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2015 HSR&D/QUERI National Conference Abstract

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3194 — OEF/OIF Reserve/National Guard Service Women's Perceptions of Evidence-Based Psychotherapy for PTSD Post-Deployment

Sadler AG, Comprehensive Access and Deliveruy Research & Evaluation Center, Iowa City VAHCS; Carver College of Medicine Department of Psychiatry; Mengeling MA, Comprehensive Access and Deliveruy Research & Evaluation Center, Iowa City VAHCS; Carver College of Medicine Department of Internal Medicine; Booth BM, Department of Psychiatry, Uiversity of Arkansas for Medical Services; Torner JC, College of Public Health, University of Iowa, Carver College of Medicine Department of Neurosurgery; Hamilton AB, Center for the Study of Health Care Innovation Implementation and Policy, Greater Los Angeles VA HCS;

Objectives:
Evidence-based psychotherapy (EBP) is an effective PTSD treatment, yet many Veterans don't engage in needed care. We explored Reserve/National Guard (RNG) servicewomen's perceptions of PTSD treatment barriers, how they learned about EPB, and how VA might improve awareness about PTSD treatments. We also sought to determine differences in these perceptions between women who have versus have not received EBP.

Methods:
Semi-structured qualitative interviews were performed by telephone with OEF/OIF RNG servicewomen, identified through VA/DoD Identity Repository, who had returned from deployment within the preceding 36 months, had a VA encounter within the prior 18 months and a positive VA PTSD online screen. Interview responses were transcribed in an Access database and the constant comparison method using open coding was used to identify salient issues.

Results:
19 participated: 14 had not been treated with EBP and 5 had. Care barriers for women not EBP treated included: shame, military career concerns, difficulty finding time to attend, the amount of time to get appointments, VA dislike, concern about clinician competency, and peers with adverse treatment experiences. Most had not been informed by their providers about EBP and care received was symptom-based, e.g. anger-management. One participant indicated their clinician used shared decision making (SDM) in considering treatment options. Participants not completing EBP indicated DVA could improve PTSD treatment awareness by: improved screening, classes explaining PTSD, female peer-to-peer supports, and "empowering Veterans" to make decisions and "not telling us what to do. EBP participants acknowledged fewer PTSD treatment barriers with the desire not to have group therapy the only differing barrier. All but one reported they were educated about treatment options and their clinician used SDM. To improve VA PTSD treatment awareness, EPB participants recommended materials specific to female RNG and to education about the range of traumas that PTSD treatment helps.

Implications:
Relative to RNG service women treated by EBP post-deployment, women not EPP treated reported more care barriers and less frequent education about PTSD treatment options by VA clinicians.

Impacts:
Addressing care barriers and clinician use of SDM to help RNG consider PTSD treatment options are indicated to promote EBP engagement.