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Bond AE, Houtsma C, Shapiro ME, Bandel SL, Moceri-Brooks J, Anestis MD. Female military service members and veterans: Understanding treatment seeking behavior and previous suicide risk among suicide decedents. DEATH STUDIES 2024:1-8. [PMID: 38912977 DOI: 10.1080/07481187.2024.2370468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
To examine the differences in treatment seeking behaviors, previous suicidal thoughts, previous suicide attempts, and disclosure of suicidal thoughts among female service members (SM)/Veteran suicide decedents who used a firearm and those who used another method. Data was acquired from the National Violent Death Reporting System which is maintained and monitored by the Center for Disease Control and Prevention. Data included in the present study were from suicide deaths that occurred between 2003-2018. Female SM/Veterans who died by firearm suicide had lower proportions of current mental health or substance use treatment, lifetime mental health or substance use treatment, and previous suicide attempts compared to those who used another method. Female SM/Veterans who die by firearm suicide are less likely to encounter mental health services than those who use another method. Conversations on secure firearm storage need to occur outside of the health care setting.
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Affiliation(s)
- Allison E Bond
- The New Jersey Gun Violence Research Center, Rutgers The State University of New Jersey, New Brunswick, USA
- Department of Psychology, Rutgers University, USA
| | - Claire Houtsma
- Southeast Louisiana Veterans Health Care System, USA
- South Central Mental Illness Research, Education and Clinical Center, USA
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mary E Shapiro
- Southeast Louisiana Veterans Health Care System, USA
- South Central Mental Illness Research, Education and Clinical Center, USA
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Shelby L Bandel
- The New Jersey Gun Violence Research Center, Rutgers The State University of New Jersey, New Brunswick, USA
- Department of Psychology, Rutgers University, USA
| | - Jayna Moceri-Brooks
- The New Jersey Gun Violence Research Center, Rutgers The State University of New Jersey, New Brunswick, USA
| | - Michael D Anestis
- The New Jersey Gun Violence Research Center, Rutgers The State University of New Jersey, New Brunswick, USA
- School of Public Health, Rutgers University, New Brunswick, USA
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Mog AC, Benson SK, Sriskantharajah V, Kelly PA, Gray KE, Callegari LS, Moy EM, Katon JG. "You want people to listen to you": Patient experiences of women's healthcare within the Veterans Health Administration. Health Serv Res 2024. [PMID: 38804072 DOI: 10.1111/1475-6773.14324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE To identify constructs that are critical in shaping Veterans' experiences with Veterans Health Administration (VA) women's healthcare, including any which have been underexplored or are not included in current VA surveys of patient experience. DATA SOURCES AND STUDY SETTING From June 2022 to January 2023, we conducted 28 semi-structured interviews with a diverse, national sample of Veterans who use VA women's healthcare. STUDY DESIGN Using VA data, we divided Veteran VA-users identified as female into four groups stratified by age (dichotomized at age 45) and race/ethnicity (non-Hispanic White vs. all other). We enrolled Veterans continuously from each recruitment strata until thematic saturation was reached. DATA COLLECTION/EXTRACTION METHODS For this qualitative study, we asked Veterans about past VA healthcare experiences. Interview questions were guided by a priori domains identified from review of the literature, including trust, safety, respect, privacy, communication and discrimination. Analysis occurred concurrently with interviews, using inductive and deductive content analysis. PRINCIPAL FINDINGS We identified five themes influencing Veterans' experiences of VA women's healthcare: feeling valued and supported, bodily autonomy, discrimination, past military experiences and trauma, and accessible care. Each emergent theme was associated with multiple of the a priori domains we asked about in the interview guide. CONCLUSIONS Our findings underscore the need for a measure of patient experience tailored to VA women's healthcare. Existing patient experience measures used within VA fail to address several aspects of experience highlighted by our study, including bodily autonomy, the influence of past military experiences and trauma on healthcare, and discrimination. Understanding distinct factors that influence women and gender-diverse Veterans' experiences with VA care is critical to advance efforts by VA to measure and improve the quality and equity of care for all Veterans.
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Affiliation(s)
- Ashley C Mog
- Seattle-Denver Center of Innovation (COIN), VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Samantha K Benson
- Seattle-Denver Center of Innovation (COIN), VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Vyshnika Sriskantharajah
- Seattle-Denver Center of Innovation (COIN), VA Puget Sound Health Care System, Seattle, Washington, USA
| | - P Adam Kelly
- Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana, USA
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Kristen E Gray
- Seattle-Denver Center of Innovation (COIN), VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington, USA
| | - Lisa S Callegari
- Seattle-Denver Center of Innovation (COIN), VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ernest M Moy
- Office of Health Equity, Veterans Health Administration, Washington, District of Columbia, USA
| | - Jodie G Katon
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
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Polzer ER, Holliday R, Rohs CM, Thomas SM, Miller CN, Simonetti JA, Brenner LA, Monteith LL. Women Veterans' perspectives, experiences, and preferences for firearm lethal means counseling discussions. PLoS One 2023; 18:e0295042. [PMID: 38055694 DOI: 10.1371/journal.pone.0295042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023] Open
Abstract
AIMS Firearms have become an increasingly common method of suicide among women Veterans, yet this population has rarely been a focus in firearm suicide prevention research. Limited knowledge is available regarding the preferences, experiences, or needs of women Veterans with respect to firearm lethal means counseling (LMC), an evidence-based suicide prevention strategy. Understanding is necessary to optimize delivery for this population. METHOD Our sample included forty women Veterans with lifetime suicidal ideation or suicide attempt(s) and firearm access following military separation, all enrolled in the Veterans Health Administration. Participants were interviewed regarding their perspectives, experiences, and preferences for firearm LMC. Data were analyzed using a mixed inductive-deductive thematic analysis. RESULTS Women Veterans' firearm and firearm LMC perspectives were shaped by their military service histories and identity, military sexual trauma, spouses/partners, children, rurality, and experiences with suicidal ideation and attempts. Half reported they had not engaged in firearm LMC previously. For those who had, positive aspects included a trusting, caring relationship, direct communication of rationale for questions, and discussion of exceptions to confidentiality. Negative aspects included conversations that felt impersonal, not sufficiently comprehensive, and Veterans' fears regarding implications of disclosure, which impeded conversations. Women Veterans' preferences for future firearm LMC encompassed providers communicating why such conversations are important, how they should be framed (e.g., around safety and genuine concern), what they should entail (e.g., discussing concerns regarding disclosure), whom should initiate (e.g., trusted caring provider) and where they should occur (e.g., safe spaces, women-specific groups comprised of peers). DISCUSSION This study is the first to examine women Veterans' experiences with, and preferences for, firearm LMC. Detailed inquiry of the nuances of how, where, why, and by whom firearms are stored and used may help to facilitate firearm LMC with women Veterans.
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Affiliation(s)
- Evan R Polzer
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado, United States of America
| | - Ryan Holliday
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado, United States of America
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Carly M Rohs
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado, United States of America
| | - Suzanne M Thomas
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado, United States of America
| | - Christin N Miller
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado, United States of America
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Joseph A Simonetti
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado, United States of America
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Lisa A Brenner
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado, United States of America
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Lindsey L Monteith
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado, United States of America
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Firearm Injury Prevention Initiative, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
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4
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Godier-McBard LR, Wood A, Kohomange M, Cable G, Fossey M. Barriers and facilitators to mental healthcare for women veterans: a scoping review. J Ment Health 2023; 32:951-961. [PMID: 36062860 DOI: 10.1080/09638237.2022.2118686] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 05/16/2022] [Accepted: 06/25/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Traditionally, veteran research and support have centred on the requirements of a predominantly male population. However, as female participation in the Armed Forces increases and their roles diversify, consideration of women's unique mental health needs is imperative. Women veterans are at greater risk of post-service mental health challenges than their male counterparts, and female mental health outcomes have deteriorated in recent years. AIMS To determine the provenance of these outcomes, a scoping review considering both barriers and facilitators to female veteran participation in mental health services was conducted. METHODS A review was carried out following the 2020 Joanna Briggs Institute Scoping Review framework. Twenty-four papers were identified, with all but one originating from the US. RESULTS This research indicated that whilst women experience barriers common to male veterans (e.g. help-seeking stigma), they also experience unique gender-specific barriers to accessing mental healthcare services (e.g. lack of gender-sensitive treatment options, feeling uncomfortable) and such barriers result in under-utilization of services. CONCLUSIONS Literature indicates that consideration and mitigation of these barriers might improve access and health outcomes for women veterans. Further research is required outside the US to understand the barriers to mental healthcare experienced by women veterans internationally.
