Attention A T users. To access the menus on this page please perform the following steps. 1. Please switch auto forms mode to off. 2. Hit enter to expand a main menu option (Health, Benefits, etc). 3. To enter and activate the submenu links, hit the down arrow. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links.

MIRECC/CoE

Menu
Menu

Quick Links

Veterans Crisis Line Badge
My healthevet badge
EBenefits Badge
 

VISN 2 Center for Integrated Healthcare (CIH)

CIH Color Logo

Research Core

Goals & Objectives

Key Publications

Research Projects

Pubs/Presentations

Research Goals & Objectives

Image of the Dictionary Definition of Research Our research activities focus on discovering better and more effective ways of treating mental and behavioral health problems in primary care or what VA now refers to as Patient Aligned Care Teams (PACTs). Our specific research goals and objectives are derived from VA's Uniform Mental Health Services Handbook and VA's FY 11-13 Mental Health Initiative Operating Plan: Improve Veterans' Mental Health (IVMH). Both of these documents contain specific guidelines for how VA Medical Centers and their associated Community Based Outpatient Clinics (CBOCs) are to implement integrated primary care.

Our specific research goals and objectives are:

Develop and then evaluate the efficacy and effectiveness of interventions for mental and behavioral health symptoms and disorders that are highly prevalent among Veterans in the Patient Aligned Care Teams.

Advance the understanding of the process of delivery of integrated mental and behavioral health treatment and prevention services in Patient Aligned Care Teams.

Identify and evaluate effective strategies to promote the implementation of evidenced-based primary care mental health integration services.

Return to Center for Integrated Healthcare's (CIH) Homepage

Key Publications

 

Arigo, D., Hooker, S., Funderburk, J. S., Dundon, M., Dubbert, P., Evans-Hudnall, G., Catanese, S., O'Donohue, J., Dickinson, E., DeMasi, C., Downey, S., & DeSouza, C. (2014). Provider and staff perceptions of veterans' attrition from a national primary care weight management program. Primary Health Care Research & Development, 1, 1-10. doi: 10.1017/S1463423614000139

Beehler, G. P., Funderburk, J. S., Possemato, K., & Dollar, K. (2013). Psychometric assessment of the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ). Translational Behavioral Medicine, 3, 379-391.

Beehler, G. P., Rodrigues, A. E., Kay, M., Kiviniemi, M. T., & Steinbrenner, L. (2014). Perceptions of barriers and facilitators of health behavior change among veteran cancer survivors. Military Medicine, 179, 998-1005.

Bergen-Cico, D., Possemato, K., & Pigeon, W. (2014). Reductions in cortisol associated with primary care mindfulness-based intervention for veterans with PTSD. Medical Care, 52, S25- S31.

Funderburk, J. S., Possemato, K., Liebman, R. E., & Maisto, S. A. (2013). Differences in what happens after you screen positive for depression versus hazardous alcohol use. Military Medicine, 178, 1071-1077.

Funderburk, J. S., Spinola, S., & Maisto, S. A. (2015). Mental health predictors of veterans willingness to consider research participation. Military Medicine, 180, 697-701. doi: 10.7205/MILMED-D-14-00478

Funderburk, J. S., & Shepardson, R. L. (2015). Recent advances in primary care behavioral health. Current Opinion in Psychology, 5, 37-41. doi: 10.1016/j.copsyc.2015.03.015

Funderburk, J. S., Fielder, R. L., & Krenek, M. (2015). Brief behavioral interventions for symptoms of depression and insomnia in university primary care. Journal of American College Health, 63, 398-402. doi: 10.1080/07448481.2015.1015031

Funderburk, J. S., Arigo, D., & Kenneson-Adams, A. (2015). Initial engagement and attrition in a national weight management program: Demographic and health predictors. Translational Behavioral Medicine. Advance online publication. doi: 10.1007/s13142-015-0335-y

Haibach, J., Beehler, G. P., Finnell, D., & Dollar, K. M. (2014). Moving toward integrated behavioral intervention for treating multimorbidity among chronic pain, depression, and substance-use disorders in primary care. Medical Care, 52, 322-327.

