Recruitment Collaborating

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Recruitment Collaborating Powered By Docstoc
					Collaborating with the OEF/OIF/OND
 Community for Research Success
               Drew A. Helmer, MD, MS
      Neurorehabilitation: Neurons to Networks
   Rehabilitation Research & Development Center of
                       Excellence
       Michael E. DeBakey VA Medical Center
               Baylor College of Medicine
                    August 10, 2011
Objectives
 At the end of this session, participants will be able to:
   Articulate challenges in recruiting OEF/OIF/OND Veterans
    for research activities.
   Discuss the pros and cons of engaging the OEF/OIF/OND
    Veteran community as an active partner in research.
   Apply examples from the case presented to their personal
    research endeavors.
Research
 The systematic collection of information for the purpose of
  discovering new, universal truths
   Generalize findings from the sample to the population
 Expensive
 Requires extensive education/training
 Invasive/intrusive
 Time consuming
Ethical Principles of Research
 Ethics guided by three Belmont Principles
   Autonomy/Respect for Persons
   Beneficence/Non-maleficence
   Justice/Equity
Community
 A group of people with diverse characteristics who are linked by social ties,
  share common perspectives, and engage in joint action in geographical locations
  or settings.
 Common elements:
    Locus
    Sharing
    Joint action
    Social ties
    Diversity
 Examples
    Family
    Neighborhood/city
    Civic or social organizations
    Business
Research Case Examples-
An intentionally provocative comparison
AIDS                            Persian Gulf War ‘Syndrome’
 Identified ca. 1980             Identified ca. 1992
 Identified etiology             Etiology(ies) unclear
 Effective, evidence-based       No specific evidence-based
  treatments widely available      treatment
 Improved prevention             Persistent post-concussive
 Continues to be prominent        symptoms in OEF/OIF
  research priority                Veterans
 Scientific benefits beyond      Low research priority
  the original focus              Impact of results?
OEF/OIF/OND Veterans
 Demographics-
      70% <40 years old
      88% men
 Geography-
      Rural vs. urban
      Regional distribution
      Mobility
 Education/Training- not researchers
 Life Experience-
      High school, some college
      Military
 Personal Priorities-
      Education/training
      Employment
      Family
 Identity- many don’t self-identify as a “Veteran”
Post-Deployment Health Research
 Examples
 Funding
 Funding Sources
 Foci
   Post-traumatic stress disorder
   Traumatic brain injury
   Pain
   Care Delivery
   Prosthetics
   Reintegration/Social Factors
Challenges of PDH Research
 Recruitment
 Retention
 Concerns about secondary gain/symptom exaggeration
 Complex comorbidities/condition overlap
 VA stigma
 Mental health stigma
 Regulatory/Policy restrictions
   Channels of communication
   Participant reimbursement
 Engaging clinicians in the effort
A Culture of Curiosity-
VHA Research Stakeholders
 Engage patients and families at enrollment
   Consent to care includes language about research uses of
    clinical data
 Engage employees
   Highlight Veteran employee participation
   Educate about ongoing projects
     Provide talking points
     Provide buttons/information cards

 Engage clinicians
   VHA physician-researchers more satisfied than non-researchers
   Include in study design, recruitment, assessment, analysis and
    dissemination
Community Engaged Research
 A framework
 A continuum
 Community Based Participatory Research
   A collaborative approach to research that equitably involves all
    partners in the research process and recognizes the unique
    strengths that each brings. CBPR begins with a research topic of
    importance to the community and has the aim of combining
    knowledge with action and achieving social change to improve
    health outcomes and eliminate health disparities. (WK Kellogg
    Foundation)
Benefits of Community Engaged Research
 Promote understanding between researchers and target groups
    (e.g., promote trust).
   Enhance participation in research activities.
   Provide a more detailed understanding of the environmental and
    social aspects of a problem that may impact implementation.
   Promote adoption of effective solutions.
   Provide continuity for sustained impact.
   Educate targeted group members.
   Prepare target community and members for findings of study.
Ethical Considerations &
Processes for Managing Issues
 Considerations
   Risks to individual
   Risks to community (group)
   Risks to individual vis a vis group membership
 Solutions
   Train Investigator and Research team
   Institutional Review Board
   Data Safety and Monitoring Plan
   Conflict of Interest Review
   Research Ethics Consultation program
   Research Subject Advocacy program
   Community Advisory Board
Neurorehabilitation:Neurons to
Networks RR&D Research COE
 Recruit for the main protocol
   Genetics
   Community Reintegration of Servicemembers instrument
   Temporal perception test
   Behavioral Assessment Core I
   Behavioral Assessment Core II
   fMRI- working memory processing
   fMRI- social interaction
                    Participant Flow

                         Referred

                        Screened

 Participants are
referred to other         BAC1
 pilots based on
  info gathered            BAC2

