Retreat-Based Program for Violence-Exposed Women Veterans

Overview

Given their elevated risk for suicide and barriers to engaging in VHA healthcare, violence-exposed women Veterans represent a specialized population for which expansions to current VHA programming are needed. This pilot study is to assess the feasibility, acceptability, and preliminary efficacy of the Growth, Resilience, Insight, and Togetherness (GRIT), a therapeutic retreat program developed with and for Veteran women, to improve social functioning as a potential upstream suicide prevention strategy in comparison to a self-guided program. If found acceptable and feasible, data gathered will inform subsequent program development and identify avenues for further research on use of retreats grounded in Whole Health principles for additional subpopulations of women Veterans and/or other high-risk populations that may benefit.

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 primary aim of this multi-site, two-year, pilot study is to evaluate the feasibility, acceptability, and preliminary efficacy of "Growth, Resilience, Insight, and Togetherness" (GRIT), a retreat-based intervention designed for women Veterans who have experienced intimate partner violence (IPV). GRIT is a retreat-based program designed to enhance social functioning for women Veterans as an upstream suicide prevention strategy. Grounded in Whole Health principles, this holistic complementary program offered in a nature-based, tranquil setting was created for, and with input from, women Veterans known to be at heightened suicide risk due to experiences of interpersonal violence. Through participation in group activities, experiential learning, and envisioning and planning for the future post-retreat, GRIT seeks to combat loneliness and isolation while fostering connection to self and others to support longer term recovery from the sequelae of violence exposure(s). Using a selective suicide prevention strategy, 48 women Veterans (N = 48) who have experienced interpersonal violence and endorse difficulties in at least two areas of social functioning will be recruited from two VA medical centers: VA Providence Healthcare system and VA Connecticut healthcare system. Eligible participants will be randomly assigned to the GRIT retreat or Growth, Resilience, and Insight (GRI), a self-guided version of the program that does not include a retreat. Participants will receive the GRIT in cohorts of approximately 12. Retreats will be co-led by pairs of VHA trained facilitators from VA Connecticut. A mixed methods approach will be used to evaluate feasibility and acceptability of GRIT and study procedures. Feasibility metrics will include ease of recruitment, program and study completion, and number of adverse events. Acceptability metrics will include participant ratings of satisfaction, credibility, perceived usefulness, and low burdensomeness of study procedures and GRIT/GRI programs. Preliminary efficacy data will be collected on social functioning and mental health impairment, and suicide risk pre-, post-, and two months following program completion.