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Health Services Research & Development

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CDA 17-006 – HSR&D Study

CDA 17-006
Increasing mental health services use through enabling resources & family support
Megan Shepherd-Banigan, PhD MPH
Durham VA Medical Center, Durham, NC
Durham, NC
Funding Period: April 2019 - March 2024


Megan Shepherd-Banigan, Ph.D., obtained her doctorate in Health Services Research from the University of Washington in 2014 and her M.P.H from the University of Miami in 2006. From July 2015-November 2017, Dr. Shepherd-Banigan was a post-doctoral research fellow at the Durham VA Health Services Research & Development (HSR&D) Center of Innovation (COIN) and is now a VA Health Research Scientist in the COIN. Her long-term professional goal is to grow her career as an independent VA health services researcher who applies a diverse array of methods to evaluate and improve the effectiveness of mental health and family service delivery systems. The short-term objective of this application is to describe and strengthen Veteran and family determinants of mental health service utilization. The proposed CDA research seeks to address scientific gaps related to the low use of psychotherapy among Veterans with PTSD: Aim 1a— Identify Veteran and family determinants that predict initiation and completion of psycho-therapy for PTSD; Aim 1b— Explore mechanisms linking enabling resources, [treatment preparedness], and initiation and completion of PTSD psychotherapy; Aim 2— Refine and test the feasibility of a family-involved treatment preparedness intervention to increase initiation and completion of EBP psychotherapy for PTSD; Aim 3— Analyze whether use of VA supportive services predicts initiation and completion of PTSD psychotherapy by strengthening economic enabling resources. This application is highly innovative and will advance clinical practice by contributing evidence about 1) the role of complex Veteran and family risk factors that inhibit PTSD treatment use and 2) promising, strategies to strengthen these factors, including a family-involved treatment preparedness intervention and VA education and vocational rehabilitation services to increase uptake of PTSD evidenced-based practices (EBPs).21 This project is consistent with VA priorities, such as increased access to care and uptake of EBPs. The research proposed in Aim 1 will employ novel machine learning causal forest methods93 to Caregiver Support Program survey data and VA administrative data to identify Veteran and family predisposing, enabling, and need factors and elucidate how enabling resources (i.e. perceived financial strain, income, education level, family strain) moderate the association between need for treatment and use/completion of psychotherapy. Subsequent qualitative interviews with Veterans and family members will seek to identify the underlying mechanisms between Veteran/family determinants and service use. The goal of Aim 2 is to refine and test the feasibility and acceptability of an existing family engagement strategy74 using a successive cohort design (SCD) among Veterans who were referred to EBP psychotherapy for PTSD. For Aim 3, VHSC, Veteran Benefits Administration, and Caregiver Support Program data will be combined to examine the effect of VA supportive service use on time to use/completion of psychotherapy treatment using Cox proportional hazard models; sequential stratified matching will be applied to minimize baseline differences between treatment groups. By the end of the 3rd year of CDA funding, a merit award application will be submitted to fund a randomized trial of the Aim 2 intervention. To complete the proposed research, the applicant requires additional skills and content expertise in four areas: [1) intervention and implementation science; 2) advanced methods in qualitative and quantitative research; 3) mental health clinical research and context; and 4) professional development and networking.] Specific topics and activities will include courses in machine learning and qualitative research; workshops about randomized clinical trials and implementation methods; clinical shadowing; and academic conferences and workshops.

