A Pilot Study to Examine Acceptability and Feasibility of Growth, Resilience, Insight, and Togetherness (GRIT), a Retreat-Based Program for Violence-Exposed Women Veterans

About This Grant

Significance to VA: Women Veterans are exposed to interpersonal violence at high rates throughout their lifespans which may escalate risk for psychosocial impairment and suicidal behavior. Facets of social functioning such as connectedness and social support can mitigate suicide risk. Given their risk for suicide and barriers to engaging in Veterans Administration (VHA) healthcare, violence-exposed women Veterans represent a specialized population for which expansion of VHA programming to include opportunities for socialization and community building as a key component of holistic health are needed. Coinciding with a congressional mandate for women-only retreat-based rehabilitation following military service, retreats are increasingly offered by community organizations. Retreats are associated with significant improvements in mental health and quality of life; however, no research to date has examined retreat programming as an upstream suicide prevention strategy for a high priority, high risk population of Veterans. The pilot will examine Growth, Resilience, Insight, and Togetherness (GRIT), a retreat program developed with and for Veteran women who have experienced interpersonal violence, relative to Growth, Resilience, and Insight (GRI), a self- guided version of the program, as an intervention for improving social functioning. Innovation and Impact: In preliminary work conducted by our team, violence-exposed women Veterans expressed a clear preference for a VHA-endorsed retreat program and were drawn to such a program by its use of non-clinical, nature-based environment. A retreat, grounded in Whole Health, provides women Veterans with many benefits such as time to reflect, connect, and access mental health programming that may be challenging to receive in their daily lives. The offering of a retreat in collaboration with an established community partner heeds the call for tailored, trauma-informed, community-based innovative prevention strategies within VHA to address the problem of suicide among women Veterans. Specific Aims: Aim 1: Determine feasibility of study methods and implementation of GRIT and GRI including the use of VHA clinicians. Aim 2: Establish relative acceptability of GRIT and GRI and study methods by assessing credibility, satisfaction, and perceived usefulness and burdensomeness among study clinicians and participants. Aim 3: Collect preliminary data on social functioning before, following, and two months after program completion along with indicators of suicide risk (i.e., overall risk, suicide ideation, posttraumatic stress symptoms, depression, emotional dysregulation, sleep quality). Data on therapeutic processes and social functioning during program participation will be gathered to identify key program components and potential adaptations for a larger multi-site randomized clinical trial. Methodology: Using a selective suicide prevention strategy, we will recruit women Veterans (N = 48) who have experienced interpersonal violence and endorse difficulties in at least two areas of social functioning to be randomly assigned to GRIT or GRI. Feasibility and acceptability will be evaluated using mixed-method data collection and synthesis of research tracking, self-report surveys and/or assessor-administered questionnaires, and semi-structured interviews with participants and VHA clinicians serving as facilitators. Path to Translation/Implementation: The pilot will establish infrastructure and methods, gather preliminary data, and build partnerships that will provide a foundation for expansions of retreat-based programming and a model for use within VHA. The pilot be an opportunity to: a) further engage key interdisciplinary collaborators; b) determine what settings are most ideal for and in need of retreat program implementation (e.g., rural regions, Women's Mental health clinics); and c) ensure that measures and evaluation plans match selective suicide prevention program goals for improving social functioning. Data gathered will be used to inform a multi- site randomized clinical trial.