Evaluation of Clinician Versus Peer-Counsellor Delivered Skills Training in Affective and Interpersonal Regulation (STAIR) Program for Australian Defence Force Members, Veterans and First Responder Personnel
Date
2023
Authors
Lane, Jonathan Paul
Editors
Advisors
Van Hooff, Miranda
McFarlane, Alexander
Lawrence-Wood, Ellie
McFarlane, Alexander
Lawrence-Wood, Ellie
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Thesis
Citation
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Abstract
Aim: This PhD thesis presents the results of a mixed-methods evaluation of a modified group Skills Training in Affective and Interpersonal Regulation (mG-STAIR) program for military, veteran and first responder (MVFR) personnel in an Australian context. This project aimed to develop, conduct, and evaluate a ‘proof of concept’ real world trial of a peer-facilitated (PF), manualised, culturally specific, transdiagnostic, group psychoeducation and skills-based intervention for chronic stress and trauma. Method: The mG-STAIR program was delivered as a mixed gender, mixed clinician and peer co-facilitated intervention in Adelaide, Hobart, Brisbane and Townsville from 2018 to 2020. Online data collection was conducted via LimeSurvey. The questionnaire was administered at four time points: (1) baseline pre-intervention, (2) post-intervention, (3) six months post-STAIR commencement, and (4) at 12 months post-STAIR commencement. In total, 158 participants enrolled in the STAIR program and completed the pre-STAIR questionnaire from June 2018 to the end of June 2020. Of these, 103 (65.2%) attended at least nine of the 12 weekly mG-STAIR program sessions and completed the post-mG-STAIR questionnaire. There were 43 and 19 participants involved at the 6- and 12-month time points, respectively. Results: The results demonstrated significantly improved mental health outcomes for depression, anxiety, PTSD, anger, psychological distress, suicidality, perceived resilience and functioning. The largest improvements in outcome measures came from those individuals with the worst symptoms. There were no differences between clinician and PF groups, or participants who completed the questionnaires versus those who did not at each time points. The qualitative data, shown through comments from participants, also strongly supported the peer-led, culturally specific, transdiagnostic model with functional recovery content. Discussion: The concept of using peer-led programs was strongly supported in the responses from participants and peer facilitators, highlighting the importance of culturally specific and functional content, and program structure. The mental health outcome improvements across multiple domains also validated the transdiagnostic focus of the intervention on emotional regulation (ER) and interpersonal relationships. The results demonstrated the importance of ER for healthy psychological functioning and how ER impacts the experience of a wide range of mental health symptoms rather than just post-traumatic stress disorder (PTSD), as per the traumatic stress spectrum model. The primary strength of the model was the integration of the culturally specific content and structure, with the use of lived experience peer facilitators for delivery. The challenges with this project included the lack of a comparator group in the methodology and the length of time and commitment required to develop a PF model with appropriate clinical and corporate governance. Conclusions: This was an innovative and effective model, using peers with lived experience to deliver culturally specific psychoeducation and skills-based content for MVFR with trauma and PTSD mental health symptoms. It has potentially significant value as an adjunct intervention to trauma focused psychotherapies for MVFR, particularly if staged prior to these emotionally intensive interventions.
School/Discipline
Adelaide Medical School
Dissertation Note
Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 2023
Provenance
This electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at: http://www.adelaide.edu.au/legals