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BACKGROUND/RATIONALE:
Peer visitation (PV) provides individuals with injury an opportunity to interact with and learn from successful role models. Peer mentoring relationships have been found to be unique in that mentors are seen as being more equitable, mutual, accepting, credible, and normalizing than other non-injured social supporters. PV has been found to be an effective means of improving long-term adjustment in people with Spinal Cord Injury (SCI). It has also been associated with increased occupational activity and life satisfaction in this population. PV has been shown to benefit individuals with medical conditions other than SCI, including brain injury, cancer, burns, and amputation. PV has yet to be systematically developed in the SCI/D system of care
The Greater Boston Chapter of the National Spinal Cord Injury Association (NSCIA) has developed a Peer Visitation Program that is specifically tailored to train and provide support to individuals with SCI. Here, a peer is selected to mentor a newly injured individual based upon his or her injury level, sex, age, and other considerations. The Greater Boston chapter developed a training DVD and written materials through a grant from the Massachusetts Health & Research Institute in Boston. This DVD is available for purchase and covers topics including: dealing with injury/dysfunction, self confidence, family adjustment, relationships with others, sexuality, housing/independent living programs, and driving/transportation. This program could also be adapted for use in training veterans with SCI at the VHA to provide effective support.
Peer visitation for amputees has received recent attention and evaluation. Using similar materials derived from the ACA (Amputee Coalition of America) five PV trainers and ninety PV have been trained at WRAMC since 2002. In a recent unpublished report from Dr. Paul Pasquina at WRAMC, more than 130 OIF/OEF amputees at WRAMC indicated that PV ranked second only to overall rehabilitation in level of importance. Such a program could be adapted to provide valuable intervention to veterans with spinal cord injury (SCI) at the VAPSHCS (VA Puget Sound Health Care System), both on an inpatient basis and in the community. The NSCIA program would require significant modification to be appropriate for veterans in the SCI/D system of care. Obviously, issues important to veterans with SCI/D would need to be incorporated. In addition, the program would need to be tailored for unique aspects of the SCI/D system of care, such as the "hub" and "spoke" model. The SCI/D system of care consists of an integrated network of "hub" and "spoke" facilities. Multidisciplinary specialty and primary care is located at 23 SCI centers (hubs) and primary care is available at 164 other facilities (spokes). Methods for making PV available in spoke facilities and rural settings would need to be developed. This program could ultimately be extended across the VHA to other SCI Centers.
OBJECTIVE(S):
The goal of this proposal is to improve on an existing peer visitation program for Spinal Cord Injured (SCI) veterans by adapting existing written materials, policies, and procedures from established programs with other populations. Additionally, this project will explore the feasibility of providing training, materials, and referrals to veterans across VISIN 20 (AK, ID, OR, WA) so peer visitation can occur in spoke facilities and in rural communities. Once written materials are completed, this group can proceed with implementation and assessment of such a program in a later study.
Specific Objective #1: Develop a peer visitation manual for veterans with SCI and their caregivers to be used in structured training (modeled on the NSCIA training), and to serve PV's as a resource thereafter. Like the NSCIA manuals from which they will be adapted, these manuals will include detailed training exercises (e.g., self-assessments, role playing, practice PV sessions) to complete during the requisite 1-day PV training, as well as background information to enhance the knowledge of the PV and resource materials to copy/distribute to the people they visit once certified as a PV. The content of all materials is 8th grade reading level or lower.
Specific Objective #2: Develop PV Trainer manual. Designed for allied health professionals who will be certified PV trainers of both veterans and caregivers, this manual will include detailed course outlines and lesson plans for training PVs (i.e., explanations of how to use each training exercise contained in the PV manuals), background information on adult learning and relevant content areas for veterans with SCI (e.g., SCI, Staying Healthy, TBI, PTSD, Caregiver Issues), and guidelines for selecting, evaluating, and certifying PVs (including standardized evaluation forms).
Specific Objective #3: Identify effective strategies for implementing the PV program at spoke facilities and in rural settings, through consultation with key informants from spoke facilities. Key informants will include 5 veterans and their caregivers, and representatives from 2 spoke facilities. Implementation barriers and facilitators will be identified.
METHODS:
Overview: Two core investigators will adapt NSCIA materials for persons with SCI and their caregivers based on a Participatory Action Research (PAR) model.
Procedures:
Specific Objectives #1 and #2: A diverse group of SCI veterans (n=3), caregivers (n=3), and professionals (n=12) with relevant expertise is being assembled to serve as an Advisory Panel. This panel will provide initial direction in identifying content to ensure it is relevant, appropriate, and responsive to the needs of SCI veterans and caregivers. Advisory Panel members will also be asked to review and approve the text in their specific areas of expertise in the final draft. Core investigators include: (1) M. Jan Tackett, Ph.D., Rehabilitation Psychologist in Spinal Cord Injury Service, VAPSHCS; (2) Randi Lincoln, Ph.D., Rehabilitation Psychologist in Spinal Cord Injury Service, VAPSHCS; (3) Phil Ullrich, Ph.D., Implementation Research Coordinator, Spinal Cord Injury QUERI, and (4) Rhonda Williams, Ph.D., Rehabilitation Psychologist in Center for Polytrauma Care, VAPSHCS. The core investigators will communicate via weekly conference calls and through two face-to-face working meetings.
Advisory panel: Confirmed members and their areas of expertise include: Jeanne M. Hoffman, Ph.D. Assistant Professor, University of Washington Department of Rehabilitation Medicine (peer visitation program implementation), Robert Hendricks, Ph.D., Health Systems Specialist, SCI&D Services, VA Central Office (VISN-wide implementation issues); Jay Uomoto, PhD, director of VAPSHCS PNS, (VA Polytrauma System of Care and brain injury), Stephen Burns, MD, Staff Physician Spinal Cord Injury Service, VAPSHCS; Miles McFall, Ph.D. Chief, Psychology Division, (PTSD and Mental Health). Non-VA participants will be offered a $200.00 honarium for their participation. An IRB application is underway to allow us to include 3 SCI veterans and 3 caregivers on the advisory panel. Inclusion criteria are: (1) ability to review materials either visually or in an auditory manner (with assistance from an investigator); (2) spinal cord injury; (3) English speaking. SCI veteran participants and their caregivers will be recruited from VAPSHCS SCI program and would be offered a $100 honorarium for their participation.
Specific Objective #3: Key informants from spoke facilities will participate in structured interviews identifying strategies for overcoming implementation barriers and identifying facilitative factors. We are approaching social workers and psychologists in VISN 20 SCI spoke facilities for input on health care integration and rural peer visitation implementation.
FINDINGS/RESULTS:
The project is in the initial phase of preparation and there are currently no findings.
IMPACT:
Existing peer visitation materials require significant modification to be appropriate for veterans in the SCI/D system of care. Obviously, issues important to veterans with SCI/D would need to be incorporated. In addition, the program would need to be tailored for unique aspects of the SCI/D system of care, such as the "hub" and "spoke" model. The SCI/D system of care consists of an integrated network of "hub" and "spoke" facilities. Multidisciplinary specialty and primary care is located at 23 SCI centers (hubs) and primary care is available at 164 other facilities (spokes). Methods for making PV available in spoke facilities and rural settings would need to be developed. This program could ultimately be extended across the VHA to other SCI Centers.
PUBLICATIONS:
None at this time.
DRA:
Acute and Traumatic Injury
DRE:
Rehabilitation
Keywords:
Caregivers – not professionals, Spinal cord injury
MeSH Terms:
none
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