Hooker, S., Macgregor, K. L., Funderburk, J. S., & Maisto, S. A. (2014). Body mass index and depressive symptoms in primary care settings: Examining the moderating roles of smoking status, alcohol consumption, and vigorous exercise. Clinical Obesity, 4, 21-29. Doi: 10.1111/cob.12035

Kaier, E., Possemato, K., Lantinga, L. J., Maisto, S. A., & Ouimette, P. (2014). Associations between PTSD and healthcare utilization among OEF/OIF veterans with hazardous alcohol use. Traumatology.

Kearney, L. K., Wray, L. O., Dollar, K., King, P. R., & Vair, C. L. (2014). Primary care-mental health integration psychological assessment of veterans. In S. S. Bush (Ed.), Psychological Assessment of Veterans. (pp. 88-126). New York, NY: Oxford University Press.

King, P. R., Beehler, G. P., & Wade, M. (2015). Self-reported pain and pain management strategies among veterans with traumatic brain injury (TBI): a pilot study. Military Medicine, 180 (8), 863-868. DOI:10.7205/MILMED-D-14-00472

King, P. R., Vair, C. L., Wade, M., Gass, J., Kusche, A., Wray, L. O., Saludades, C., & Chang, J. (2015). Outpatient health care utilization among a sample of cognitively-impaired veterans receiving care in geriatric evaluation and management clinics. Psychological Services, 12(1), 66-72. Retrieved from: http://dx.doi.org/10.1037/ser0000015

King, P. R., Wade, M., & Beehler, G. P. (2014). Health service and medication use among veterans with persistent postconcussive symptoms. The Journal of Nervous and Mental Disease, 202, 231-238.

King, P. R., Donnelly, K.T., Wade, M., Donnelly, J.P., Dunnam, M., Warner, G., Kittleson, C.J., & Alt, M. (2014). The relationships among pre-military vocational aptitude assessment, traumatic brain injury, and post-deployment cognitive functioning in combat veterans. Archives of Clinical Neuropsychology, 29(4), 391-402. DOI:10.1093/arclin/acu011

Oslin, D. W., Lynch, K. G., Maisto, S. A., Lantinga, L. J., McKay, J. R., Possemato, K., Ingram, E., & Wierzbicki, M. (2014). A randomized clinical trial of alcohol care management delivered in Department of Veterans Affairs primary care clinics versus specialty addiction treatment. Journal of General Internal Medicine, 29(1), 162-168. doi: 10.1007/s11606-013-2625-8

Pigeon, W., Campbell, C., Possemato, K., & Ouimette, P. (2013). Longitudinal relationships of insomnia, nightmares, and PTSD severity in recent combat veterans. Journal of Psychosomatic Research, 75, 545-550.

Pigeon, W., & Funderburk, J. S. (2014). Delivering a brief insomnia intervention to depressed VA primary care patients. Cognitive and Behavioral Practice, 21(3), 252-260. doi: 10.1016/j.cbpra.2013.10.007

Pigeon, W., Allen, C., Possemato, K., Treatman, S., & Bergen-Cico, D. (2015). Feasibility and acceptability of a brief mindfulness program for veterans in primary care with posttraumatic stress disorder. Mindfulness, 6(5), 986-995.

Pomerantz, A. S., Kearney, L. K., Wray, L. O., Post, E. P., & McCarthy, J. F. (2014). Mental health services in the medical home in the Department of Veterans Affairs: Factors for successful integration. Psychological Services, 11(3), 243-253.

Possemato, K., Kuhn, E., Johnson, E., Kanurim, N., Hoffman, J., De Stefano, L., & Brooks, E. (2015). A pilot randomized controlled trial of clinician-supported PTSD Coach: Impact on PTSD and mental health treatment utilization. General Hospital Psychiatry. Advance online publication. doi: http://dx.doi.org/10.1016/j.genhosppsych.2015.09.005

Possemato, K., Marsh, L.A., & Bishop, T. M. (2013). Technology-based research and treatment approaches for post-traumatic stress disorder and substance use disorders. In P. Ouimette & J. Read (Eds.), Trauma and Substance Abuse: Causes Consequences and Treatment of Co-morbid Disorders. Washington: APA.