                           fMRI
Who
 Inclusion Criteria
   OEF/OIF veterans
   mTBI or controls
   Injured after 2003
 Exclusion Criteria
   Pre or Post deployment hospitalization for head injury
   Baseline cerebral palsy, mental disability, epilepsy, bipolar
    disorder, schizophrenia
   Any history of brain surgery
Targets for Recruitment
 Core pilots of the protocol had a wide range of recruitment
  targets, without specific time frames
 Current expectation
   60 cases & 40 controls per year
   Recruitment weekly goals
     Referrals- 10
     Screened- 8
     Eligible- 3
   These targets will result in 144 subjects a year
Resources for Recruitment
 Director of Recruitment and Retention Core
   Clinical Champion for Post-deployment health at facility and
    VISN
 Full time research assistant
 Administrative assistance from administrative officer and
  other research assistants
 Center investigators
      Overall Numbers for TBI CoE
 Referrals= 420
 Screened= 302
 Initial visits= 118
     2011 summary
40
35
30
25
20
                    Screened
15
                    Initial visits
10
 5
 0
     Participant Volume
90                                                       70
80
                                                         60
70
                                                         50
60
50                                                       40

40                                                       30   Volume
30
                                                         20
20
                                                         10
10
 0                                                       0
     1/20/10-1/1/11   1/1/11-6/26/11   6/27/11-Present
Reasons for Exclusion/Drop Off
 From referral to screening
   Not interested
   No contact info
   Not qualified; not OIF/OEF veteran
 From screening to initial visit (BAC1)
   No show (3 chances)
 From initial visit (BAC1) to neuropsychologic testing (BAC2)
   Failed effort testing
   Positive alcohol abuse screen
   Positive substance abuse screen
Referrals by source to date
 Post deployment clinic           36 – 9%
 Traumatic Brain Injury clinic   167 – 40%
 Mental Health                   42 – 9%
 Other- **                       178 – 42%

 **(PrimeCare, Vet Centers, CBOC’s, community events)**
Putting things in perspective
In the greater Houston area:
 19,000 deployed OIF/OEF veterans
 10,000 have used VHA
 5,000 used VHA in past year
 2132 out of 9082 (23%) screened positive for TBI
 1471 out of 2132 (69%) completed TBI 2nd level clinical
  evaluation
 989 of 1471 (68%) were determined to have experienced a
  concussion/mTBI
Recruitment Sources
Recruitment Strategies
 Direct
 Indirect
 Community Engaged Research
 Marketing/Public Relations
 Social Media
Direct Recruitment
 Face to face- in facility
 Ellington Field Joint Reserve Base
 OEF/OIF program outreach
   Welcome home events
   Yellow Ribbons
 Veteran Service Organization Meetings/Activities
   Lonestar Veterans Association
   Iraq and Afghanistan Veterans Association
   Student Veteran Associations
Indirect Recruitment
 VHA providers
   PrimeCare
   TBI clinic
   Post Deployment Clinic
   Mental Health (Trauma Recovery Program)
   Community Based Outpatient Clinics
 School Veteran Counselors
 Veteran Service Organizations
 Vet Centers
 Other community-based healthcare providers
Community Engagement
 Community Council for TBI COE
 Speakers bureau
 Attendance/sponsorship at community events
 Engage OIF/OEF/OND Veteran volunteers
 Clinical placements for OEF/OIF/OND Veterans
Social Media/Other Technology
 Facebook
   VHA national
   VHA local
   Non-VHA
   Invited group facebook page
 Twitter
 Text messaging
Marketing/Public Relations
 Press releases
 Media relations
 Brochures
 Advertisements
Criteria for Recruitment Activities
 Audience size
 Audience type: military, researchers, students
 Type of activity: direct, indirect, community engagement, PR
 Cost
 Other potential benefits to N:N2N COE
   Education
   Name recognition
   Goodwill
Current/Future direction for
recruitment
 Maintain/Build/Enhance current clinical referral base
 Schools
   Working with counselors for new enrollment year
 Strengthen relationships with VSO’s
 Advertisements
 Social media
   Plan to use local Facebook page starting October 1, 2011
 Mail recruitment letters from providers
 “Refer a friend” rewards program
Retention
 Ongoing contact with VSO’s
 Mailed thank you cards at end of calendar year 2010
 Newsletter planned for end of 2011
 Recontact participants for new research opportunities
Observed Challenges
 Recruiting controls
 Scheduling appointments (no-shows)
 Comorbidities (e.g., PTSD, mTBI, alcohol abuse)
 Failure rate on effort testing
 Paucity of visible, effective OEF/OIF VSO’s
 Volunteer fatigue in VSO community leaders
 Delay in development of ‘veteran’ identity
 Stigma of combat experience in the school/workplace
 Handling disappointed ineligible Veterans
Next Steps
 Enhance retention through a longitudinal study
   Need more resources
 Promote more ‘give backs’ to participants and community
   Newsletter
   Presentations of results to lay audiences
   Summary of some findings from assessments
 Enlarge pool of OEF/OIF/OND Veteran volunteers engaged
  in COE activities
 Formalize/enhance Veteran Community Council
  involvement
Conclusions
 Recruiting OEF/OIF/OND Veterans for research is
  challenging.
 Community engaged research activities may help.
   Other benefits to community
   Cost/benefit assessment is critical
 Veterans must participate in research if they want answers to
  their concerns about deployment-related health issues.
 Researchers must consider the priorities of the Veteran
  community regarding deployment-related health issues,
  demonstrate appreciation for their participation, and educate
  the community to succeed.
Contact Information
 Drew A. Helmer, MD, MS
 Michael E. DeBakey VA Medical Center
 Houston, TX 77030
 Drew.helmer@va.gov
 713-791-1414 x 7010 or 713-794-8157

				
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