Karen H Seal1,2, Jeffrey M Pyne3,4, Jennifer K Manuel1,5, Yongmei Li1, Christopher J Koenig1,6, Kara A Zamora1, Traci H Abraham3,4,7, Marie M Mesidor8, Coleen Hill1, Madeline Uddo9,10, Michelle Hamilton9,10, Brian Borsari1,5, Daniel Bertenthal1, James J Casey1, P Adam Kelly9,10. 1. San Francisco Veterans Affairs Health Care System, San Francisco, California, USA. 2. Departments of Medicine and Psychiatry, University of California San Francisco, San Francisco, California, USA. 3. Department of Veterans Affairs, Center for Mental Healthcare & Outcomes Research, Health Services Research and Development, Little Rock, Arkansas, USA. 4. Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. 5. Department of Psychiatry, University of California San Francisco, San Francisco, California, USA. 6. Department of Communication Studies, San Francisco State University, San Francisco, California, USA. 7. Department of Veterans Affairs, South Central Mental Illness Research Education Clinical Center (MIRECC), Little Rock, Arkansas, USA. 8. Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA. 9. Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana, USA. 10. Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Abstract
PURPOSE: To determine the effectiveness of telephone motivational coaching delivered by veteran peers to improve mental health (MH) treatment engagement among veterans. METHODS:Veterans receiving primary care from primarily rural VA community-based outpatient clinics were enrolled. Veterans not engaged in MH treatment screening positive for ≥1 MH problem(s) were randomized to receive veteran peer-delivered feedback on MH screen results and referrals plus 4 sessions of telephone motivational coaching (intervention) versus veteran peer-delivered MH results and referrals without motivational coaching (control). Blinded telephone assessments were conducted at baseline, 8, 16, and 32 weeks. Cox proportional hazard models compared MH clinician-directed treatment initiation between groups; descriptive analyses compared MH treatment retention, changes in MH symptoms, quality of life, and self-care. FINDINGS: Among 272 veterans screening positive for ≥1 MH problem(s), 45% who received veteran peer telephone motivational coaching versus 46% of control participants initiated MH treatment (primary outcome) (hazard ratio: 1.09, 95% CI: 0.76-1.57), representing no between-group differences. In contrast, veterans receiving veteran peer motivational coaching achieved significantly greater improvements in depression, posttraumatic stress disorder and cannabis use scores, quality of life domains, and adoption of some self-care strategies than controls (secondary outcomes). Qualitative data revealed that veterans who received veteran peer motivational coaching may no longer have perceived a need for MH treatment. CONCLUSIONS: Among veterans with MH problems using predominantly rural VA community clinics, telephone peer motivational coaching did not enhance MH treatment engagement, but instead had positive effects on MH symptoms, quality of life indicators, and use of self-care strategies.
RCT Entities:
PURPOSE: To determine the effectiveness of telephone motivational coaching delivered by veteran peers to improve mental health (MH) treatment engagement among veterans. METHODS: Veterans receiving primary care from primarily rural VA community-based outpatient clinics were enrolled. Veterans not engaged in MH treatment screening positive for ≥1 MH problem(s) were randomized to receive veteran peer-delivered feedback on MH screen results and referrals plus 4 sessions of telephone motivational coaching (intervention) versus veteran peer-delivered MH results and referrals without motivational coaching (control). Blinded telephone assessments were conducted at baseline, 8, 16, and 32 weeks. Cox proportional hazard models compared MH clinician-directed treatment initiation between groups; descriptive analyses compared MH treatment retention, changes in MH symptoms, quality of life, and self-care. FINDINGS: Among 272 veterans screening positive for ≥1 MH problem(s), 45% who received veteran peer telephone motivational coaching versus 46% of control participants initiated MH treatment (primary outcome) (hazard ratio: 1.09, 95% CI: 0.76-1.57), representing no between-group differences. In contrast, veterans receiving veteran peer motivational coaching achieved significantly greater improvements in depression, posttraumatic stress disorder and cannabis use scores, quality of life domains, and adoption of some self-care strategies than controls (secondary outcomes). Qualitative data revealed that veterans who received veteran peer motivational coaching may no longer have perceived a need for MH treatment. CONCLUSIONS: Among veterans with MH problems using predominantly rural VA community clinics, telephone peer motivational coaching did not enhance MH treatment engagement, but instead had positive effects on MH symptoms, quality of life indicators, and use of self-care strategies.