, without
compromising the high caller satisfaction of the CIC program. To accomplish this, the
investigators will use a two-group randomized controlled trial. Spouse/partners who
believe their Veteran needs PTSD treatment will be randomized to CIC+VA-CRAFT or CIC only
(i.e., TAU). Assessments will occur at baseline, post-treatment (month 3), and follow-up
(month 6). To maximize generalizability of findings to the intended population,
recruitment will use targeted social media advertising and referrals from the existing
CIC program. Specific aims are:
Aim 1: Determine the effectiveness of CIC+VA-CRAFT for Veteran mental health service
initiation. The investigators hypothesize that spouse/partners in CIC+VA-CRAFT will
report higher rates of mental health service initiation for their Veterans than will
participants in the CIC only condition.
Aim 2: Investigate caller satisfaction with CIC+VA-CRAFT relative to CIC only. The
investigators hypothesize that satisfaction with CIC+VA-CRAFT will be non-inferior to
satisfaction with the CIC program.
Aim 3: Conduct a process evaluation to inform potential future implementation of
CIC+VA-CRAFT. Qualitative interviews with spouse/partners, their Veterans, and study and
CIC coaches, will be used to inform future implementation of the CIC+VA-CRAFT
intervention into the CIC program.
Exploratory Aims:
Explore potential within-condition improvements and between-condition changes on
spouse/partner and family outcomes. The investigators will test for these effects on
measures of caregiver burden, psychological distress, quality of life, and family
conflict and cohesion.
Explore potential intervention mediators and moderators of Veteran mental health
treatment initiation. The investigators will explore if self-efficacy, outcome
expectancy, and treatment conversations mediate the effect of the intervention on
mental health treatment initiation. Demographic variables, perceived Veteran
symptomatology, and partner symptomatology will be explored as moderators of the
effect of the intervention.
The long-term goal of this research 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. This proposal has been developed
in collaboration with the existing VA CIC and VA-CRAFT programs and involves the
leadership of these programs to facilitate the blended intervention's rapid dissemination
should the trial prove successful.