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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3094 — Implementation of Evidence-Based Treatments for Women Veterans with Multiple Mental Health Conditions: A Study of Existing Practices

Hamilton AB, VA Greater Los Angeles Healthcare System and UCLA; Oishi SKlap R, and Yano EM, VA Greater Los Angeles Healthcare System;

A sizable proportion of women Veterans suffer from comorbid mental health conditions, particularly PTSD, anxiety, depression, and substance use disorders. While evidence-based treatments (EBTs) exist for these conditions, few treatments simultaneously address multiple conditions. A key question from an implementation perspective is how to deploy EBTs in the context of multiple psychiatric comorbidities. The objective of this study was, per the QUERI framework (Step 3), to define existing practice patterns with regard to mental health care for women Veterans with mental health comorbidities.

We conducted semi-structured interviews with a purposive sample of 31 individuals who provide direct care to women Veterans in VA women’s clinics involved in the Women Veterans Practice-Based Research Network. The sample includes Women Veteran Program Managers, Military Sexual Trauma coordinators, internists, psychiatrists, psychologists, social workers, case managers, nurses, and clerks. The interview covered numerous topics, including perceived needs of women Veterans and services provided for this population. Data was analyzed using the constant comparison method.

Mental health clinicians had a high level of familiarity with prevailing EBTs for women’s mental health conditions, particularly PTSD. In some sites, several EBTS were available and utilized, with treatment planning and implementation typically guided by a combination of patient preference and clinical judgment; these sites tended to have several options for group therapy. In other sites, elements of various EBTs were combined to produce a personalized treatment approach, with a strong emphasis on individual therapy. Coordination across primary care and mental health services was considered to be of paramount importance, with integration of services going beyond co-location to include team-based decision-making. Women Veterans’ complicated health care and psychosocial needs were consistently described as both challenging and motivating.

EBTs for women Veterans’ common, co-occurring mental health conditions were consistently recognized and utilized, albeit in different formulations, often depending on the context in which care was provided.

Because best practices are still in development in treatment for mental health comorbidity, it is important to identify existing practice patterns—and potential improvements on these practice patterns—especially in settings such as primary care where quality improvement is being pursued. Accurate knowledge about current clinical practices can help with the development of care models that address women Veterans’ complex needs.

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