Possemato, K., Bishop, T. M., Willis, M. A., & Lantinga, L. J. (2013). Healthcare utilization and symptom variation among veterans using Behavioral Telehealth Center services. Journal of Behavioral Health Services & Research, 40(4), 416-426. doi: 10.1007/s11414-013-9338-y

Possemato, K., Acosta, M., Lantinga, L. J., Marsch, L., Maisto, S. A., & Rosenblum, A. A. (2014). Web-based self-management program for OEF/OIF veterans with PTSD and substance misuse: Program development and veteran feedback. Cognitive & Behavioral Practice. Advance online publication.

Possemato, K., Mckenzie, S. M., McDevitt-Murphy, S., Williams, J., & Ouimette, P. (2014). The Relationship between Post-Deployment Factors and PTSD Severity in Recent Combat Veterans. Military Psychology, 26, 15-22.

Shepardson, R. L., & Funderburk, J. S. (2014). Implementation of universal behavioral health screening in a university health setting. Journal of Clinical Psychology in Medical Settings, 21, 253-266. doi:10.1007/s10880-014-9401-8

Shepardson, R. L., Funderburk, J. S., Pigeon, W., & Maisto, S. A. (2014). Insomnia treatment experience and preferences among VA primary care patients. Military Medicine, 179 (10), 1072-1076.

Wray, L. O., Wade, M., Beehler, G. P., Hershey, L., & Vair, C. L. (2014). A program to improve identification of undiagnosed dementia in primary care and its association with health care utilization. American Journal of Geriatric Psychiatry.

Return to Center for Integrated Healthcare's (CIH) Homepage

Research Projects

CIH research investigators are conducting over 60 different research protocols. Listed below are a sample of some of those projects.

Psychometric Assessment of a Measure of Protocol Adherence for Behavioral Health Providers in Co-located Collaborative Care

Research Team Members: Gregory P. Beehler, PhD, MA; Jennifer S. Funderburk, PhD; Kyle Possemato, PhD; Katherine M. Dollar, PhD; & Dezarie J. HutchisonAbstract: This study collected data from 173 Primary Care-Mental Health Integration providers in VA primary care clinics using an online questionnaire to assess the reliability and validity of the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ). Psychometric assessment resulted in a reliable 48-item measure that demonstrated strong convergent and divergent validity, and known-group comparisons provided partial support for criterion validity. The PPAQ is a reliable and valid self-report of behavioral health provider fidelity with implications for improving provider training, program monitoring, and clinical research.

 

Keywords: primary care-mental health integration, fidelity, protocol adherence, measurement, reliability, validity

 

Return to Top of Page

 

Veteran Cancer Survivors' Perceptions of Health Behavior Change and Preventive Health Services Delivery

Research Team Members: Gregory P. Beehler, PhD, MA; Marc T. Kiviniemi, PhD; Amy Rodrigues, PhD; & Lynn Steinbrenner, MDAbstract: This study conducted qualitative interviews among 35 Veterans with a history of cancer to: 1) identify barriers and facilitators to engaging in distress management and healthy lifestyle change, and 2) preferences for an integrated survivorship wellness program. Qualitative analysis revealed six clusters of barriers and facilitators to engaging in healthy lifestyle change, and contextual themes related to the impact of cancer diagnosis, changes in identity as a cancer survivor, and living with emotional and physical side effects. Results from this study can guide the development of a Veteran-centered survivorship wellness program which may increase Veteran engagement in mental and behavioral health services.

 

Keywords: cancer survivors, wellness, healthcare integration, patient-centered care

 

Return to Top of Page

 

Identifying Measurement-based Care Practices in Co-located, Collaborative Care

Research Team Members: Gregory P. Beehler, PhD, MA; Paul King, PhD, Christina Vair, PhD, Jennifer S. Funderburk, PhD; & Kaitlin Lilienthal, PhDAbstract: Measurement-based care refers to the use of screening and ongoing symptom monitoring to guide treatment selection and treatment modifications to improve outcomes for chronic health conditions. The aim of measurement-based care is to rapidly and precisely diagnose diseases in order to improve shared treatment planning between providers and patients. This study will examine the extent to which VA Co-located, Collaborative Care (CCC) providers are engaging in measurement-based care principles by conducting an audit of electronic medical record data from VISN 2. Specifically, this study will 1) describe CCC providers’ use of standardized measures for mental health symptoms or functional outcomes related to depressive disorders, anxiety disorders,and/or PTSD; and 2) identify the prevalence of documented measurement-based care elements across the trajectory of care (i.e., initial assessment, behavioral intervention linked to assessment,outcome monitoring, and treatment modification).

