Document text
Principal Investigator: Ippolytos Andreas Kalofonos
Organization: VA GREATER LOS ANGELES HEALTHCARE SYSTEM
Fiscal Year: 2024
Funding agency: Veterans Affairs
Veterans with Serious Mental Illness (SMI) struggle with social integration - participation in work, housing, and
citizenship - due to symptoms, stigma, and psychosocial functioning deficits. This has a tremendous impact on
mortality, comparable to that of smoking and greater than obesity and alcohol abuse. Despite considerable VA
efforts to provide mental health care to Veterans with SMI, programs that promote social integration are
lacking. Veterans with SMI are at especially high risk for poor social integration and suicidal ideation during the
COVID-19 pandemic. There is an urgency to advance treatments targeting Veterans' social integration.
This project addresses this need with a group-based, peer specialist (PS) co-facilitated psychosocial
intervention for Veterans with SMI, called “Veteran Voices and Visions” (VVV). VVV targets Veterans with SMI
who experience psychosis, a group particularly in need of support with social integration. Virtual VVV groups
are co-led by VA mental health clinicians (MHCs) and PSs via online video conference. VVV is an adaptation
of a community-based support group model called the Hearing Voices (HV) approach that was developed over
30 years ago in the Netherlands. It has since spread to over twenty-five countries, representing hundreds of
support groups worldwide. The approach facilitates group cohesion around and normalization of the common
psychotic symptoms of SMI: hallucinations, delusions, and social isolation. Despite its global scope, this
approach has neither been formally adapted nor rigorously studied in public health systems, including the VA.
This intervention has the potential to create and foster a supportive community that improves the social
integration of participants by reducing their distress and self-stigma, and increasing self-efficacy. These three
process outcomes are strongly associated with social integration. This proposal is directly aligned with VA
priorities to advance the breadth of existing psychosocial interventions for Veterans with SMI, improve access
via telehealth services, and support Veterans' independence, wellbeing, empowerment, and whole health.
The goal of this proposal is (1) to develop a manual, training guidelines, and a fidelity scale for VVV, (2) to
assess the feasibility and acceptability of VVV, and (3) collect pilot outcome data. The manual, training
guidelines, and fidelity scale will be developed by the research team in collaboration with 4 advisory panels:
Veterans with SMI, MHCs, PSs, and non-VA experts in HV. Then, 5 MHCs and 5 PSs will be trained to use the
new VVV manual, and each MHC-PS pair will conduct a group with the new protocol. Thirty Veterans will be
recruited to participate in these 5 groups and assessments will be conducted at baseline, midpoint, and post-
intervention. Baseline assessments include measurement of psychiatric symptoms, level of distress from
psychosis, internalized self-stigma, self-efficacy, sense of belonging, recovery, and social integration. Follow-
up assessments conducted at 10 and at 20 weeks will include these same measurements as baseline, as well
as a survey and qualitative interview on intervention acceptability. Feasibility data on numbers approached,
enrolled, and retained, and treatment fidelity will be collected. Fidelity will be assessed in two ways: (1)
facilitators will complete self-administered reflection worksheets after each session and (2) research team
members will rate 5 randomly selected audio-recorded sessions from each group for formal fidelity ratings.
The goal of the within-subjects trial evaluating feasibility and acceptability of the manualized VVV protocol for
improving self-efficacy, self-stigma and social functioning in Veterans with psychosis. To that end, the study
will be run using the full collection of measures that would be included in a subsequent RCT. However, since
the study is designed to assess whether the proposed intervention can be successfully implemented in the
target population and to evaluate the properties of a candidate set of outcome measures, rather than
demonstrate efficacy, most of the analyses will be descriptive. This will lay the groundwork for a future Merit
that will support a controlled efficacy study.
Terms: <Address><Alcohol abuse><Belief><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Caring><Collaborations><Collection><Communities><Country><Curiosities><Data><Dedications><Delusions><Development><Distress><Education><Educational aspects><Employment><Enrollment><EtOH abuse><Feeling suicidal><Fostering><Frequencies><Friendships><Future><Geography><Goals><Grant><Guidelines><Hallucinations><Health Services><Health system><Hearing><Housing><Improve Access><Intervention><Intervention Strategies><Interview><Jobs><Life><Link><Loneliness><Manuals><Marriage><Measurement><Measures><Mental Health><Mental Health Services><Mental Hygiene><Mental Hygiene Services><Meta-Analysis><Modeling><Netherlands><Obesity><Occupations><Outcome><Outcome Measure><Participant><Personal Satisfaction><Phase><Population><Process><Professional Positions><Property><Protocol><Protocols documentation><Psychological Health><Psychoses><Psychotic Disorders><Public Health><QOL><Quality of life><Random Allocation><Random Selection><Recovery><Research><Running><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Safety><Self Administered><Self Administration><Self Efficacy><Self-Help Groups><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Sight><Smoking><Social Functioning><Social isolation><Specialist><Standardization><Suicidal thoughts><Support Groups><Survey Instrument><Surveys><Symptoms><Target Populations><Training><Training Programs><Transportation><Trust><Veterans><Vision><Voice><Vulnerable Populations><Work><acceptability and feasibility><adiposity><adverse consequence><adverse outcome><alcohol co-abuse><alcohol problem><chronic mental illness><cohesion><conference><convention><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><corpulence><design><designing><developmental><disparate effect><disparate impact><disparate result><efficacy study><empowerment><enroll><ethanol abuse><experience><follow up assessment><followup assessment><function socially><functioning social><hazardous alcohol use><health related quality of life><high risk><improved><inequitable effect><inequitable impact><inequitable outcome><innovate><innovation><innovative><insight><internalized stigma><interventional strategy><lonely><measurable outcome><member><mental health care><mental healthcare><mortality><outcome disparities><outcome inequality><outcome inequity><outcome measurement><peer><peer support><persistent mental illness><pilot trial><post intervention><problem alcohol use><problem drinking><problematic alcohol consumption><problematic alcohol use><programs><psychiatric symptom><psychosocial><psychotic illness><psychotic symptoms><recruit><remediation><self help organization><self-stigma><serious mental disorder><serious mental illness><service engagement><services engagement><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><severe mental disorder><severe mental illness><social integration><social movement><social stigma><stigma><suicidal ideation><suicidal risk><suicidal thinking><suicide ideation><suicide risk><summit><symposia><symposium><telehealth><thoughts about suicide><unequal effect><unequal impact><unequal outcome><videoconference><videoconferences><virtual><virtual platform><visual function><vulnerable group><vulnerable individual><vulnerable people><well-being><wellbeing><whole health><whole person health>