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Health Services Research & Development

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2008 HSR&D National Meeting Abstract

National Meeting 2008

3044 — Providing Care for the OIF and OEF Veterans with Mental Disorders: Site Manager Survey Results from 12 Different VA Medical Centers

Felker B (Puget Sound), Jakupcak M (Puget Sound), Stecker T (Little Rock), Hedeen A (Puget Sound), Staves P (Denver), Conybeare D (Puget Sound), Li E (Puget Sound)

Veterans from Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF) are entering the VA system needing treatment for mental disorders. Medical centers are striving to provide mental health care. However, it is unclear as to how this care is being delivered. This Rapid Response Project sought to better understand how care is being provided for this population.

Four medical centers from VISNs 16, 19, and 20 were chosen to include sites that have and have not received augmented funding for the OIF/OEF population, are both large and small, and operate in different geographic regions. Clinic site managers for mental health and primary care were identified. A qualitative semi-structured phone based survey asked the respondent to identify: 1) the role of screening and the OIF/OEF clinical reminder; 2) site of care; 3) barriers and facilitators to care; 4) collaborative relationships; 5) outcome data collection; 6) opinions on core components of care; 7) clinical challenges for this population; 8) outreach efforts; 9) types of mental health diagnoses being made; and 10) model of care being used.

Phone survey results were obtained from 11 of 12 primary care clinics and 12 of 12 mental health clinics. Though all sites are using clinical reminders, many report limited clinical utility from these reminders. More mental health clinics than primary care clinics use standardized intake assessments, however few sites use well-validated objective outcome measures. Common mental disorders include PTSD, Major Depression, and Substance Use Disorders. Few sites use the PHQ-9, PCL, or the AUDIT as objective measures for these disorders. Site managers noted that traditional models of mental health care and clinic hours seem less effective than ones that offer outreach activities, after hour appointments, phone-based care, case management and individual therapy that include families.

Traditional models of mental health care were reported to be less effective than alternative models that emphasize outreach, rapid access, flexible scheduling, phone-based care, individual therapy, case management, and family involvement.

Results from this project will better inform the structure of care currently being delivered to treat the OIF/OEF veterans suffering from mental disorders.

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