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CDA 17-006 – HSR&D Study

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CDA 17-006
Increasing mental health services use through enabling resources & family support
Megan Shepherd-Banigan PhD MPH
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.

NIH Reporter Project Information:


Journal Articles

  1. Goldstein KM, Kung LCY, Dailey SA, Kroll-Desrosiers A, Burke C, Shepherd-Banigan M, Lumsden R, Sims C, Schexnayder J, Patel D, Cantrell S, Sheahan KL, Gierisch JM. Strategies for enhancing the representation of women in clinical trials: an evidence map. Systematic reviews. 2024 Jan 2; 13(1):2.
  2. Van Houtven CH, Smith VA, Miller KEM, Berkowitz TSZ, Shepherd-Banigan M, Hein T, Penney LS, Allen KD, Kabat M, Jobin T, Hastings SN. Comprehensive Caregiver Supports and Ascertainment and Treatment of Veteran Pain. Medical care research and review : MCRR. 2023 Dec 7; 10775587231210026.
  3. Shepherd-Banigan M, Cannedy S, Rodriguez A, Burns M, Woolson S, Hamilton A, Quiroz I, Matthews H, Garber-Cardwell D, Byrd KG, Brown A, Goldstein KM. Veteran Caretaker Perspectives of the Need for Childcare Assistance During Health Care Appointments. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2023 Oct 12.
  4. Goldstein KM, Patel DB, Van Loon KA, Shapiro A, Rushton S, Lewinski AA, Lanford TJ, Cantrell S, Zullig LL, Wilson SM, Shepherd-Banigan M, Alton Dailey S, Sims C, Robinson C, Chawla N, Bosworth HB, Hamilton A, Naylor J, Gierisch JM. Optimizing the Equitable Deployment of Virtual Care for Women: Protocol for a Qualitative Evidence Synthesis Examining Patient and Provider Perspectives Supplemented with Primary Qualitative Data. Health equity. 2023 Sep 13; 7(1):570-580.
  5. Dennis PA, Stechuchak KM, Van Houtven CH, Decosimo K, Coffman CJ, Grubber JM, Lindquist JH, Sperber NR, Hastings SN, Shepherd-Banigan M, Kaufman BG, Smith VA. Informing a home time measure reflective of quality of life: A data driven investigation of time frames and settings of health care utilization. Health services research. 2023 Dec 1; 58(6):1233-1244.
  6. Shepherd-Banigan M, Shapiro A, Stechuchak KM, Sheahan KL, Ackland PE, Smith VA, Bokhour BG, Glynn SM, Calhoun PS, Edelman D, Weidenbacher HJ, Eldridge MR, Van Houtven CH. Exploring the importance of predisposing, enabling, and need factors for promoting Veteran engagement in mental health therapy for post-traumatic stress: a multiple methods study. BMC psychiatry. 2023 May 27; 23(1):372.
  7. Shepherd-Banigan M, Miller KEM, Hastings SN, Schleiden LJ, Thorpe JM. Use of high cost care among Veterans with comorbid mental illness and Alzheimer's Disease and related dementias. PLoS ONE. 2023 May 12; 18(5):e0282071.
  8. Shepherd-Banigan M, Shapiro A, Sheahan KL, Ackland PE, Meis LA, Thompson-Hollands J, Edelman D, Calhoun PS, Weidenbacher H, Van Houtven CH. Mental health therapy for veterans with PTSD as a family affair: A qualitative inquiry into how family support and social norms influence veteran engagement in care. Psychological Services. 2023 Nov 1; 20(4):839-848.
  9. Jacobs JC, Bowling CB, Brown T, Smith VA, Decosimo K, Wilson SM, Hastings SN, Shepherd-Banigan M, Allen K, Van Houtven C. Racial inequality in functional trajectories between Black and White U.S. veterans. Journal of the American Geriatrics Society. 2023 Apr 1; 71(4):1081-1092.
  10. 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.
  11. Ma JE, Grubber J, Coffman CJ, Wang V, Hastings SN, Allen KD, Shepherd-Banigan M, Decosimo K, Dadolf J, Sullivan C, Sperber NR, Van Houtven CH. Identifying Family and Unpaid Caregivers in Electronic Health Records: Descriptive Analysis. JMIR formative research. 2022 Jul 18; 6(7):e35623.
  12. 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.
  13. 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.
  14. 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.
  15. 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.
  16. 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.
  17. 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.
  18. 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.
  19. 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.
  20. 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.
  21. 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.
  22. 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.
  23. 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.
  24. 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.
  25. 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.
  26. 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.
  27. 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.
  28. 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.
  29. 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.
  30. 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.
  31. 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.
  32. 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.
  33. 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.
  34. 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.
  35. 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.
  36. 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.
  37. 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.
  38. 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.
  39. 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.

  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.
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.

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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