 

Keywords: mental health, primary care, measurement, screening

 

Return to Top of Page

 

Prevalence and Correlates of Eating Behaviors among Women Veterans in Primary Care.

Research Team Members: Laura J. Buchholz, PhD; Paul King, PhD,; & Laura O. Wray, PhD Abstract: Given that women are a growing subset of the active duty military and Veteran populations, research examining women’s health is a top priority for the Veterans Health Administration (VHA). Eating disorders (EDs) are more prevalent among women Veterans than their male counterparts, and have a higher prevalence among Veterans than community samples. Although eating pathology is associated with various physical and mental health comorbidities that are common within primary care settings, limited research has examined the rates and correlates of eating pathology among women within primary care. Primary care is an important setting to detect and assess eating pathology, given that women with EDs are not likely to seek treatment, and when they do, they are more likely to see a primary care provider than a mental health professional. Thus, the purpose of this pilot grant is to extend the existing literature by examining the rates and correlates of eating disorder symptomatology among women Veterans who use primary care for services. A secondary aim of this pilot grant is to obtain detailed information regarding treatment preferences for eating pathology among women Veterans who use primary care. Results of this study will lay the groundwork for a future grant application to examine early detection and intervention of women at high risk for developing EDs.

 

Keywords: women Veterans, primary care, eating behaviors, depression, PTSD, alcohol use

 

Return to Top of Page

 

A Pilot Study of the Effects of Brief Behavioral Activation on Depression and Suicidal Ideation

Research Team Members: Jennifer S. Funderburk, PhD; Wilfred R. Pigeon, PhD; & Stephen A. Maisto, PhDAbstract: Depressive symptoms are the most common referral problem mental health providers report seeing in VA primary care settings. However, the most significant barrier to providing empirically-based brief psychotherapies for depression in primary care is treatment duration. Behavioral Activation (BA) is an intervention that focuses on helping the patient systematically engage in pleasurable activities in an effort to increase response-contingent reinforcement. Although research has established the traditional format of BA (7-20 sessions) as an efficacious treatment for depression, there are no published studies testing whether a briefer BA intervention in primary care is efficacious. The present study collected preliminary data to evaluate a 4-session version of BA(BA-PC) as an intervention for Veterans presenting with a full range of depressive symptoms within a primary care setting.

 

Keywords: depression, behavioral activation, brief intervention

 

Return to Top of Page

 

Patients with Multiple Risk Factors: How Can We Help Them?

Research Team Members: Jennifer S. Funderburk, PhD; & Stephen A. Maisto, PhDAbstract: There is a need for more research on interventions that can address co-occurring risk factors of alcohol misuse, smoking, overweight/obesity, and symptoms of posttraumatic stress and depression, which are predictive of higher use of healthcare services and overall poorer health among Veterans. Prior to designing the intervention, it is important to further understand which aspects these Veterans will prefer. Therefore, the goals of this study are to collect data (via a telephone interview and chart review) to increase understanding of the existing interventions typically employed to target these symptoms, patients’ receptivity to existing and new interventions, and their perceived barriers to engaging in specific interventions. This information will be used to tailor healthcare services to patients and settings, thereby enhancing healthcare efficiency and decreasing healthcare utilization.

 

Keywords: treatment preferences, alcohol, posttraumatic stress

 

Return to Top of Page

 

Enhanced Behavioral Activation for Patients with Hypertension and Depression

Research Team Members: Jennifer S. Funderburk, PhD; Kimberly Barrie, MPH, LCSW; & Kyle Possemato, PhDAbstract: Due to the prevalence of hypertension (HTN) and depression and the associated negative consequences for Veterans experiencing these disorders, treatments that can address the co-occurrence of symptoms are necessary. Enhancing behavioral activation, an evidence-based treatment for depression, with exercise, an intervention that targets HTN and depression, may be one way to address the co-occurrence of symptoms. In addition, engaging Veterans in a group medical visit that includes an intervention, such as BA and exercise, may be one way to engage more Veterans in treatment and improve health due to the involvement of the PACT team and the potential for de-stigmatizing treatment by decreasing the emphasis on depression.