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Affiliation(s)
- Lauren Rose Godier-McBard
- Veterans and Families Institute for Military Social Research, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Abigail Wood
- Veterans and Families Institute for Military Social Research, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Manjana Kohomange
- School of Medicine, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Graham Cable
- Forces in Mind Trust Research Centre, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Matt Fossey
- Veterans and Families Institute for Military Social Research, Anglia Ruskin University, Chelmsford, United Kingdom
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Lafferty M, Winchell K, Cottrell E, Knight S, Nugent SM. Women of the Gulf War: Understanding Their Military and Health Experiences Over 30 Years. Mil Med 2023; 188:3191-3198. [PMID: 36179086 DOI: 10.1093/milmed/usac283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/28/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Women Veterans of the Persian Gulf War (GW) expanded the military roles they had filled in previous military eras, with some women engaging in direct combat for the first time. Many GW service members, including women, had unique combat exposures to hazardous agents during deployment, which might have contributed to the development of chronic health problems. This study aims to understand the experiences of women GW Veterans (GWVs) as it is related to their military service and subsequent health in order to better inform and improve their clinical care. MATERIALS AND METHODS We conducted in-depth interviews with 10 women GWVs to understand their experiences and perspectives about how their military service in the Gulf has impacted their lives and health. We used an integrated approach of content analysis and inductive thematic analysis to interpret interview data. RESULTS Besides having many of the same war-related exposures as men, women faced additional challenges in a military that was inadequately prepared to accommodate them, and they felt disadvantaged as women within the military and local culture. After service, participants had emergent physical and mental health concerns, which they described as developing into chronic and complex conditions, affecting their relationships and careers. While seeking care and service connection at Veterans Health Administration (VA), women voiced frustration over claim denials and feeling dismissed. They provided suggestions of how VA services could be improved for women and GWVs. Participants found some nonpharmacological approaches for symptom management and coping strategies to be helpful. CONCLUSIONS Women in the GW encountered challenges in military and healthcare systems that were inadequately prepared to address their needs. Women faced chronic health conditions common to GWV and voiced the desire to be understood as a cohort with unique needs. There is an ongoing need to expand services within the VA for women GWVs, particularly involving psychosocial support and management of chronic illness. While the small sample size can limit generalizability, the nature of these in-depth, minimally guided interviews provides a rich narrative of the women GWVs in this geographically diverse sample.
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Affiliation(s)
- Megan Lafferty
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care, Portland, OR 97239, USA
| | - Kara Winchell
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care, Portland, OR 97239, USA
| | - Erika Cottrell
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Sara Knight
- VA Salt Lake City Health Care System, Salt Lake City, UT 84148, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, USA
| | - Shannon M Nugent
- VA Portland Health Care System, Center to Improve Veteran Involvement in Care, Portland, OR 97239, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, 97239, USA
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Rohs CM, Albright KR, Monteith LL, Lane AD, Fehling KB. Perspectives of VA healthcare from rural women veterans not enrolled in or using VA healthcare. PLoS One 2023; 18:e0289885. [PMID: 37578986 PMCID: PMC10424869 DOI: 10.1371/journal.pone.0289885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023] Open
Abstract
PURPOSE Women Veterans have unique healthcare needs and often experience comorbid health conditions. Despite this, many women Veterans are not enrolled in the Veterans Health Administration (VHA) and do not use VHA services. Underutilization of VHA services may be particularly prevalent among rural women Veterans, who may experience unique barriers to using VHA care. Nonetheless, knowledge of rural women Veterans and their experiences remains limited. We sought to understand rural women Veterans' perceptions and needs related to VHA healthcare, including barriers to enrolling in and using VHA services, and perspectives on how to communicate with rural women Veterans about VHA services. METHODS Rural women Veterans were recruited through community engagement with established partners and a mass mailing to rural women Veterans not enrolled in or using VHA healthcare. Ten virtual focus groups were conducted with a total of twenty-nine rural women Veterans (27 not enrolled in VHA care and 2 who had not used VHA care in the past 5 years) in 2021. A thematic inductive analytic approach was used to analyze focus group transcripts. FINDINGS Primary themes regarding rural women Veterans' perceptions of barriers to enrollment and use of VHA healthcare included: (1) poor communication about eligibility and the process of enrollment; (2) belief that VHA does not offer sufficient women's healthcare services; and (3) inconvenience of accessing VHA facilities. CONCLUSION Although VHA has substantially expanded healthcare services for women Veterans, awareness of such services and the nuances of eligibility and enrollment remains an impediment to enrolling in and using VHA healthcare among rural women Veterans. Recommended strategies include targeted communication with rural women Veterans not enrolled in VHA care to increase their awareness of the enrollment process, eligibility, and expansion of women's healthcare services. Creative strategies to address access and transportation barriers in rural locations are also needed.
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Affiliation(s)
- Carly M. Rohs
- Seattle-Denver Center for Innovation (COIN), Rocky Mountain Regional VA Medical Center, Aurora, Colorado, United States of America
- VA Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado, United States of America
| | - Karen R. Albright
- Seattle-Denver Center for Innovation (COIN), Rocky Mountain Regional VA Medical Center, Aurora, Colorado, United States of America
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Lindsey L. Monteith
- VA Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Aurora, Colorado, United States of America
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Amber D. Lane
- Seattle-Denver Center for Innovation (COIN), Rocky Mountain Regional VA Medical Center, Aurora, Colorado, United States of America
| | - Kelty B. Fehling
- Seattle-Denver Center for Innovation (COIN), Rocky Mountain Regional VA Medical Center, Aurora, Colorado, United States of America
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Silvestrini M, Chen JA. "It's a sign of weakness": Masculinity and help-seeking behaviors among male veterans accessing posttraumatic stress disorder care. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2023; 15:665-671. [PMID: 36201833 PMCID: PMC11107421 DOI: 10.1037/tra0001382] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Male veterans delay posttraumatic stress disorder (PTSD) treatment and are less likely to engage in help-seeking behaviors or receive adequate mental health treatment. Male veterans face additional stigma seeking mental health care due to traditional masculine ideologies perpetuated by military culture. This study presents the perspectives of male veterans accessing Veterans Affairs (VA) PTSD services, focusing particularly on help-seeking behaviors and barriers to care. METHOD Semistructured interviews were conducted with 13 United States male veterans seeking treatment in VA primary care. Qualitative data analysis was coded using Atlas.ti, and thematic analysis was used to develop and refine themes. This study is part of a larger study examining veterans' initiation of PTSD treatment. RESULTS Findings indicate that male veterans in this sample may be reluctant to initiate PTSD care due to stigma, distrust of the military or mental health care, and a desire to avoid reliving their trauma. Significant others may encourage help-seeking behaviors among this population. Veterans also reported a need for mental health services that address PTSD from noncombat trauma and from military sexual trauma (MST). CONCLUSIONS Findings indicate that male veterans face unique challenges accessing mental health services and may benefit from increased VA services focused on MST and noncombat specific PTSD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Jessica A Chen
- VA Puget Sound HCS Seattle Division, Puget Sound Health Care System
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8
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Godier‐McBard LR, Gillin N, Fossey MJ. 'Treat everyone like they're a man': Stakeholder perspectives on the provision of health and social care support for female veterans in the UK. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3966-e3976. [PMID: 35289437 PMCID: PMC10078761 DOI: 10.1111/hsc.13790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/04/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
International research suggests that female veterans may experience gender-specific barriers to accessing veteran-specific care. This is the first UK study to report an exploratory qualitative investigation of the provision of health and social care support for female veterans and whether this support meets their needs. The research team carried out 13 virtual semi-structured interviews between October and November 2020, with representatives from statutory and third sector organisations that provide support to UK female veterans. Ethical approval was obtained from the Anglia Ruskin University School of Education and Social Care Research Ethics Committee. The authors identified four overarching themes and nine sub-themes in a thematic analysis following the framework outlined by Braun and Clarke (2006). The findings of this study suggest that practitioners from statutory and third sector organisations perceive the UK veteran support sector as male-dominated and male-targeted, with a lack of consideration for female veterans' needs. Participants reported a lack of engagement with veteran-specific services by female veterans and suggested that women either do not identify with the 'veteran' label or do not feel comfortable accessing male-dominated veteran-specific services. The need for specific services for female veterans split participant opinion, with most of those who were female veterans themselves highlighting the importance of 'safe spaces' for women, particularly those who had experienced gender-based violence during military service. Others felt that the veteran support sector currently lacked evidence of women's unique support needs, and an examination of current provision was required. The authors recommend a thorough assessment of UK female veterans' health and social care needs, alongside development of training and guidance for health and social care professionals, to ensure that veteran services are adequately developed, tailored and targeted with women's needs in mind.