External Links for this Project

NIH Reporter

Grant Number: IK2HX002591-01A2

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Journal Articles

  1. Shepherd-Banigan M, Kaufman BG, Decosimo K, Dadolf J, Boucher NA, Mahanna EP, Bruening R, Sullivan C, Wang V, Hastings SN, Allen KD, Sperber N, Coffman CJ, Van Houtven CH. Adaptation and Implementation of a Family Caregiver Skills Training Program: From Single Site RCT to Multisite Pragmatic Intervention. Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing. 2020 Jan 1; 52(1):23-33. [view]
  2. Shepherd-Banigan M, Wells SY, Falkovic M, Ackland PE, Swinkels C, Dedert E, Ruffin R, Van Houtven CH, Calhoun PS, Edelman D, Weidenbacher HJ, Shapiro A, Glynn S. Adapting a family-involved intervention to increase initiation and completion of evidenced-based psychotherapy for posttraumatic stress disorder. SSM. Mental health. 2022 Dec 1; 2:8. [view]
  3. Smith VA, Lindquist J, Miller KEM, Shepherd-Banigan M, Olsen M, Campbell-Kotler M, Henius J, Kabat M, Van Houtven CH. Comprehensive Family Caregiver Support and Caregiver Well-Being: Preliminary Evidence From a Pre-post-survey Study With a Non-equivalent Control Group. Frontiers in public health. 2019 May 22; 7:122. [view]
  4. Van Houtven CH, Smith VA, Stechuchak KM, Shepherd-Banigan M, Hastings SN, Maciejewski ML, Wieland GD, Olsen MK, Miller KEM, Kabat M, Henius J, Campbell-Kotler M, Oddone EZ. Comprehensive Support for Family Caregivers: Impact on Veteran Health Care Utilization and Costs. Medical care research and review : MCRR. 2019 Feb 1; 76(1):89-114. [view]
  5. Van Houtven CH, Smith VA, Stechuchak KM, Berkowitz TSZ, Miller KEM, Shepherd-Banigan M, Kabat M, Henius J. Comprehensive support of family caregivers: Are there health system cost offsets? Health services research. 2020 Oct 1; 55(5):710-721. [view]
  6. Bruening R, Sperber N, Miller K, Andrews S, Steinhauser K, Wieland GD, Lindquist J, Shepherd-Banigan M, Ramos K, Henius J, Kabat M, Van Houtven C. Connecting Caregivers to Support: Lessons Learned From the VA Caregiver Support Program. Journal of applied gerontology : the official journal of the Southern Gerontological Society. 2020 Apr 1; 39(4):368-376. [view]
  7. Sperber NR, Shapiro A, Boucher NA, Decosimo KP, Shepherd-Banigan M, Whitfield C, Hastings SN, Van Houtven CH. Developing a person-centered, population based measure of "home time": Perspectives of older patients and unpaid caregivers. Healthcare (Amsterdam, Netherlands). 2021 Dec 1; 9(4):100591. [view]
  8. Shepherd-Banigan M, James HJ, Smith VA, Plassman BL, Jutkowitz E, Belanger E, Van Houtven CH. Drivers of Long-Term Care Considerations by Persons With Cognitive Impairment. Journal of applied gerontology : the official journal of the Southern Gerontological Society. 2021 Jun 1; 40(6):648-660. [view]
  9. Hughes JM, Freiermuth CE, Shepherd-Banigan M, Ragsdale L, Eucker SA, Goldstein K, Hastings SN, Rodriguez RL, Fulton J, Ramos K, Tabriz AA, Gordon AM, Gierisch JM, Kosinski A, Williams JW. Emergency Department Interventions for Older Adults: A Systematic Review. Journal of the American Geriatrics Society. 2019 Jul 1; 67(7):1516-1525. [view]
  10. Shepherd-Banigan M, Pogoda TK, McKenna K, Sperber N, Van Houtven CH. Experiences of VA vocational and education training and assistance services: Facilitators and barriers reported by veterans with disabilities. Psychiatric Rehabilitation Journal. 2021 Jun 1; 44(2):148-156. [view]