 

Keywords: hypertension, depression, exercise, behavioral activation

 

Return to Top of Page

 

Brief Alcohol Training for Integrated Providers in Primary Care

Research Team Members: Jennifer S. Funderburk, PhD; & Stephen Maisto, PhDAbstract: This study will help improve the quality of trainings for behavioral health providers (BHPs) implementing brief alcohol interventions. Objectives of this study are to evaluate a previously delivered Center for Integrated Healthcare (CIH) in-person workshop for BHPs implementing brief alcohol interventions in primary care; collect feedback and suggestions on how to improve the workshop and translate it into a webinar; evaluate the workshop when translated into a webinar and describe participant’s feedback regarding the usefulness of the workshop in clinical practice, level of understanding of the components of a brief alcohol interventions, and suggestions on how the webinar could be improved.

 

Keywords: alcohol, brief intervention, training, evaluation

 

Return to Top of Page

 

MOVE! Attrition Study 2: Objective Predictors of Attrition and Attendance in MOVE!

Research Team Members: Jennifer S. Funderburk, PhD; Arigo, D.Abstract: The purpose of this data pull is to explore demographic attributes related to attrition and attendance in the VA’s MOVE!® weight management program. Identifying factors associated with attrition will serve two goals. The immediate goal is to inform the design of a new survey; this future survey study will investigate veterans’ perceptions of attrition from MOVE! and individuals’ reasons for discontinuing participation. The long-term goal is to educate MOVE! providers about experiences relevant to dropout. This education will help providers minimize attrition, thereby maximizing the program’s reach and effectiveness.

 

Keywords: weight management, MOVE!, obesity, attrition, veteran perceptions

 

Return to Top of Page

 

Feasibility of Assessing Daily Fluctuations in Modifiable Behaviors and Mood Symptoms in Veterans with Affective Disorders

Research Team Members: Jennifer S. Funderburk, PhD; & Stephen A. Maisto, PhDAbstract: In this pilot project, Ecological Momentary Assessment (EMA) methods will be used to study the effects on mood of daily fluctuations of factors related to circadian rhythm, including sleep patterns, eating habits, exercise and alcohol consumption. EMA data will be collected from Veterans three times per day for 6 weeks. These data will be collected via a customized app on a secure mobile device (iPod touch). The feasibility of collecting EMA data on this platform will be assessed by participant compliance with the protocol and qualitative feedback. This pilot project will also provide preliminary data on the effect of health behaviors on subsequent positive and negative mood symptoms in Veterans with affective disorders seen in a primary care setting. The feasibility information and preliminary data from this pilot study will inform a larger study of health behavior and mood symptoms among Veterans with affective disorders. The data may form the foundation for the development of an Ecological Momentary Intervention (EMI), which is based on self-monitoring to improve patient’s understanding of the relationship between health behaviors and mood symptoms. EMI potentially can be used as an adjunct to traditional treatment or as a stand-alone therapeutic approach, under the guidance of a behavioral health provider. Therefore, treatment and management strategies that can be self-directed and/or provided in a primary care setting, such as mobile technology-based EMI, may provide an appealing option to Veterans with affective disorders.

 

Keywords: ecological momentary assessment, mood disorders, mobile technology, circadian rhythm

 

Return to Top of Page

 

Evaluation of Barriers and Facilitators to Mental Health Treatment Utilization Among Primary Care Veterans

Research Team Members: Emily M. Johnson, PhD; Kyle Possemato, PhD; & Brad Webster, BAAbstract: The primary goal of this study is to conduct a comprehensive assessment of barriers and facilitators to mental healthcare utilization in order to investigate which of the domains of mental healthcare barriers/facilitators are most closely associated with treatment utilization in primary care Veterans. This study involves asking Veterans who have or have not recently used mental health treatment about multiple domains of potential mental healthcare barriers and facilitators along with medical record reviews to evaluate mental health service utilization. We are recruiting primary care Veterans representing a range and variety of mental health concerns and treatment experiences; conducting a telephone interview; administering measures of mental healthcare barriers, facilitators, and related concepts; assessing patient needs, resources, and engagement; and assessing medical record data on VHA mental health treatment utilization. We hope to learn about how to design interventions to reduce barriers and better engage with and meet the needs of Veterans in primary care.