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Affiliation(s)
- Lauren R. Godier‐McBard
- Veterans and Families Institute for Military Social ResearchAnglia Ruskin UniversityChelmsfordUK
| | - Nicola Gillin
- Veterans and Families Institute for Military Social ResearchAnglia Ruskin UniversityChelmsfordUK
| | - Matt J. Fossey
- Veterans and Families Institute for Military Social ResearchAnglia Ruskin UniversityChelmsfordUK
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9
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Graham K, Murphy D, Hendrikx LJ. Exploring Barriers to Mental Health Treatment in the Female Veteran Population: A Qualitative Study. JOURNAL OF VETERANS STUDIES 2022. [DOI: 10.21061/jvs.v8i3.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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10
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Lafferty M, Strange W, Kaboli P, Tuepker A, Teo AR. Patient Sense of Belonging in the Veterans Health Administration: A Qualitative Study of Appointment Attendance and Patient Engagement. Med Care 2022; 60:726-732. [PMID: 35880766 PMCID: PMC9378705 DOI: 10.1097/mlr.0000000000001749] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health care systems have increasingly focused on patient engagement in efforts to improve patient-centered care. Appointment attendance is an integral component of patient engagement, and missed appointments are an ongoing problem for health care systems. Virtually no studies have examined how the sense of belonging is related to patient engagement within a health care system. OBJECTIVE To examine patient experiences in the Veterans Health Administration (VA) with outpatient appointment attendance to identify factors that affect sense of belonging and patient engagement. RESEARCH DESIGN AND PARTICIPANTS This study draws from qualitative data collected as part of a study to reduce missed appointments through use of enhanced appointment reminder letters. We conducted semistructured interviews with 27 VA patients with primary care or mental health clinic visits, using deductive and inductive analysis to develop themes. More than half of the participants were Vietnam veterans, 24 were over 40 years old, 21 were White, and 18 were men. RESULTS We identified 3 factors that influence sense of belonging within the VA: (1) feelings of camaraderie and commitment toward other veterans were relevant to patient experience in the VA; (2) interactions with all staff influenced the engagement a patient felt with a particular clinic, care team, and the VA; (3) personalized communication and messaging could humanize the VA and demonstrate its interest in engaging with veterans. Lastly, we found (4) sense of belonging appeared to promote appointment attendance and patient engagement. CONCLUSIONS There are multiple opportunities to strengthen patients' sense of belonging within the health care system that serves them. For veterans, strategies that build their sense of belonging may be a novel approach to increase appointment attendance and patient engagement in their health care.
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Affiliation(s)
- Megan Lafferty
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland, USA
| | - Wynn Strange
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland, USA
| | - Peter Kaboli
- Comprehensive Access and Delivery Research and Evaluation (CADRE) Center at the Iowa City VA Healthcare System, Iowa City, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, USA
| | - Anaïs Tuepker
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland, USA
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, USA
| | - Alan R. Teo
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, USA
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, USA
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11
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Creech SK, Pearson R, Saenz JJ, Braciszewski JM, Riggs SA, Taft CT. Pilot trial of Strength at Home Parents, a trauma-informed parenting support treatment for veterans. COUPLE & FAMILY PSYCHOLOGY 2022; 11:205-216. [PMID: 36185500 PMCID: PMC9524484 DOI: 10.1037/cfp0000232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PTSD is associated with compromised parenting which is not adequately addressed in available evidence-based PTSD treatments. Strength at Home - Parents (SAHP) is a trauma-informed parenting intervention which aims to improve parenting behaviors and overall parent-child functioning. Here we report pilot data obtained in a sample of veterans (N=21) with PTSD and parent-child functioning difficulties. Results support feasibility of study methods, and intervention acceptability, credibility and satisfaction. Movement on primary outcome measures suggested improved overall family functioning, a decrease in the use of dysfunctional parenting practices, an increase in positive parenting practices and a trend towards a reduction in parenting stress. Results should be interpreted with caution because of the small sample size and attrition at follow-up. Limitations withstanding, findings support further study of the intervention, which would provide insights into whether an efficacy trial is indicated.
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Affiliation(s)
- Suzannah K Creech
- VHA VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Affairs Healthcare System, Waco, TX; and the Dell Medical School of the University of Texas, Department of Psychiatry and Behavioral Sciences, Austin, TX
| | - Rahel Pearson
- VHA VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Affairs Healthcare System, Waco, TX; and the Dell Medical School of the University of Texas, Department of Psychiatry and Behavioral Sciences, Austin, TX
| | - Jeremy J Saenz
- VHA VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Affairs Healthcare System, Waco, TX; and the Dell Medical School of the University of Texas, Department of Psychiatry and Behavioral Sciences, Austin, TX
| | | | - Shelley A Riggs
- University of North Texas, Denton, TX; and Sam Houston State University, Huntsville, TX
| | - Casey T Taft
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA; and Boston University School of Medicine, Boston, MA
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12
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Katz LS, Jensen G. Outcomes of a Five-Day Warrior Renew Retreat to Reduce Symptoms Related to Military Sexual Trauma for Women Veterans. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2022. [DOI: 10.1007/s10879-022-09545-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Chrystal JG, Frayne S, Dyer KE, Moreau JL, Gammage CE, Saechao F, Berg E, Washington DL, Yano EM, Hamilton AB. Women Veterans' Attrition from the VA Health Care System. Womens Health Issues 2022; 32:182-193. [PMID: 34972600 DOI: 10.1016/j.whi.2021.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Patient attrition from the Veterans Health Administration (VA) health care system could undercut its mission to ensure care for eligible veterans. Attrition of women veterans could exacerbate their minority status and impede systemic efforts to provide high-quality care. We obtained women veterans' perspectives on why they left or continued to use VA health care. METHODS A sampling frame of new women veteran VA patients was stratified by those who discontinued (attriters) and those who continued (non-attriters) using VA care. Semistructured interviews were conducted from 2017 to 2018. Transcribed interviews were coded for women's decision-making, contexts, and recommendations related to health care use. RESULTS Fifty-one women veterans (25 attriters and 26 non-attriters) completed interviews. Reasons for attrition included challenging patient care experiences (e.g., provider turnover, claim processing challenges) and the availability of private health insurance. Personal experiences with VA care (e.g., gender-specific care) were impactful in women's decision to use VA. The affordability of VA care was influential for both groups to stay connected to services. More than one-third of women originally categorized as attriters described subsequently reentering or planning to reenter VA care. Suggestions to decrease attrition included increasing outreach, improving access, and continuing to tailor care delivery to women veterans' needs. CONCLUSIONS Understanding the drivers of patients' decisions to use or not use the VA is critical for the development of strategies to improve retention of current patients and optimize health outcomes for veterans. Women veterans described complex reasons why they left or continued using VA, with cost/affordability playing an important role even in considerations of returning to VA after a long hiatus.
