MIRECC / CoE

Principal Investigator: Darius Dawson, PhD; Houston, TX

About: African American Veterans are at greater risk of developing tobacco-related diseases, despite equal or lower prevalence rates. These Veterans seek tobacco cessation treatment at lower rates than other racial/ethnic groups, along with historical underuse of mental health services. Despite use of tobacco cessation services being low among Veterans, increasing engagement of African American Veterans into treatment will decrease rising health burdens in this population. This project will develop a plan to increase African American Veteran engagement in tobacco cessation treatment to strive for health equity in this domain.

Significance: Using telehealth and technology-based modalities to deliver tobacco cessation treatment to African American Veterans is particularly novel and innovative. Also, the use of community resources, peer support, and marketing advertisement may be useful tools to engage this underserved population.

Principal Investigator: Mark Kunik, MD, MPH; Houston, TX

About: In the changed landscape of the COVID-19 pandemic, little is known about the best ways to help Veterans with type 2 diabetes address their complex physical and mental health needs. Social distancing may lessen the availability or use of some pre-existing sources of information, resources, social support and infrastructure. Virtual or online options may be acceptable alternatives to some Veterans, but not others. Through the conduct and analysis of in-depth qualitative phone interviews, this project will examine pandemic-related barriers to and facilitators of engaging in health maintenance behaviors and accessing resources, mental health care, medical care and other services vital to the health of Veterans with type 2 diabetes.

Significance: This pilot will be used to design interventions that assist Veterans with type 2 diabetes and other chronic conditions in meeting their needs during the current pandemic and future crises that result in social isolation and reduced access to resources and services.

Principal Investigator:Sonia Singh, PhD; Little Rock, AR

About: Veterans who identify as Lesbian, Gay, Bisexual, and Transgender (LGBT) experience disparities in health and mental health compared to cisgender, heterosexual Veterans. LGBT Veterans are more likely to have poor health, more chronic conditions, and higher risk of cardiovascular disease and HIV/AIDS. These disparities are exacerbated for rural LGBT Veterans. To better serve these Veterans, the VHA instituted directives for LGBT-affirming care and created a LGBT Veteran Care Coordinator (VCC) position in each medical center to champion LBGT-affirming care. Framed in the Consolidated Framework for Implementation Research (CFIR) and incorporating health equity domains, this study will test the feasibility and acceptability of methods to obtain provider and LGBT Veteran perceptions of LGBT-affirming care.

Significance: The goal of this research is to empower facility, VISN, and national leadership to improve LGBT-affirming care efforts by supporting implementation of policy and practices to ensure standardized care for LGBT Veterans.

Principal Applicant: Jeffry Scott Bethay, PhD; Jackson, MS

Co-Applicants: Jonathan Weinstein, PhD and Whitney Stubbs, PhD

About: This transdiagnostic individual psychotherapy treatment manual based on acceptance and commitment therapy (ACT) is for Veterans with mixed anxiety and trauma-related disorders. It will outline a general course of treatment while providing guidance to providers on adapting ACT treatment to different clinical presentations such as panic, generalized anxiety, social anxiety, obsessive compulsive disorder, and PTSD. It will include exposure exercises and treatment materials that may be distributed through secure messaging or other electronic means such as screen-sharing, thus enhancing the implementation of evidence-based treatment via telehealth.

Significance: ACT has the potential to increase agency and empowerment in underserved Veterans by emphasizing personal values and commitment to effective action. This transdiagnostic manual may improve efficiency of service delivery, making evidence-based psychotherapy more accessible to rural Veterans with anxiety and trauma-related disorders.

Principal Applicant: Adeel Meraj, MD; San Antonio, TX

Co-Applicants: Lauren Koep PsyD and Muhammad Rais Baig, MD

About: This accessible, user-friendly, self-desensitization guide aims to improve positive airway pressure (PAP) therapy compliance in Veterans with trauma-related disorders. This evidence-based, exposure-therapy approach will help improve adherence to PAP therapy which will result in improvement of quality of sleep and an improvement in quality of life. This tool will benefit Veterans residing in rural areas with limited medical resources and with no access to primary care mental health integration or comprehensive sleep medicine services.