 

Keywords: mental health, behavioral health, utilization, access, barrier, facilitators

 

Return to Top of Page

 

Knowledge, Symptom Perception, and Treatment Experiences of Veterans with Traumatic Brain Injury (TBI) in Primary Care

Research Team Members: Paul King, PhD; Laura O. Wray, PhD; & Gregory Beehler, PhD, MAAbstract: This project aims to elicit Veterans’ comprehension of TBI, symptom experiences and attributions, and perceptions of their care and recovery, particularly within the VA primary care setting. Veterans with TBI history who use VA Primary Care services, including co-located, collaborative care, have been invited to participate. Telephone interviews and self-report surveys are being employed to explore Veterans’ understanding of TBI, perceptions of manifest symptoms, and processes and experiences involved in their personal care.

 

Keywords: integrated primary care, traumatic brain injury (TBI), recovery, perceptions of Veterans

 

Return to Top of Page

 

Veterans’ priorities for assessment and treatment in VHA Primary Care-Mental Health Integration (PC-MHI) Services

Research Team Members: Paul King, PhD; Gregory Beehler, PhD, MA; Laura J. Buchholz, PhD; Emily Johnson, PhD; &  Laura O. Wray, PhDAbstract: Primary Care-Mental Health Integration (PC-MHI) services differ significantly in scope from traditional outpatient mental health services, in that PC-MHI interventions tend to focus on a broad array of patients’ current problems and solutions as opposed to diagnosis-specific assessment and intervention. Despite differences in scope, measurement of treatment outcomes is nonetheless important. Although administrative data indicate that the most common conditions addressed in PC-MHI include depression, anxiety, PTSD, and alcohol misuse, prior CIH studies in VISN2 have demonstrated that PC-MHI providers are not likely to utilize standardized outcome measures that directly pertain to these conditions. Instead, PC-MHI providers appear more likely to utilize idiographic evaluations of functional domains when working with patients. This finding suggests that a potential disconnect exists between the content of extant nomothetic measures that are primarily focused on specific diagnoses (e.g., Patient Health Questionnaire-9 for depression), and what clinical stakeholders themselves identify as priorities for assessment, intervention, and outcome monitoring. In particular, documentation of Veterans’ perspectives on priorities for PC-MHI evaluation and intervention is scant. Therefore, the primary purpose of this proposed pilot grant is to conduct a patient-centered survey to identify and describe Veterans’ priorities for, and perspectives on, PC-MHI care. These data will directly support Dr. King’s (PI) future Career Development Award resubmission that is aimed at developing a brief, patient-centered functional assessment tool suitable for use in PC-MHI. In particular, results will be used to ensure that Veteran priorities and values are reflected during the process of building the item pool in this future application. Additional aims are to describe the relationship between Veterans’ opinions on functional priority areas, perspectives regarding receipt of PC-MHI services, and whether functional problem areas predict utilization of related mental health care services.

 

Keywords: primary care-mental health integration(PC-MHI) services, veterans, patient-centered approaches, measurement-based care

 

Return to Top of Page

 

Clinician Supported PTSD Coach for Primary Care Veterans with PTSD

Research Team Members: Kyle Possemato, PhD; Eric Kuhn, PhD; Emily Johnson, PhD;  Kimberly Barrie, MPH,LCSWAbstract: A series of studies are being conducted with the goal of improving PTSD treatment services for primary care Veterans using the PTSD Coach mobile application. A qualitative study of mental health and primary care leadership and providers is collecting stakeholder feedback to develop a PTSD Coach Care Management manual. A pilot randomized controlled trial compared Clinician-Supported PTSD Coach to Self-Managed PTSD Coach and found that clinician support was associated with more symptom relief and higher rates of mental health care utilization. A HSR&D-funded multisite trial will being in 2016 to test the effectiveness of Clinician-Supported PTSD Coach in reducing PTSD symptoms in primary care veterans.

 

Keywords: PTSD, primary care, mobile applications, clinician support

 

Return to Top of Page

 

Web-based Cognitive Behavioral Therapy for OEF/OIF Veterans with PTSD and Hazardous Alcohol Use.

