Literature Collection

OBJECTIVES: This study aimed to develop a brief, Veteran-targeted intervention to educate and activate Veteran engagement in patient-centered mental health care and test its feasibility, acceptability, and preliminary efficacy. METHODS: Participatory action research methods were used with Veterans, VA clinicians, and VA researchers to develop a Veteran engagement intervention. Once developed, qualitative interviews were conducted with participants in a ten-person acceptability trial. This was followed by a pilot randomized controlled trial (n = 48) to test feasibility and explore preliminary efficacy. RESULTS: Omnis Salutis is a three session, individual intervention grounded in Motivational Interviewing, which aims to help Veterans identify their well-being goals and be an active leader in their mental health care. Acceptability was confirmed in qualitative interviews, with participants noting that Veterans are socialized to hierarchical provider relationships and Omnis Salutis was an effective method of activating Veterans. Feasibility of interventionist training and intervention delivery was demonstrated both in-person and on the telehealth platform with 41 Veterans completing three sessions of the experimental and control conditions and interventionists demonstrating over 90 % fidelity to the intervention. Though not statistically powered, at three months post-exposure, there were small effect size indicating that Omnis Salutis participants may have greater self-reported involvement in care and lower perceptions of their providers' patient-centeredness than the control. CONCLUSIONS: Omnis Salutis was developed to support recent Veterans preference for multi-faceted mental health care which supports their functional recovery, and VA's efforts to create a patient-centered, Whole Health system of care. PRACTICE IMPLICATIONS: Providers should be aware that Veterans have been socialized in a hierarchical health care system. Veterans may need additional time and education to understand the patient-centered approach and learn new ways of engaging in health care. Further research is needed to determine if Omnis Salutis increases patients' ability to effectively participate in health care encounters and self-care behaviors by increasing their ability to identify and communicate their health care goals and motivations.

Chronic insomnia is commonly reported in primary care settings. One-session cognitive behavioural therapy for insomnia (CBT-I) is a brief intervention designed to fit the fast-paced nature of primary care but has not been studied in this context. This preliminary study assessed the effectiveness of one-session CBT-I in an integrated primary care clinic. Adult patients (N = 37) with clinically elevated insomnia symptoms were randomly assigned to receive either one-session CBT-I (n = 17) or an active attentional control (n = 20). The primary outcomes included insomnia symptoms, total wake time (TWT) and sleep efficiency (SE). Outcomes were assessed at baseline, post-treatment, 1-month post-treatment and 3-months post-treatment. At post-treatment, the CBT-I group showed greater improvements than the control group in TWT and SE, and these differences persisted at the 1-month follow-up. The CBT-I group also demonstrated larger reductions in insomnia symptoms than controls at 1- and 3-month follow-ups. More specifically, the CBT-I group demonstrated significant improvements in TWT, mean (SD) change = -57.0 min (57.5) and SE, mean (SD) change = 8.8% (9.3). At 1 month, these improvements persisted, with sustained improvements in TWT, mean (SD) change = -62.1 min (44.3) and SE, mean (SD) change = 10.8% (9.5), for the CBT-I group. Additionally, CBT-I participants reported significantly lower insomnia symptoms at 1 month, mean (SD) change = -6.4 (3.9) and 3 months post-treatment, mean (SD) change = -7.3 (4.2). This study provides preliminary support for using one-session CBT-I to treat clinically elevated insomnia symptoms in primary care.