We are proposing a study to [improve health and wellness] in Veterans with post-traumatic stress disorder (PTSD) through peer-delivered Whole Health Coaching. PTSD is highly prevalent within the Veterans Health Administration (VHA). Veterans with PTSD demonstrate low rates of health behaviors (e.g., exercise, [engagement in PTSD care,] and medical screening) and high rates of unhealthy behaviors (e.g., smoking and substance use). Therefore, interventions to increase [health and wellness] behaviors in Veterans with PTSD are critically needed. Dr. Johnson is a licensed clinical psychologist currently holding a temporary appointment in a training role at the Center for Integrated Healthcare (CIH; VISN 2 Center of Excellence) at the Syracuse VA Medical Center. Her long-term goal is to facilitate Veteran recovery and rehabilitation from PTSD through primary care; the objective in this application is to use a VHA intervention, Whole Health Coaching, to increase [health and wellness] behaviors in order to target factors that negatively impact psychosocial recovery. Whole Health Coaching uses a patient-centered approach to [improve health and wellness] by developing a personal health mission, goals and action steps, and evaluating progress on self-identified proactive health behaviors. Whole Health Coaching is designed to facilitate change via setting values based goals (e.g., increase self-care and healthcare engagement) in functional areas such as relationships, surroundings, and personal and work life. We propose to use peer support specialists ("peers")—Veterans in recovery from mental illness who are hired and trained to use their own recovery to assist others in a clinical setting. Peers are already implementing Whole Health Coaching as part of the Peers in PACT initiative. The objectives of the research project are to (1) pilot test peer-delivered Whole Health Coaching with Veterans with PTSD in PACT and (2) provide training to continue Dr. Johnson’s development into an independent RR&D researcher. Specifically, the CDA-1 project will implement peer-delivered Whole Health Coaching with Veterans (n = 8-10) who are experiencing clinically significant PTSD symptoms but have chosen not to engage in specialty mental health. The CDA-1 project utilizes a concurrent/non-concurrent multiple baseline design across subjects to investigate [goal attainment] before, during, and after Whole Health Coaching. Other outcomes of interest include functional outcomes and PTSD symptoms. Following the intervention, Veterans will provide feedback about Whole Health Coaching to inform and improve this intervention’s delivery. Primary analysis of quantitative data involves multilevel modeling and visual analysis. Feedback data will be analyzed using Rapid Assessment Process. This CDA-1 will provide time for Dr. Johnson to receive training in: (1) addressing PTSD in Patient Aligned Care Teams (PACT), (2) research methodology, (3) recovery orientation, and (4) grant writing. These targeted areas of development will prepare her to pursue a research career in psychosocial recovery and rehabilitation. Dr. Johnson’s team of mentors (Dr. Possemato: PTSD in PACT expert, Dr. Maisto: methodological and PC-MHI expert, Dr. Chinman: recovery orientation and peers in VHA expert) will facilitate this project and Dr. Johnson’s career development. The proposed project is novel in that it is investigating the use of peers in a new area of research and the utility of an existing intervention for use with a specific at-risk population, primary care Veterans with PTSD. Further, this study will be the first to evaluate patient outcomes associated with Whole Health Coaching and will inform subsequent research on improving psychosocial recovery.

PTSD is a common problem for Veterans that leads to poor outcomes. Whole Health Coaching is a VA- developed intervention to increase Veterans' involvement in their own healthcare and improve recovery through identifying Veteran's values, creating a personalized health plan, and setting health and wellness goals. For Veterans with PTSD, it can be a significant addition to other health services to develop an overall wellness plan based on individual values, needs, and lifestyle. Whole Health Coaching is designed to address a crucial need for Veterans, and trainings for Whole Health Coaching have been implemented nationally. However, to date there is no research evidence supporting the efficacy of this intervention. The proposed project will generate data about how peer-delivered Whole Health Coaching can help Veterans be more active in their healthcare and invested in their wellness and recovery.