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Affiliation(s)
- Joya G Chrystal
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California.
| | - Susan Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Healthcare System, Menlo Park, California; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Karen E Dyer
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California
| | - Jessica L Moreau
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California
| | - Cynthia E Gammage
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California
| | - Fay Saechao
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Healthcare System, Menlo Park, California
| | - Eric Berg
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Healthcare System, Menlo Park, California
| | - Donna L Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California; Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles, California
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California; Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, California
| | - Alison B Hamilton
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Health Services Research and Development (HSR&D), Los Angeles, California; Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Semel Institute/NPI, Los Angeles, California
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Changes in the health and broader well-being of U.S. veterans in the first three years after leaving military service: Overall trends and group differences. Soc Sci Med 2022; 294:114702. [PMID: 35051742 DOI: 10.1016/j.socscimed.2022.114702] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/30/2021] [Accepted: 01/04/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Scholars have theorized that the initial period after military discharge may be a particularly vulnerable time for veterans. Yet, several recent studies raise the prospect that risk for poor adjustment may actually increase rather than decrease over time. The current study examined whether the U.S. military veteran population experiences improvements or declines in their health and broader well-being during the first three years after leaving military service and documented differences based on gender, military rank, and warzone deployment history. METHODS A population-based sample of 3733 newly separated veterans completed a survey within three months of separation (Fall 2016), followed by five additional surveys at six-month intervals. Weighted multilevel logistic regressions were conducted to examine changes in the proportion of veterans reporting good health and broader well-being over time. RESULTS Most aspects of veterans' health and broader well-being worsened over time, with a noteworthy increase in reporting of mental health conditions and a decline in veterans' community involvement. Declines in the proportion of veterans reporting good health and well-being were most notable for women, with smaller differences observed for other subgroups. CONCLUSIONS The finding that veterans experienced worsening health and broader well-being over time highlights the need for enhanced prevention and early intervention efforts to mitigate these declines. Findings also point to the importance of attending to the unique readjustment concerns of female veterans and other at-risk subgroups.
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15
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Fletcher TL, Amspoker AB, Wassef M, Hogan JB, Helm A, Jackson C, Jacobs A, Shammet R, Speicher S, Lindsay JA, Cloitre M. Increasing access to care for trauma-exposed rural veterans: A mixed methods outcome evaluation of a web-based skills training program with telehealth-delivered coaching. J Rural Health 2021; 38:740-747. [PMID: 34648188 DOI: 10.1111/jrh.12628] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE While rural veterans with trauma exposure report high rates of posttraumatic stress disorder (PTSD), depression, and functional impairment, utilization of health services is low. This pilot study used mixed qualitative and quantitative methods to evaluate the potential benefits of a transdiagnostic web-based skills training program paired with telehealth-delivered coaching to address a range of symptoms and functional difficulties. The study directed substantial outreach efforts to women veterans who had experienced military sexual trauma given their growing representation in the Veterans Healthcare Administration (VHA) and identified need for services. METHODS Participants were 32 trauma-exposed veterans enrolled in rural-serving VHA facilities who screened positive for either PTSD or depression. Symptoms of PTSD, depression, emotion regulation, and interpersonal problems were assessed at baseline, midpoint, posttreatment, and 3-month follow-up. Veterans completed exit interviews to identify benefits and limitations of the program. RESULTS Intent-to-treat analyses revealed significant symptom reduction for all outcomes, with large to moderate effect sizes at 3-month follow-up. Outcomes did not differ by gender or military sexual trauma status. Veterans' rating of the therapeutic alliance was high and interview responses indicated that the presence of the coach was critical to success in the program. CONCLUSION This remotely delivered transdiagnostic intervention provided significant benefits across a range of symptoms and functional outcomes and was viewed positively by veterans. The results indicate that further research (ie, a randomized controlled trial) is warranted. Attention to the role of the coach as a means by which to increase engagement and retention in technology-delivered interventions is warranted.
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Affiliation(s)
- Terri L Fletcher
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA
| | - Amber B Amspoker
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA.,Baylor College of Medicine, Department of Medicine, Houston, Texas, USA
| | - Miryam Wassef
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA
| | - Julianna B Hogan
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA
| | - Ashley Helm
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA
| | | | - Adam Jacobs
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Rayan Shammet
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Sarah Speicher
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Jan A Lindsay
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA.,Baylor College of Medicine, Department of Medicine, Houston, Texas, USA
| | - Marylène Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, California, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
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16
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Jones AL, Gordon AJ, Gabrielian SE, Montgomery AE, Blosnich JR, Varley AL, deRussy AJ, Austin EL, Hoge AE, Kim YI, Gelberg L, Kertesz SG. Perceptions of Care Coordination Among Homeless Veterans Receiving Medical Care in the Veterans Health Administration and Community Care Settings: Results From a National Survey. Med Care 2021; 59:504-512. [PMID: 33827108 PMCID: PMC8119353 DOI: 10.1097/mlr.0000000000001547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Initiatives to expand Veterans' access to purchased health care outside Veterans Health Administration (VHA) facilities ("community care") present care coordination challenges for Veterans experiencing homelessness. OBJECTIVE Among Veterans with homeless experiences, to evaluate community care use and satisfaction, and compare perceptions of care coordination among Veterans using VHA services and community care to those using VHA services without community care. RESEARCH DESIGN Cross-sectional analysis of responses to a 2018 mailed survey. SUBJECTS VHA outpatients with homeless experiences. MEASURES Self-reported use of community care, Likert-style ratings of satisfaction with that care, and Access/Coordination experiences from the Primary Care Quality-Homeless (PCQ-H) survey. RESULTS Of 4777 respondents, 1325 (26.7%) reported using community care; most of this subsample affirmed satisfaction with the community care they received (83%) and its timeliness (75%). After covariate adjustment, Veteran characteristics associated with greater community care use included female sex, being of retirement age and nonmarried, and having higher education, more financial hardship, ≥3 chronic conditions, psychological distress, depression, and posttraumatic stress disorder. Satisfaction with community care was lower among patients with travel barriers, psychological distress, and less social support. Compared with those using the VHA without community care, Veterans using VHA services and community care were more likely to report unfavorable access/coordination experiences [odds ratio (OR)=1.34, confidence interval (CI)=1.15-1.57]. This included hassles following referral (OR=1.37, CI=1.14-1.65) and perceived delays in receiving health care (OR=1.38, CI=1.19-1.61). CONCLUSIONS Veterans with homeless experiences value community care options. Potential access benefits are balanced with risks of unfavorable coordination experiences for vulnerable Veterans with limited resources.
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Affiliation(s)
- Audrey L Jones
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, Veterans Affairs Salt Lake City Health Care System
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Adam J Gordon
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, Veterans Affairs Salt Lake City Health Care System
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Sonya E Gabrielian
- VA Greater Los Angeles Health Care System
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA
| | - Ann Elizabeth Montgomery
- Birmingham VA Medical Center
- University of Alabama at Birmingham School of Public Health, Birmingham, AL
| | - John R Blosnich
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
| | | | | | - Erika L Austin
- Birmingham VA Medical Center
- University of Alabama at Birmingham School of Public Health, Birmingham, AL
| | | | - Young-Il Kim
- Birmingham VA Medical Center
- University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Lillian Gelberg
- VA Greater Los Angeles Health Care System
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA
| | - Stefan G Kertesz
- Birmingham VA Medical Center
- University of Alabama at Birmingham School of Public Health, Birmingham, AL
- University of Alabama at Birmingham School of Medicine, Birmingham, AL
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17
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Jones AL, Fine MJ, Taber PA, Hausmann LR, Burkitt KH, Stone RA, Zickmund SL. National Media Coverage of the Veterans Affairs Waitlist Scandal: Effects on Veterans' Distrust of the VA Health Care System. Med Care 2021; 59:S322-S326. [PMID: 33976083 PMCID: PMC8121177 DOI: 10.1097/mlr.0000000000001551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND On April 23, 2014, US media outlets broadcast reports of excessive wait times and "secret" waitlists at some Veterans Affairs (VA) hospitals, precipitating legislation to increase Veterans' access to private sector health care. OBJECTIVE The aims were to assess changes in Veterans' distrust in the VA health care system before and after the media coverage and explore sex and racial/ethnic differences in the temporal patterns. METHODS Veterans completed semistructured interviews on health care satisfaction from June 2013 to January 2015, including a validated scale of health system distrust (range: 1-5). We used linear splines with knots at 90-day intervals to assess changes in distrust before and after April 23, 2014 ("day 0") in linear mixed models. To explore sex and racial/ethnic differences in temporal patterns, we stratified models by sex and tested for interactions of race/ethnicity with time. RESULTS For women (n=600), distrust scores (mean=2.09) increased by 0.45 in days 0-90 (P<0.01), then decreased by 0.45 in days 90-180 (P<0.01). Among men (n=575), distrust scores (mean=2.05) increased by 0.18 in days 0-90 (P=0.059). Distrust levels were significantly higher for Black versus White women (time adjusted mean difference=0.21) and for Black and Hispanic versus White men (differences=0.26 and 0.18). However, the temporal patterns did not vary by race/ethnicity for women or men (interaction P=0.85 and 0.21, respectively). CONCLUSIONS Health system distrust increased in women following media coverage of VA access problems and was higher in Black/Hispanic versus White Veterans at all time periods. Such perceptions could influence Veteran decisions to seek health care in the community rather than VA.
