# Impact of Veteran Voices & Visions Peer Support Groups on Social Integration for Veterans with SMI/Psychosis

> **NIH VA I21** · VA GREATER LOS ANGELES HEALTHCARE SYSTEM · 2024 · —

## Abstract

Veterans with Serious Mental Illness (SMI) struggle with social integration - participation in work, housing, and
citizenship - due to symptoms, stigma, and psychosocial functioning deficits. This has a tremendous impact on
mortality, comparable to that of smoking and greater than obesity and alcohol abuse. Despite considerable VA
efforts to provide mental health care to Veterans with SMI, programs that promote social integration are
lacking. Veterans with SMI are at especially high risk for poor social integration and suicidal ideation during the
COVID-19 pandemic. There is an urgency to advance treatments targeting Veterans' social integration.
This project addresses this need with a group-based, peer specialist (PS) co-facilitated psychosocial
intervention for Veterans with SMI, called “Veteran Voices and Visions” (VVV). VVV targets Veterans with SMI
who experience psychosis, a group particularly in need of support with social integration. Virtual VVV groups
are co-led by VA mental health clinicians (MHCs) and PSs via online video conference. VVV is an adaptation
of a community-based support group model called the Hearing Voices (HV) approach that was developed over
30 years ago in the Netherlands. It has since spread to over twenty-five countries, representing hundreds of
support groups worldwide. The approach facilitates group cohesion around and normalization of the common
psychotic symptoms of SMI: hallucinations, delusions, and social isolation. Despite its global scope, this
approach has neither been formally adapted nor rigorously studied in public health systems, including the VA.
This intervention has the potential to create and foster a supportive community that improves the social
integration of participants by reducing their distress and self-stigma, and increasing self-efficacy. These three
process outcomes are strongly associated with social integration. This proposal is directly aligned with VA
priorities to advance the breadth of existing psychosocial interventions for Veterans with SMI, improve access
via telehealth services, and support Veterans' independence, wellbeing, empowerment, and whole health.
The goal of this proposal is (1) to develop a manual, training guidelines, and a fidelity scale for VVV, (2) to
assess the feasibility and acceptability of VVV, and (3) collect pilot outcome data. The manual, training
guidelines, and fidelity scale will be developed by the research team in collaboration with 4 advisory panels:
Veterans with SMI, MHCs, PSs, and non-VA experts in HV. Then, 5 MHCs and 5 PSs will be trained to use the
new VVV manual, and each MHC-PS pair will conduct a group with the new protocol. Thirty Veterans will be
recruited to participate in these 5 groups and assessments will be conducted at baseline, midpoint, and post-
intervention. Baseline assessments include measurement of psychiatric symptoms, level of distress from
psychosis, internalized self-stigma, self-efficacy, sense of belonging, recovery, and s...

## Key facts

- **NIH application ID:** 10754880
- **Project number:** 5I21RX004376-02
- **Recipient organization:** VA GREATER LOS ANGELES HEALTHCARE SYSTEM
- **Principal Investigator:** Ippolytos Andreas Kalofonos
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-12-01 → 2025-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10754880

## Citation

> US National Institutes of Health, RePORTER application 10754880, Impact of Veteran Voices & Visions Peer Support Groups on Social Integration for Veterans with SMI/Psychosis (5I21RX004376-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10754880. Licensed CC0.

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