Significance: Rural Veterans have decreased access to mental health and comprehensive sleep services. This guide will serve as an effective tool to improve compliance to PAP therapy and this can result in improvement of various medical and psychiatric conditions.

Principal Applicant: Julianna B. Hogan, PhD; Houston, TX

Co-Applicants: McKenzie K. Roddy, PhD and Marylene Cloitre, PhD

About: This “Pro Tips” document will describe best practices for incorporating the web-based webSTAIR program into clinical practice. The program was designed to increase access for rural and underserved Veterans, especially for female Veterans with a history of military sexual trauma (MST). It is beneficial to Veterans who have been exposed to a trauma and are experiencing either symptoms of PTSD and/or depression. It decreases both physical (e.g., distance to clinic, transportation, childcare) and psychological (e.g., stigma, fear of coming to the clinic) barriers to mental health treatment. “Pro Tips” will include tips from experienced providers, common pitfalls and how to avoid them, and session-by-session guides describing key program content to discuss with Veterans and help them apply to own lives.

Significance: “Pro Tips” for webSTAIR will increase fidelity to the model and uptake of the program by providers. It will ease provider concerns so that more providers can deliver webSTAIR, thereby increasing reach to rural and underserved Veterans.

Principal Applicant: Austen R. Anderson, PhD; Waco, TX

Co-Applicant: Joseph Mignogna, PhD

About: These handy resource materials will encourage Veterans to engage with nature to improve their mental health and wellbeing. It will have a workbook for Veterans and their caregivers that provides psychoeducational information and cognitive-behavioral tools to help increase the quantity and quality of their exposure to natural environments. It will also have a provider manual that describes a brief intervention to help Veterans make behavior changes related to their exposure to natural environments. Both will be focused and brief, with the latter acting as a self-contained module for ongoing behavioral treatment or health behavior coaching. The intervention will encourage self-reflection, goal setting, and behavior change.

Significance: Addressing one of the eight components of health and well-being in the Circle of Health from the Whole Health approach to Veteran care (Surroundings), this product can help Veterans enhance their wellness through self-care and collaborative intervention with providers. While rural Veterans lack access to many health resources, they may have an abundance of natural environments that can help them improve their mental health by engaging in safe, meaningful, and healthy activities in nature.

Principal Applicant: Marie Mesidor, PhD; Little Rock, AR

Co-Applicant: Elizabeth Calloway, MS, RD, LD

About: This patient guide will educate Veterans who are living with mental illnesses and have a body mass index in the morbidly obese or obese range with comorbid health complications on the ongoing need for behavior change following bariatric surgery. Veterans with mental illnesses seeking surgery are more at risk for complications that result in higher use of emergency department services and hospital admissions post-surgery. Further, psychological factors significantly contribute to the approximately 20% of cases in which individuals do not experience significant weight loss following surgery. This patient guide will also help primary care and mental health providers who make referrals to the MOVE! program, which typically coordinates bariatric surgery referrals in VHA.

Significance: This guide will help rural and underserved Veterans address psychosocial and mental illness factors that may serve as barriers to approval for bariatric surgery prior to taking steps to seek surgery. Providers can use it to help Veterans prepare for success with bariatric surgery, without having to come to the main facility to meet with program staff.

Principal Applicant: Patricia Pernicano, PsyD; San Antonio, TX

Co-Applicant: Chaplain Kerry Haynes, DMin

About: This project will create and disseminate materials to increase community and mental health provider knowledge and awareness of Veteran moral injury. This curriculum will include a manual and video for a 4-week moral injury educational program. Previously piloted as a telehealth group, the 4-week course includes information about moral injury, ways in which Veterans become "stuck," responsibility and guilt, decisional release and forgiveness, and putting the event in context to move forward in life. It serves as pretreatment for cognitive processing therapy, prolonged exposure, or moral injury recovery.

Significance: There are few VA training materials available for moral injury. Integrative programming (Chaplaincy and Mental Health) has proven to be an excellent way to address this important topic. With the COVID-19 pandemic and the move of services to telehealth, these materials can help Veterans be better prepared to enter a more intensive moral injury or PTSD therapy program.