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Affiliation(s)
- Audrey L. Jones
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT
| | - Michael J. Fine
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion
- Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Peter A. Taber
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT
| | - Leslie R.M. Hausmann
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion
- Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kelly H. Burkitt
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion
| | - Roslyn A. Stone
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion
| | - Susan L. Zickmund
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT
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18
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Braun TD, Uebelacker LA, Ward M, Holzhauer CG, McCallister K, Abrantes A. "We really need this": Trauma-informed yoga for Veteran women with a history of military sexual trauma. Complement Ther Med 2021; 59:102729. [PMID: 33965560 DOI: 10.1016/j.ctim.2021.102729] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/27/2021] [Accepted: 04/30/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Up to 70% of women service members in the United States report military sexual trauma (MST); many develop post-traumatic stress disorder (PTSD) and co-occurring disorders. Trauma-informed yoga (TIY) is suggested to improve psychiatric symptoms and shown feasible and acceptable in emerging research, yet no work has evaluated TIY in MST survivors. The current quality improvement project aimed to examine TIY's feasibility, acceptability, and perceived effects in the context of MST. DESIGN Collective case series (N = 7). SETTING New England Vet Center. INTERVENTIONS Extant TIY program (Mindful Yoga Therapy) adapted for Veteran women with MST in concurrent psychotherapy. MAIN OUTCOME MEASURES Attrition and attendance; qualitative exit interview; validated self-report measure of negative affect pre/post each yoga class, and symptom severity assessments and surveys before (T1; Time 1) and after the yoga program (T2; Time 2). RESULTS Feasibility was demonstrated and women reported TIY was acceptable. In qualitative interviews, women reported improved symptom severity, diet, exercise, alcohol use, sleep, and pain; reduced medication use; and themes related to stress reduction, mindfulness, and self-compassion. Regarding quantitative change, results suggest acute reductions in negative affect following yoga sessions across participants, as well as improved affect dysregulation, shame, and mindfulness T1 to T2. CONCLUSIONS TIY is both feasible and acceptable to Veteran women MST survivors in one specific Vet Center, with perceived behavioral health benefits. Results suggest TIY may target psychosocial mechanisms implicated in health behavior change (stress reduction, mindfulness, affect regulation, shame). Formal research should be conducted to confirm these QI project results.
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Affiliation(s)
- Tosca D Braun
- VA Central Western Massachusetts, 421 N. Main St., Leeds, MA, 01053, United States; West Springfield, MA Vet Center, 95 Ashley Ave., West Springfield, MA, 01089-1352, United States; Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903, United States(1); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, 700 Butler Drive, Providence, RI, 02906, United States.
| | - Lisa A Uebelacker
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, 700 Butler Drive, Providence, RI, 02906, United States; Psychosocial Research, Butler Hospital, 345 Blackstone Blvd., Providence, RI, 02906, United States.
| | - Mariana Ward
- Memorial Sloan Kettering, Sloan Kettering Institute, 1275 York Ave., New York, NY, 10065, United States.
| | - Cathryn Glanton Holzhauer
- VA Central Western Massachusetts, 421 N. Main St., Leeds, MA, 01053, United States; Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Ave., North Worcester, MA, 01655, United States.
| | - Kelly McCallister
- West Springfield, MA Vet Center, 95 Ashley Ave., West Springfield, MA, 01089-1352, United States.
| | - Ana Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, 700 Butler Drive, Providence, RI, 02906, United States; Behavioral Medicine and Addictions Research, Butler Hospital, 345 Blackstone Blvd., Providence, RI, 02906, United States.
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19
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Wallace D, Lane J, Heffernan K, Nas Jones C. Australian military and veterans' mental health care: improving assessment of military personnel and veterans. Australas Psychiatry 2021; 29:153-156. [PMID: 32713189 DOI: 10.1177/1039856220943043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe key practical knowledge and skill components required for clinicians involved with the assessment of military personnel and veterans. CONCLUSIONS Assessment of military and veterans' mental health issues involves a tailored history-taking process that includes specific aspects of service, transition and reporting requirements. Recommendations for the detailed assessment of military personnel and veterans are provided. Comorbid conditions, chronic pain and the needs of both women and older veterans are also discussed.
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Affiliation(s)
- Duncan Wallace
- Australian Defence Force Centre for Mental Health, Australia.,School of Psychiatry, University of NSW, Australia
| | - Jonathan Lane
- Centre for Traumatic Stress Studies, University of Adelaide, Australia.,School of Medicine, University of Tasmania, Australia
| | - Kristi Heffernan
- Joint Health Command, Australian Defence Force, Australia.,Phoenix Australia - Centre for Posttraumatic Mental Health, Australia
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20
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The Focus They Deserve: Improving Women Veterans' Health Care Access. Womens Health Issues 2021; 31:399-407. [PMID: 33582001 DOI: 10.1016/j.whi.2020.12.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 12/18/2020] [Accepted: 12/24/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE Veterans Health Administration (VHA) initiatives aim to provide veterans timely access to quality health care. The focus of this analysis was provider and staff perspectives on women veterans' access in the context of national efforts to improve veterans' access to care. METHODS We completed 21 site visits at Veterans Health Administration medical facilities to evaluate the implementation of a national access initiative. Qualitative data collection included semistructured interviews (n = 127), focus groups (n = 81), and observations with local leadership, administrators, providers, and support staff across primary and specialty care services at each facility. Deductive and inductive content analysis was used to identify barriers, facilitators, and contextual factors affecting implementation of initiatives and women veterans' access. RESULTS Participants identified barriers to women veterans' access and strategies used to improve access. Barriers included a limited availability of providers trained in women's health and gender-specific care services (e.g., women's specialty care), inefficient referral and coordination with community providers, and psychosocial factors (e.g., childcare). Participants also identified issues related to childcare and perceived harassment in medical facility settings as distinct access issues for women veterans. Strategies focused on increasing internal capacity to provide on-site women's comprehensive care and specialty services by streamlining provider training and credentialing, contracting providers, using telehealth, and improving access to community providers to fill gaps in women's services. Participants also highlighted efforts to improve gender-sensitive care delivery. CONCLUSIONS Although some issues affect all veterans, problems with community care referrals may disproportionately affect women veterans' access owing to a necessary reliance on community care for a range of gender-specific services.
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21
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Sullivan-Baca E, Naylon K, Zartman A, Ardolf B, Westhafer JG. Gender Differences in Veterans Referred for Neuropsychological Evaluation in an Outpatient Neuropsychology Consultation Service. Arch Clin Neuropsychol 2020; 35:562-575. [PMID: 32128586 DOI: 10.1093/arclin/acaa008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/21/2020] [Accepted: 01/25/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The number of women veterans seeking Veterans Health Administration services has substantially increased over the past decade. Neuropsychology remains an understudied area in the examination of gender differences. The present study sought to delineate similarities and differences in men and women veterans presenting for neuropsychological evaluation in terms of demographics, referral, medical conditions, effort, and outcome diagnosis. METHOD A database collected from an outpatient VA neuropsychology clinic from 2013 to 2019 was analyzed (n = 232 women, 2642 men). Additional analyses examined younger (n = 836 men, 155 women) and older (n = 1805 men, 77 women) age cohorts. RESULTS Women veterans were younger and more educated than men, whereas men had higher prevalence of vascular risk factors. Both groups were most often referred from mental health clinics and memory was the most common referral question. Although men performed worse on performance validity measures, clinicians rated women as evidencing poorer effort on a cumulative rating based on formal and embedded performance validity measures, behavioral observations, and inconsistent test patterns. Older women reported more depressive symptoms than older men and were more commonly diagnosed with depression. CONCLUSIONS This exploratory study fills a gap in the understanding of gender differences in veterans presenting for neuropsychological evaluations. Findings emphasize consideration for the intersection of gender with demographics, medical factors, effort, and psychological symptoms by VA neuropsychologists. A better understanding of relationships between gender and these factors may inform neuropsychologists' test selection, interpretation of behavioral observations, and diagnostic considerations to best treat women veterans.
