Health Services Research & Development

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2006 HSR&D National Meeting Abstract


1023 — VA Post-Deployment Screening and Treatment Referral of OEF/OIF Veterans

Author List:
Seal KH (San Francisco VA Medical Center)
Miner CR (San Francisco VA Medical Center)
Chu A (San Francisco VA Medical Center)
Bertenthal D (San Francisco VA Medical Center)

Objectives:
Among veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), we sought to determine the frequency of: 1) positive screens for mental health disorders, 2) mental health treatment acceptance, and 3) initial appointments kept.

Methods:
In June 2004, the VA “Afghan and Iraq Post-Deployment Screen” was instituted as a mandated electronic clinical reminder. The screen consisted of brief, validated screening measures: 4-items for PTSD, 2-items for depression and the AUDIT-C for high-risk drinking. At the San Francisco VA Medical Center (SFVAMC), veterans screening positive for one or more disorders were offered a referral for mental health treatment. Among OEF/OIF veterans presenting to SFVAMC between June 2004 -October 2005, we analyzed the frequency of positive screens and, in an intention-to-treat analysis, we determined the frequency of mental health treatment referrals accepted and initial appointments kept.

Results:
554 OEF/OIF veterans were seen at SFVAMC, and of these, 176 (32%) underwent post-deployment screening. Of those screened, 90% were male; median age was 26 years. Positive screens for PTSD were found in 79 veterans (45%); 52 (30%) screened positive for depression and 56 (32%) screened positive for high-risk drinking. Of 56 OEF/OIF veterans screening positive for high-risk drinking, 55% reported >= 3 drinks/day and 71% reported drinking >= 6 drinks/occasion; 8/56 (14%) accepted a treatment referral, which resulted in only one scheduled clinic appointment, which was kept. Of 79 veterans screening positive for PTSD, 44/79 (56%) accepted a referral for mental health treatment which resulted in 32/79 (41%) scheduled clinic appointments, of which 28/79 (35%) were kept.

Implications:
While only a minority of OEF/OIF veterans have been screened, a high proportion screened positive for combat-related mental health disorders. A smaller proportion accepted a treatment referral, yet not all received a scheduled clinic appointment, resulting in less than half of veterans with positive screens receiving mental health treatment.

Impacts:
Techniques such as motivational interviewing may enhance acceptance of mental health treatment referrals among veterans screening positive for combat-related mental health disorders. Moreover, once a mental health treatment referral is accepted, system improvements are needed to ensure that a clinic appointment is scheduled.