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Problem-solving training for Veterans in home based primary care: an evaluation of intervention effectiveness

Published online by Cambridge University Press:  18 January 2021

Sherry A. Beaudreau ,
Michele J. Karel ,
Jennifer S. Funderburk ,
Arthur M. Nezu ,
Christine Maguth Nezu ,
Ann Aspnes  and
Julie Loebach Wetherell
Sherry A. Beaudreau*
Affiliation:
Psychiatry Service, Sierra Pacific Mental Illness, Research, Education and Clinical Centers (MIRECC), Veterans Affairs Palo, Alto Health Care System, Palo Alto, CA, USA Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
Michele J. Karel
Affiliation:
Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, DC, USA
Jennifer S. Funderburk
Affiliation:
VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA Department of Psychiatry, University of Rochester, Rochester, NY, USA
Arthur M. Nezu
Affiliation:
Department of Psychology, Drexel University, Philadelphia, PA, USA
Christine Maguth Nezu
Affiliation:
Department of Psychology, Drexel University, Philadelphia, PA, USA
Ann Aspnes
Affiliation:
Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, DC, USA
Julie Loebach Wetherell
Affiliation:
Mental Health Service, Home-Based Primary Care, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA Department of Psychiatry, University of California, San Diego, CA, USA
*
Correspondence should be addressed to: Sherry A. Beaudreau, Veterans Affairs Palo Alto Health Care System, Psychiatry/MIRECC (151Y), 3801 Miranda Ave, Palo Alto, CA 94304, USA. Phone: +1(650) 493-5000 x64119; Fax: +1(650) 852-3297. Email: [email protected].
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Abstract

Background:

Veterans enrolled in Veterans Health Administration (VHA) Home Based Primary Care (HBPC), a program providing in-home medical and mental health care by an interdisciplinary care team, often face substantial physical, cognitive, and mental health challenges. This program evaluation examined the impact of a brief problem-solving intervention on depressive symptoms, quality of life, and problem-solving abilities for Veterans enrolled in HBPC.

Design:

Pre- and post-intervention outcomes for Veterans, and qualitative feedback from Veterans and clinicians regarding program satisfaction.

Participants and Setting:

A total of 230 HBPC patients (mean age in years = 72.1, SD = 11.6) within the U.S. national VHA health care system.

Intervention:

Six-session, individual Problem-Solving Training (PST-HBPC).

Method:

Licensed psychologists and social workers (n = 115) completed training and administered the treatment with HBPC Veterans between 2014 and 2017.

Measurements and Results:

From baseline to post-intervention, Veterans completing five or more PST-HBPC sessions (n = 199) reported significant reductions in depressive symptoms on the Patient Health Questionnaire 9-item (PHQ-9), in difficulty functioning due to depressive symptoms (PHQ-9 item 10), and in thoughts of death (PHQ-9 item 9). They also reported more effective problem-solving on the Social Problem-Solving Inventory – Revised: Short form (total score and subscales), and improved quality of life across life domains on the World Health Organization Quality of Life-BREF (WHOQOL-BREF) scale. Both clinicians and Veterans also reported satisfaction with the program.

Conclusions:

Preliminary findings support the continued dissemination and implementation of this brief PST intervention for HBPC Veterans, and its potential for use with non-VA home care populations with complex comorbidities.

Keywords

cognitive behavioral therapycommunity caredepression
Type
Original Research Article
Information
International Psychogeriatrics , Volume 34 , Issue 2: Issue Theme: Technology, Virtual Reality, and Other Promising Interventions for Older Adults , February 2022 , pp. 165 - 176
Copyright
© International Psychogeriatric Association 2021

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