Research Team Members: Kyle Possemato, PhD; Emily Johnson, PhDStephen Maisto, PhDKimberly Barrie, MPH, LCSW; Wade Goldstein, MS; Bronte Emery, BA; Leigha De Stefano, BAAbstract: A team within the CIH has partnered with investigators at the National Development Research Institutes to develop and test the effectiveness of a web-based cognitive behavioral treatment that teaches skills for managing PTSD symptoms and reducing substance use in primary care patients. In a NIAAA-funded study we gathered Veterans' feedback to develop the intervention and then tested it in a multisite randomized clinical trial. We found that the program significantly reduced alcohol use among veterans. Dr. Possemato is now leading a pilot study to incorporate peer support specialists into the delivery of the web-based treatment with the goal of increased veterans engagement in the treatment modules and boosting the effects on PTSD symptoms.

 

Keywords: PTSD, hazardous alcohol use, primary care, peer support specialists, CBT

 

Return to Top of Page

 

Referral Management System for Primary Care Patients with PTSD

Research Team Members: Kyle Possemato, PhD;   Laura O. Wray, PhD;   Emily Johnson, PhD;   Tracy Stecker, PhD;   Brad Webster,BAAbstract: This line of research seeks to address the low rates of engagement in evidence-based psychotherapy for PTSD in primary care patients by addressing both patient-level and system level barriers. A MH QUERI-funded study was conducted that implemented a Referral Management System to address patient-level barriers with the delivery of a 1-session cognitive-behavioral therapy intervention to identify and change treatment seeking beliefs. System-level barriers were addressed by phone contacts to assist veterans in attending appointments and primary care staff trainings on how to implement clinical practice guidelines for PTSD. The Referral Management System was associated with more patient engagement in PTSD specialty care and stakeholder feedback is now being used to guide further development and testing of this system.

 

Keywords: PTSD, primary care, evidence-based treatment, treatment engagement, CBT

 

Return to Top of Page

 

Primary Care-Based Mindfulness Training for Veterans with PTSD

Research Team Members: Kyle Possemato, PhD;   Wilfred Pigeon, PhD;   Dessa Bergen-Cico, PhD;   Scott Treatman, DOAbstract: This line of research is testing the effectiveness of a primary care-based mindfulness training in Veterans with PTSD. The training consists of 4 group classes and is based on Mindfulness Based Stress Reduction. In a pilot study we found that participation in mindfulness training was associated with significant decreases in PTSD and depression severity compared to Veterans who did not participate. Further research is planned to train VA mental health providers and peer support specialists to jointly deliver these classes and to conduct a larger test of the effectiveness of primary care-based mindfulness training.

 

Keywords: PTSD, primary care, mindfulness, peer-support specialistsReturn to Top of Page

 

Veteran Preferences for Treating Post-traumatic Stress Disorder

Research Team Members: Kyle Possemato, PhD; Laura O. Wray, PhD; Gregory P. Beehler, PhD, MAAbstract: The study takes a patient-centered approach to collect qualitative data via focus groups of Veteran primary care patients with a chart diagnosis of PTSD who are not actively engaged in PTSD treatment. Data are collected on Veterans’: 1) interests/ motivations for treatment, 2) perceived barriers and facilitators for treatment, 3) presenting concerns regarding PTSD symptoms, and 4) treatment preferences.

 

Keywords: PTSD, primary care, treatment preferences, barriers, facilitators, treatment

 

Return to Top of Page

 

Riluzole for PTSD: Efficacy of a Glutamatergic Modulator as Augmentation Treatment for Posttraumatic Stress Disorder

Research Team Members: Kyle Possemato, PhD; Larry J. Lantinga, PhD; Shannon McKenzie, BA; Bronte Emery, BA; Leigha De Stefano, BA; & David Benedek, MDAbstract: Dr. Possemato serves at the local PI for this Department of Defense funded project led by Col. David Benedek from the Walter Reed National Military Medical Center. This is a randomized controlled trial comparing Riluzole medication to placebo in OEF/OIF Veterans who are currently prescribed an antidepressant medication for PTSD but continue to experience significant symptoms. This study investigates if Riluzole efficaciously and safely augments antidepressant medication in reducing PTSD and other mental health symptoms.