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Affiliation(s)
| | - Kara Naylon
- VA North Texas Healthcare System, Dallas, TX, USA
| | | | - Barry Ardolf
- VA North Texas Healthcare System, Dallas, TX, USA
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22
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Oakley T, King L, Ketcheson F, Richardson JD. Gender differences in clinical presentation among treatment-seeking Veterans and Canadian Armed Forces personnel. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2020. [DOI: 10.3138/jmvfh-2019-0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: Limited research has investigated gender differences among treatment-seeking Veterans and serving military personnel, despite important implications for treatment provision. In order to better serve the needs of women with military service, the authors sought to address this gap by examining the clinical presentation of men and women requesting services for military-related operational stress injuries (OSIs). Methods: Using a sample of 648 treatment-seeking male ( n = 550) and female ( n = 99) Veterans and Canadian Armed Forces (CAF) personnel, the authors compared prevalence of childhood sexual and physical abuse, probable mental health diagnoses (posttraumatic stress disorder [PTSD], depression, and generalized anxiety disorder [GAD]), and severity of pain and somatic symptoms. Results were rerun to control for sociodemographic variables that significantly differed by gender. Results: Rates of probable PTSD were higher for women ( p < 0.05), and women reported significantly more somatic symptoms ( p < 0.001), pain severity ( p < 0.01), and childhood sexual abuse (47% of the sample; p < 0.001). Both men and women reported equally high rates of childhood physical abuse (71% for both genders). Discussion: Women in this study had a higher prevalence of probable PTSD and childhood sexual abuse, and reported higher severity of pain and somatic symptoms. The study highlights the diverse range of issues that are clinically relevant for – and may complicate the treatment of – women with military service who have OSIs.
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Affiliation(s)
- Tanya Oakley
- Operational Stress Injury Clinic, Parkwood Institute, St. Joseph’s Health Care, London, Ontario, Canada
| | - Lisa King
- Operational Stress Injury Clinic, Parkwood Institute, St. Joseph’s Health Care, London, Ontario, Canada
| | - Felicia Ketcheson
- Operational Stress Injury Clinic, Parkwood Institute, St. Joseph’s Health Care, London, Ontario, Canada
| | - J. Don Richardson
- Operational Stress Injury Clinic, Parkwood Institute, St. Joseph’s Health Care, London, Ontario, Canada
- MacDonald Franklin OSI Research Centre, Western University, London, Ontario, Canada
- Department of Psychiatry, Western University, London, Ontario, Canada
- Department of Psychiatry, McMaster University, Hamilton, Ontario, Canada
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23
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Farmer CC, Rossi FS, Michael EM, Kimerling R. Psychotherapy Utilization, Preferences, and Retention among Women Veterans with Post-traumatic Stress Disorder. Womens Health Issues 2020; 30:366-373. [PMID: 32680627 DOI: 10.1016/j.whi.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 05/18/2020] [Accepted: 06/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Psychotherapy is the gold standard treatment for post-traumatic stress disorder (PTSD), yet psychotherapy use and retention among veterans is low. Little is known about the barriers to care and factors associated with women veterans' PTSD psychotherapy use and retention. Using a nationally representative sample of 986 women Veterans Health Administration primary care users with PTSD and a perceived need for mental health care, we examined 1) the proportion of women who used psychotherapy, 2) retention in psychotherapy among women who used any psychotherapy, and 3) individual factors related to psychotherapy use and retention. METHODS Women completed a survey on their mental health care experiences. Outpatient mental health care use in the year before the survey was obtained from Veterans Health Administration administrative data. RESULTS Most women (79.1%) used psychotherapy, and 41.7% of those women had a minimal therapeutic dose of psychotherapy (≥8 visits). Mental health diagnostic comorbidity and being African American/Black or identifying as neither African American/Black nor White were significantly associated with higher psychotherapy use. Mental health diagnostic comorbidity, exposure to military sexual trauma, and receiving treatment aligned with gender-related and group-related preferences were associated with higher psychotherapy retention. Being a parent was associated with lower retention. CONCLUSIONS Although a significant proportion of women veterans with PTSD are using psychotherapy, retention is enhanced when women are able to obtain treatment aligned with their preferences. Thus, efforts to promote patient-centered, shared decisions regarding mental health treatment options could increase the efficacy and efficiency of treatment for PTSD among women.
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Affiliation(s)
- Courtney C Farmer
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, California
| | - Fernanda S Rossi
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California; Center for Primary Care and Outcomes Research and Center for Health Policy, Stanford University School of Medicine, Palo Alto, California
| | - Elizabeth M Michael
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, California
| | - Rachel Kimerling
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California; National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California.
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Women Veterans' Perspectives on How to Make Veterans Affairs Healthcare Settings More Welcoming to Women. Womens Health Issues 2020; 30:299-305. [DOI: 10.1016/j.whi.2020.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/04/2020] [Accepted: 03/17/2020] [Indexed: 02/06/2023]
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Silvestrini M, Nicosia F, Spar MJ, Gibson CJ, Brown RT. "We Have a Long Way to Go:" A Case Study Examination of Older Women Veterans' Experiences in VA Primary Care. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 57:46958020931311. [PMID: 32525421 PMCID: PMC7290258 DOI: 10.1177/0046958020931311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Women Veterans are a growing population with complex care needs. While previous research has examined the experiences of women Veterans, little attention has been paid to the specific experiences of older women Veterans. These case studies present the experiences of 2 older women Veterans who have been enrolled in Veterans Affairs (VA) health care for several decades. Results suggest that these older women Veterans have faced gender-specific challenges and barriers throughout their time accessing VA care. The experiences of these participants suggest that they have gender-sensitive needs that are not always addressed by VA primary care and that women’s groups are important mechanisms by which they have gained psychological support in a gender-sensitive environment. These cases suggest that access to gender-sensitive services and women-centered spaces are important for these 2 older women Veterans and should be explored in future research.
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Affiliation(s)
- Molly Silvestrini
- San Francisco VA Health Care System, CA, USA.,University of California, San Francisco, USA
| | - Francesca Nicosia
- San Francisco VA Health Care System, CA, USA.,University of California, San Francisco, USA
| | - Malena J Spar
- San Francisco VA Health Care System, CA, USA.,University of California, San Francisco, USA
| | - Carolyn J Gibson
- San Francisco VA Health Care System, CA, USA.,University of California, San Francisco, USA
| | - Rebecca T Brown
- San Francisco VA Health Care System, CA, USA.,University of California, San Francisco, USA.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
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Than C, Chuang E, Washington DL, Needleman J, Canelo I, Meredith LS, Yano EM. Understanding Gender Sensitivity of the Health Care Workforce at the Veterans Health Administration. Womens Health Issues 2020; 30:120-127. [PMID: 32094056 DOI: 10.1016/j.whi.2020.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 12/23/2019] [Accepted: 01/06/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Gender sensitivity of providers and staff has assumed increasing importance in closing historical gender disparities in health care quality and outcomes. The Department of Veterans Affairs (VA) has implemented several initiatives intended to improve gender sensitivity of its health care workforce. The current study examines practice- and individual-level characteristics associated with gender sensitivity of primary care providers (PCPs) and staff. METHODS We surveyed PCPs and staff (nurses, medical assistants, and clerks) at 12 VA medical centers (VAMCs) (n = 256 of 649; response rate, 39%). Gender sensitivity was measured using a 10-item scale adapted from the Gender Awareness Inventory-VA. We used weighted multivariate regression with maximum likelihood estimation to identify individual- and practice-level characteristics associated with gender sensitivity of PCPs and staff. RESULTS PCPs and staff had similar gender sensitivity but differed in most characteristics associated with that gender sensitivity. Among PCPs, women's health training and positive communication with others in the clinic were associated with greater gender sensitivity. For staff, prior work experience caring for women, working in Women's Health Patient-Aligned Care Teams, and rural location were associated with greater gender sensitivity, whereas more years of VA service was associated with lower gender sensitivity. Working at VA medical centers with a higher volume of women veteran patients was associated with greater gender sensitivity for both PCPs and staff. CONCLUSIONS Women's health training and experience in working with other women's health professionals are strongly correlated with greater gender sensitivity in the clinical workforce.