  11. Van Houtven CH, Smith VA, Lindquist JH, Chapman JG, Hendrix C, Hastings SN, Oddone EZ, King HA, Shepherd-Banigan M, Weinberger M. Family Caregiver Skills Training to Improve Experiences of Care: a Randomized Clinical Trial. Journal of general internal medicine. 2019 Oct 1; 34(10):2114-2122. [view]
  12. Shepherd-Banigan M, Sherman SR, Lindquist JH, Miller KEM, Tucker M, Smith VA, Van Houtven CH. Family Caregivers of Veterans Experience High Levels of Burden, Distress, and Financial Strain. Journal of the American Geriatrics Society. 2020 Nov 1; 68(11):2675-2683. [view]
  13. James HJ, Van Houtven CH, Lippmann S, Burke JR, Shepherd-Banigan M, Belanger E, Wetle TF, Plassman BL. How Accurately Do Patients and Their Care Partners Report Results of Amyloid- PET Scans for Alzheimer's Disease Assessment? Journal of Alzheimer's Disease : Jad. 2020 Jan 1; 74(2):625-636. [view]
  14. Goldstein K, Perry KR, Lewinski A, Walsh CW, Shepherd-Banigan M, Bosworth HB, Weidenbacher HJ, Blalock D, Zullig LL. How can equitable video visit access be delivered in primary care? A qualitative study among rural primary care teams and patients. BMJ (Clinical research ed.). 2022 Aug 5; 12:. doi:10.1136/ bmjopen-2022-062261. [view]
  15. Shepherd-Banigan M, Smith VA, Lindquist JH, Cary MP, Miller KEM, Chapman JG, Van Houtven CH. Identifying treatment effects of an informal caregiver education intervention to increase days in the community and decrease caregiver distress: a machine-learning secondary analysis of subgroup effects in the HI-FIVES randomized clinical trial. Trials. 2020 Feb 14; 21(1):189. [view]
  16. Sperber NR, Boucher NA, Delgado R, Shepherd-Banigan ME, McKenna K, Moore M, Barrett R, Kabat M, Van Houtven CH. Including Family Caregivers In Seriously Ill Veterans' Care: A Mixed-Methods Study. Health affairs (Project Hope). 2019 Jun 1; 38(6):957-963. [view]
  17. Boucher NA, Shepherd-Banigan M, McKenna K, Delgado RE, Peacock K, Van Houtven CH, Van Noord M, Sperber NR. Inclusion of Caregivers in Veterans' Care: A Critical Literature Review. Medical care research and review : MCRR. 2021 Oct 1; 78(5):463-474. [view]
  18. Shepherd-Banigan M, Smith VA, Stechuchak KM, Van Houtven CH. Informal Caregiver Support Policies Change Use of Vocational Assistance Services for Individuals With Disabilities. Medical care research and review : MCRR. 2022 Apr 1; 79(2):218-232. [view]
  19. Miller KEM, Lindquist JH, Olsen MK, Smith V, Voils CI, Oddone EZ, Sperber NR, Shepherd-Banigan M, Wieland GD, Henius J, Kabat M, Van Houtven CH. Invisible partners in care: Snapshot of well-being among caregivers receiving comprehensive support from Veterans Affairs. Health science reports. 2019 Mar 1; 2(3):e112. [view]
  20. Shepherd-Banigan M, Sperber N, McKenna K, Pogoda TK, Van Houtven CH. Leveraging institutional support for family caregivers to meet the health and vocational needs of persons with disabilities. Nursing Outlook. 2020 Mar 1; 68(2):184-193. [view]
  21. Van Houtven CH, Lippmann SJ, Bélanger E, Smith VA, James HJ, Shepherd-Banigan M, Jutkowitz E, O'Brien E, Wolff JL, Burke JR, Plassman BL. Measurement Properties of the CAPACITY Instrument to Assess Perceived Communication With the Health Care Team Among Care Partners of Patients With Cognitive Impairment. Medical care. 2020 Sep 1; 58(9):842-849. [view]