 

Keywords: PTSD, antidepressant medication, Riluzole, OEF/OIF veterans

 

Return to Top of Page

 

Comorbid Tobacco Use and Hazardous Alcohol Use Among Veterans in Primary Care

Research Team Members: Jennifer M. Wray, PhD; Jennifer S. Funderburk, PhD; & Stephen Maisto, PhDAbstract: Tobacco use and hazardous alcohol use are among the top preventable causes of death in the United States. Research outside of the Veteran’s Affairs Healthcare System indicates that tobacco use and hazardous drinking tend to co-occur, but prevalence rates from a Veteran sample have not been reported. While integrated treatments addressing comorbid smoking and hazardous drinking have demonstrated some efficacy, the adaptation of these treatments for the primary care setting (and with a Veteran sample) have not yet been tested. We aim to identify strategies that can be used to engage this subset of Veterans in treatment for comorbid tobacco use and alcohol misuse. Results from this pilot project will help inform the demand for and feasibility of an integrated intervention for tobacco use and hazardous drinking in VA primary care.

 

Keywords: primary care-mental health integration, tobacco use, at-risk drinking, comorbidity, Veterans

 

Return to Top of Page

 

Facilitators and Barriers to Recovery-Oriented Mental Health Services in Primary Care

Research Team: Laura O. Wray, PhD; Stephen A. Maisto, PhD, Gregory P. Beehler, PhD; Emily Pikoff-Mirwis, PhD, Paul King, PhD; Christina Vair, PhD; & Johnpatrick Marr, BAAbstract: Prior studies have demonstrated that Primary Care – Mental Health Integration contributes to positive outcomes, including: increased patient engagement, symptom reduction, and improved access to evidence-based MH treatments. However, little is known about patients' perceptions of these services. This study uses qualitative, focus group methods to better understand Veterans' perceptions of barriers and facilitators to mental health treatment in primary care within the VA healthcare system. It also examines Veterans' attitudes towards primary care screening for early signs of memory impairment. Finally, as part of the VHA's efforts to adopt the recovery model for mental health services, this study seeks Veteran input on ways to make VA mental health services more recovery oriented. The results of this study will be useful in understanding Veteran perceptions of MH services and recovery-oriented care, and in improving access to effective MH treatment to Veterans from all service eras.

 

Keywords: primary care-mental health integration, veteran perceptions of mental health services, recovery-oriented care, qualitative research

 

Return to Top of Page

 

Gaps in Primary Care of Dementia

Research Team: Laura O. Wray, PhD; J. Riley McCarten, MD; Maurice Dysken, MD; Gregory Beehler, PhD; Christina Vair, PhD; & Johnpatrick Marr, BAAbstract: The prevalence of dementia in VA primary care patients has been estimated to be 11% in Veterans aged 70 and older. Nationally, people with dementia, Veterans included, use more health care services, visit the ER more frequently, and stay longer in the hospital than their age-peers. This pattern suggests that the quality of care they receive can be improved. The Veterans Health Administration primary care system is being transformed into Patient Aligned Care Teams (PACT) that include integrated mental health staff. This transformation will allow us to improve care for Veterans with dementia, but only if their needs are addressed. This study lays the groundwork for quality improvement by examining the barriers and facilitators to excellent PACT care for Veterans with dementia and by identifying the gaps in care at the patient, family, provider and system level.

 

Keywords: dementia, primary care-mental health integration, patient aligned care teams, quality of care, qualitative research

 

Return to Top of Page

 

Association of VISN 2 RAPID Program and Incidence of Dementia in Primary Care: A Program Evaluation Project

Research Team Members: Laura O. Wray, PhD; Gregory P. Beehler, PhD, MA; Michael Wade, MS; Christina Vair, PhD; & Johnpatrick K. Marr, BAAbstract: The primary objective of this project is to evaluate the association between the VISN 2 RAPID Dementia Case Finding program and recognition of dementia in older Primary Care Veterans as measured by incidence of new dementia diagnosis across VISN 2. Additionally, we seek to examine the success of the VISN 2 RAPID Program in identifying Veterans at increased risk based for undiagnosed dementia based on risk factors gleaned from the electronic medical record. Finally, we are seeking to develop and pilot a methodology for chart review evaluation of the impact of the RAPID program on processes of care in the Primary Care setting. Results will be used to develop power estimates for future studies.

 

Keywords: dementia, primary care patients, cas finding, undiagnosed dementia

 

Return to Top of Page

 

Return to Center for Integrated Healthcare's (CIH) Homepage

Publications and Presentations

The publications and presentations by Center for Integrated Healthcare's personnel are listed below by calendar year:

Return to Center for Integrated Healthcare's (CIH) Homepage