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Affiliation(s)
- Claire Than
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, California
| | - Emmeline Chuang
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, California
| | - Donna L Washington
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, Geffen School of Medicine, UCLA, Los Angeles, California
| | - Jack Needleman
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, California
| | - Ismelda Canelo
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | | | - Elizabeth M Yano
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, California.
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Sexton MB, Anderson RE, Bennett DC, Thomas EJ, Broman RB, Richards SKH. Military Sexual Trauma Survivor Preferences for Provider Gender and Associations With Mental Health Evaluation Attendance. THE BEHAVIOR THERAPIST 2020; 43:6-14. [PMID: 34898807 PMCID: PMC8664057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Minden B Sexton
- VA Ann Arbor Healthcare System, University of Michigan Medical School
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Boykin DM, Keegan F, Thompson KE, Voelkel E, Lindsay JA, Fletcher TL. Video to Home Delivery of Evidence-Based Psychotherapy to Veterans With Posttraumatic Stress Disorder. Front Psychiatry 2019; 10:893. [PMID: 31920747 PMCID: PMC6915196 DOI: 10.3389/fpsyt.2019.00893] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 11/13/2019] [Indexed: 11/13/2022] Open
Abstract
Background: The Veterans Health Administration (VHA) has pioneered the implementation of video to home (VTH) technology to increase access to mental health treatments for Veterans facing barriers to receiving in-person care, particularly for posttraumatic stress disorder (PTSD). Randomized controlled trials have established the noninferiority of evidence-based psychotherapies (EBPs) for PTSD delivered through VTH, compared to in-person delivery. Less is known about the use of VTH to deliver EBPs for PTSD in routine clinical practice. Objective: We examined the provision of EBPs for PTSD delivered via VTH at a large Southwestern VHA PTSD outpatient clinic. Methods: Data were obtained from chart review of the electronic medical records of Veterans receiving at least one session of Cognitive Processing Therapy or Prolonged Exposure via VTH in the VHA PTSD clinic during the study time frame. Results: Fourteen providers (including six psychology trainees) delivered EBPs for PTSD via VTH between 2016 and 2018. Providers treated 74 Veterans (33.8% women) from diverse sociocultural backgrounds who ranged in age from 25 to 79. Each provider treated about 3.08 (± 2.18) Veterans using VTH, not including one provider who saw more than 30. A hybrid approach, in which VTH-delivery was coupled with in-person delivery, was used with 70.3% of Veterans across treatment (including sessions completed before initiation and after termination of the EBP). This demonstrates the versatility of VTH for meeting individual patient needs. Most EBP sessions (85.4%) were conducted over VTH. Despite Veterans attending an average of 6.85 (± 4.88) EBP sessions, 50% terminated before session 7. This dropout rate is consistent with national and local EBP completion averages within the VHA. Veterans receiving Cognitive Processing Therapy via VTH were more likely to complete treatment than those receiving Prolonged Exposure. No other patient factors predicted attrition. Conclusions: This study highlights the use of VTH as "tool in the toolbox" that expands the scope of practice for providers and increases opportunities for Veterans to receive EBPs for PTSD. We describe other potential advantages of using VTH to deliver EBPs for PTSD.
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Affiliation(s)
- Derrecka M. Boykin
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, United States
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Fallon Keegan
- Department of Psychology, University of North Texas, Denton, TX, United States
| | - Karin E. Thompson
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, United States
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
- Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Emily Voelkel
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
- Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Jan A. Lindsay
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, United States
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Terri L. Fletcher
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, United States
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
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Perceived Barriers and Facilitators to Contraceptive Use Among Women Veterans Accessing the Veterans Affairs Healthcare System. Womens Health Issues 2019; 30:57-63. [PMID: 31558352 DOI: 10.1016/j.whi.2019.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/09/2019] [Accepted: 08/20/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although many studies evaluate factors influencing contraceptive use, little is known about barriers and facilitators that may be specific to or prevalent among women veterans using the Veterans Affairs Healthcare System (VA). DESIGN Semistructured telephone interviews with a national sample of 189 women veterans at risk for unintended pregnancy who receive care in the VA were used to explore barriers and facilitators to contraceptive use as well as elicit suggestions for improving VA contraceptive care. The sample consisted primarily of women with risk factors for adverse reproductive health outcomes, including belonging to ethnic/racial minority groups, having a medical or mental health condition(s), and/or reporting a history of military sexual trauma. Transcript narratives were analyzed using content analysis and the constant comparison method. RESULTS Five distinct themes emerged as barriers or facilitators to contraceptive use depending on participants' VA facility and provider, and women offered concrete suggestions to address each barrier. Most participants (56%) noted poor efficiency as a barrier; others (39%) felt hindered by limited contraceptive counseling and patient education. Approximately one-third (34%) noted that low patient awareness of services impeded care and another one-third (32%) stressed poor interaction with providers as a barrier. Finally, 31% noted feeling ostracized at VA, and emphasized fostering a woman-friendly environment to remove discomfort associated with seeking contraceptive care. CONCLUSIONS These findings suggest that, despite widespread access to low-cost contraception, many women veterans experience barriers to accessing high-quality contraceptive care. These barriers are system and provider specific and warrant further internal evaluation.
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Smoking Cessation among Female and Male Veterans before and after a Randomized Trial of Proactive Outreach. Womens Health Issues 2019; 29 Suppl 1:S15-S23. [PMID: 31253237 PMCID: PMC8269751 DOI: 10.1016/j.whi.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 03/27/2019] [Accepted: 04/02/2019] [Indexed: 11/04/2022]
Abstract
Introduction: Female veterans smoke cigarettes at high rates compared with both male veterans and nonveteran women. Proactive outreach (PRO) to smokers may reduce gender disparities in cessation care. The objectives of this study were to compare baseline experiences with VA smoking cessation care for men and women and to assess for gender differences in response to a PRO intervention. Methods: We conducted a post hoc subgroup analysis of a pragmatic, multisite randomized, controlled trial comparing PRO with usual care (UC). Baseline experiences included physician advice to quit, satisfaction with care, and past-year treatment use. At the 1-year follow-up, treatment use, quit attempts, and 6-month prolonged abstinence for women and men randomized to PRO versus UC were compared using logistic regression. Results: Baseline and follow-up surveys were returned by 138 women and 2,516 men. At baseline, women were less likely than men to report being very or somewhat satisfied with the process of obtaining smoking cessation medications in the VA (47% of women vs. 62% of men), but no less likely to report having used cessation medications from the VA in the past year (39% of women vs. 34% of men). After the intervention, phone counseling and combined therapy increased among both women and men in PRO as compared with UC. At the 1-year follow-up, men in PRO were significantly more likely to report prolonged abstinence than those in UC (odds ratio, 1.65; 95% CI, 1.28–2.14); results for women were in the same direction but not statistically significant (odds ratio, 1.39; 95% CI, 0.48–3.99). Conclusions: Satisfaction with cessation care in VA remains low. PRO to smokers was associated with an increased use of cessation therapies, and increased odds of achieving prolonged abstinence. A subgroup analysis by gender did not reveal significant differences in the treatment effect.