  22. Shepherd-Banigan M, Jones KA, Wang K, DePasquale N, Van Houtven C, Olsen JM. Mechanisms Through Which a Family Caregiver Coaching Intervention Might Reduce Anxiety Among Children in Military Households. Maternal and child health journal. 2020 Oct 1; 24(10):1248-1258. [view]
  23. Shepherd-Banigan M, Drake C, Dietch JR, Shapiro A, Tabriz AA, Van Voorhees EE, Uthappa DM, Wang TW, Lusk JB, Rossitch SS, Fulton J, Gordon A, Ear B, Cantrell S, Gierisch JM, Williams JW, Goldstein KM. Primary Care Engagement Among Individuals with Experiences of Homelessness and Serious Mental Illness: an Evidence Map. Journal of general internal medicine. 2022 May 1; 37(6):1513-1523. [view]
  24. Boucher NA, Zullig LL, Shepherd-Banigan M, Decosimo KP, Dadolf J, Choate A, Mahanna EP, Sperber NR, Wang V, Allen KA, Hastings SN, Van Houtven CH. Replicating an effective VA program to train and support family caregivers: a hybrid type III effectiveness-implementation design. BMC health services research. 2021 May 6; 21(1):430. [view]
  25. Curry JF, Shepherd-Banigan M, Van Voorhees E, Wagner HR, Kelley ML, Strauss J, Naylor J, Veterans Affairs Mid-Atlantic MIRECC Women Veterans Work Group , Veterans Affairs Mid-Atlantic MIRECC Work Group. Sex differences in predictors of recurrent major depression among current-era military veterans. Psychological Services. 2021 May 1; 18(2):275-284. [view]
  26. Van Houtven CH, Ma JE, Grubber J, Shepherd-Banigan M, Lewis K, Christensen L, Richardson C, Kabat M, Decosimo K, Miller KEM, Coffman CJ, Malo T, Allen KD, Hastings SN. Systematic identification of family caregivers in health systems: Proposed solutions from a caregiver-focused research study. Journal of the American Geriatrics Society. 2022 Aug 1; 70(8):2435-2439. [view]
  27. Maciejewski ML, Shepherd-Banigan M, Raffa SD, Weidenbacher HJ. Systematic Review of Behavioral Weight Management Program MOVE! for Veterans. American journal of preventive medicine. 2018 May 1; 54(5):704-714. [view]
  28. Shepherd-Banigan M, Smith VA, Maciejewski ML, Stechuchak KM, Hastings SN, Wieland GD, Miller KEM, Kabat M, Henius J, Campbell-Kotler M, Van Houtven CH. The Effect of Support and Training for Family Members on Access to Outpatient Services for Veterans with Posttraumatic Stress Disorder (PTSD). Administration and policy in mental health. 2018 Jul 1; 45(4):550-564. [view]
  29. King HA, Shepherd-Banigan M, Chapman JG, Bruening R, Decosimo KP, Van Houtven CH. Use of motivational techniques to enhance unpaid caregiver engagement in a tailored skills training intervention. Aging & mental health. 2022 Feb 1; 26(2):337-344. [view]

  1. Hughes JM, Freiermuth CE, Williams JW, Ragsdale L, Eucker S, Goldstein K, Rodriguez R, Fulton J, Hastings SN, Shepherd-Banigan M, Ramos K, Tabriz AA, Gordon AM, Gierisch JM, Kosinski A, McDuffie J, Van Noord M. Emergency Department Interventions for Older Adults. VA Evidence-based Synthesis Program Reports. Washington (DC): Department of Veterans Affairs (US); 2018 Jun 1. [view]
Government Briefings

  1. Van Houtven CH, Sperber NR, Shepherd-Banigan M, Decosimo KP. Function QUERI and iHI-Fives: Briefing before the VA Deputy Chief Patient Care Services Officer for Care Management and Social Work (Lisa Pape, LISW); Acting Director of Caregiver Support Program (Jennifer Perez, LICSW); 2019 Oct 23; Washington, DC. [view]

DRA: Mental, Cognitive and Behavioral Disorders, Health Systems
DRE: TRL - Applied/Translational
Keywords: None at this time.
MeSH Terms: None at this time.

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