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Dyer KE, Potter SJ, Hamilton AB, Luger TM, Bergman AA, Yano EM, Klap R. Gender Differences in Veterans’ Perceptions of Harassment on Veterans Health Administration Grounds. Womens Health Issues 2019; 29 Suppl 1:S83-S93. [DOI: 10.1016/j.whi.2019.04.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 04/27/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
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Callegari LS, Tartaglione EV, Magnusson SL, Nelson KM, Arteburn DE, Szarka J, Zephyrin L, Borrero S. Understanding Women Veterans' Family Planning Counseling Experiences and Preferences to Inform Patient-Centered Care. Womens Health Issues 2019; 29:283-289. [PMID: 30981559 DOI: 10.1016/j.whi.2019.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 03/04/2019] [Accepted: 03/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Women veterans' unique experiences in the military and burden of health comorbidities increase their risk of adverse pregnancy outcomes and may influence their counseling needs related to planning or preventing pregnancy. We investigated women veterans' experiences of family planning counseling in the military and Veterans Affairs (VA) health care systems as well as their counseling preferences. METHODS We conducted 32 qualitative interviews among women veterans ages 18-44 years receiving primary care at the VA Puget Sound or VA Pittsburgh health care systems between March and June 2016 to explore their experiences and preferences related to counseling about pregnancy goals and planning and contraception. Transcripts were analyzed using inductive and deductive content analysis, and key themes were identified. RESULTS Nearly all participants described negative experiences in family planning counseling encounters in the military and/or VA, including perceptions of gender-based discrimination and pressure to choose certain contraceptive methods, perceived judgment of their reproductive choices, and a lack of continuity with providers. Some women also reported positive experiences in family planning encounters in the VA, including feeling respected, receiving comprehensive information about options, and having their perspectives and concerns elicited. Counseling preferences that emerged included that providers initiate and validate family planning discussions, establish trust and avoid judgment, elicit women's individual preferences, and engage them as equal partners in decision making. CONCLUSIONS Women veterans reported a spectrum of negative and positive experiences in family planning encounters in the military and VA that, in conjunction with their preferences, provide key insights for patient-centered reproductive health care in VA.
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Affiliation(s)
- Lisa S Callegari
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington; Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, Washington; Department of Health Services, University of Washington School of Public Health, Seattle, Washington.
| | - Erica V Tartaglione
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
| | - Sara L Magnusson
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
| | - Karin M Nelson
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington; Department of Health Services, University of Washington School of Public Health, Seattle, Washington; Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - David E Arteburn
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington; Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Jackie Szarka
- Health Services Research and Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
| | | | - Sonya Borrero
- Center for Health Equity, Research, and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania; Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Klap R, Darling JE, Hamilton AB, Rose DE, Dyer K, Canelo I, Haskell S, Yano EM. Prevalence of Stranger Harassment of Women Veterans at Veterans Affairs Medical Centers and Impacts on Delayed and Missed Care. Womens Health Issues 2019; 29:107-115. [DOI: 10.1016/j.whi.2018.12.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 12/08/2018] [Accepted: 12/10/2018] [Indexed: 11/28/2022]
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Cichowski S, Ashley M, Ortiz O, Dunivan G. Female Veterans' Experiences With VHA Treatment for Military Sexual Trauma. Fed Pract 2019; 36:41-47. [PMID: 30766417 PMCID: PMC6366579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Provider validation and support for females' experiences as well as a range of therapies are essential treatments for female veterans with military sexual trauma.
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Affiliation(s)
- Sara Cichowski
- is a Female Pelvic Medicine and Reconstructive Surgeon at New Mexico VA Health Care System and University of New Mexico. is a Medical Student, is a Resident Physician in psychiatry, and is a Female Pelvic Medicine and Reconstructive Surgeon, all at the University of New Mexico in Albuquerque
| | - Malia Ashley
- is a Female Pelvic Medicine and Reconstructive Surgeon at New Mexico VA Health Care System and University of New Mexico. is a Medical Student, is a Resident Physician in psychiatry, and is a Female Pelvic Medicine and Reconstructive Surgeon, all at the University of New Mexico in Albuquerque
| | - Orlando Ortiz
- is a Female Pelvic Medicine and Reconstructive Surgeon at New Mexico VA Health Care System and University of New Mexico. is a Medical Student, is a Resident Physician in psychiatry, and is a Female Pelvic Medicine and Reconstructive Surgeon, all at the University of New Mexico in Albuquerque
| | - Gena Dunivan
- is a Female Pelvic Medicine and Reconstructive Surgeon at New Mexico VA Health Care System and University of New Mexico. is a Medical Student, is a Resident Physician in psychiatry, and is a Female Pelvic Medicine and Reconstructive Surgeon, all at the University of New Mexico in Albuquerque
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Local Leaders' Perspectives on Women Veterans' Health Care: What Would Ideal Look Like? Womens Health Issues 2018; 29:64-71. [PMID: 30455089 DOI: 10.1016/j.whi.2018.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 09/20/2018] [Accepted: 10/10/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The Veterans Health Administration (VHA) faces challenges in providing comprehensive, gender-sensitive care for women. National policies have led to important advancements, but local leadership also plays a vital role in implementing changes and operationalizing national priorities. In this article, we explore the notions of ideal women veterans' health care articulated by women's health leaders at local VHA facilities and regional networks, with the goal of identifying elements that could inform practice and policy. METHODS We conducted semistructured interviews with 86 local and regional women's health leaders at 12 VHA medical centers across four regions. At the conclusion of interviews about women's primary care, participants were asked to imagine "ideal care" for women veterans. Interviews were transcribed and coded using a hybrid inductive/deductive approach. RESULTS In describing ideal care, participants commonly touched on whether women veterans should have separate primary care services from men; the need for childcare, expanded reproductive health services, resources, and staffing; geographic accessibility; the value of input from women veterans; the physical appearance of facilities; fostering active interest in women's health across providers and staff; and the relative priority of women's health at the VHA. CONCLUSIONS Policy and practice changes to care for women veterans must be mindful of key stakeholders' vision for that care. Specific features of that vision include clinic construction that anticipates a growing patient population, providing childcare and expanded reproductive health services, ensuring adequate support staff, expanding mechanisms to incorporate women veterans' input, and fostering a culture oriented towards women's health at the organizational level.
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Shamaskin-Garroway AM, Knobf MT, Adams LJ, Haskell SG. "I Think It's Pretty Much the Same, as It Should Be": Perspectives of Inpatient Care Among Women Veterans. QUALITATIVE HEALTH RESEARCH 2018; 28:600-609. [PMID: 29231129 DOI: 10.1177/1049732317746380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of this study was to gain a deeper understanding of the inpatient hospitalization experience for women veterans through in-depth interviews. Women veterans who were admitted for inpatient care on medical units within a university-affiliated VA hospital were invited to participate in a semistructured interview that inquired about their hospital experience, interactions with medical providers, and how being a woman veteran might affect this experience. Interviews were transcribed verbatim and analyzed using constant comparative method until thematic saturation was achieved ( n = 25). Three themes, (a) Being a woman and a veteran: Intersecting identities, (b) Expecting equality and equity, and (c) Defining woman-centered inpatient care described the unique perspective and context for Veterans Health Administration (VHA) health care of women veterans. These findings provide insight and guidance to clinical practice and care delivery for women veterans, including training and interpersonal approaches medical providers can take to improve the hospital experience for women.
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Affiliation(s)
- Andrea M Shamaskin-Garroway
- 1 School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
- 2 VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - M Tish Knobf
- 3 Yale School of Nursing, Orange, Connecticut, USA
| | - Lynette J Adams
- 2 VA Connecticut Healthcare System, West Haven, Connecticut, USA
- 4 Yale School of Medicine, New Haven, Connecticut, USA
| | - Sally G Haskell
- 2 VA Connecticut Healthcare System, West Haven, Connecticut, USA
- 4 Yale School of Medicine, New Haven, Connecticut, USA
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Moreau JL, Cordasco KM, Young AS, Oishi SM, Rose DE, Canelo I, Yano EM, Haskell SG, Hamilton AB. The Use of Telemental Health to Meet the Mental Health Needs of Women Using Department of Veterans Affairs Services. Womens Health Issues 2018; 28:181-187. [DOI: 10.1016/j.whi.2017.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 11/27/2017] [Accepted: 12/11/2017] [Indexed: 01/01/2023]
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