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2023 HSR&D/QUERI National Conference Abstract

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1020 — Examining Discussions of Racial Trauma for Black Veterans Engaged in PTSD Evidence-Based Psychotherapy to Advance Health Equity

Lead/Presenter: Asale Hubbard,  San Francisco VA Health Care System; University of California, San Francisco
All Authors: Hubbard AA (San Francisco VA Health Care System; University of California, San Francisco), Cottonham, D (Lyra Health; San Francisco VA Health Care System) Purcell, N (San Francisco VA Health Care System; University of California, San Francisco) Burkman, K. (San Francisco VA Health Care System; University of California, San Francisco) Huggins, J. (San Francisco VA Health Care System; University of California, San Francisco) Mehlman, H (San Francisco VA Health Care System; University of California, San Francisco) Maguen, S. (San Francisco VA Health Care System; University of California, San Francisco)

Objectives:
Following PTSD evidence-based psychotherapies (EBPs), there is evidence that Black Veterans demonstrate less posttraumatic stress (PTSD) symptom improvement than their White counterparts (e.g., Maguen et al., 2020; Lamp et al., 2019). We aimed to understand this disparity through interviews with Black Veterans to determine their experience in PTSD EBPs.

Methods:
Using the VHA electronic health record we identified Black Veterans who engaged in PTSD EBPs. We sought to include up to 20 self-identified Black Veterans of all eras, 18-82 years old who engaged in care at a VHA medical facility. Prospective Veterans were emailed to inquire about their interest in the study, and those who expressed interest were scheduled for a 45-60 min video interview. Veterans were asked to provide information about their experiences engaging in PTSD EBPs and the extent to which experiences of racial trauma was included as part of their psychotherapy treatment. We utilized the Rapid Assessment Process methodology to capture and analyze qualitative content from interviews (Beebe, 2001; McMullen et al., 2011; Sobo et al., 2003). Analysis team members reviewed transcripts of audio recorded interviews and summarized the interviews using summary templates. Themes were identified through analysis of summary templates and refined through regular team discussions.

Results:
Although interviews and data analysis are still underway, some prominent themes emerged thus far. While all Black Veterans endorsed having racially traumatic experiences, there was great variability in the degree to which those experiences were discussed as part of their PTSD EBP treatment. An emerging theme included whether Black Veterans felt that PTSD EBP was attuned to their experiences was the degree to which their VA provider discussed racial trauma in PTSD EBP treatment and the Veterans’ perception of their VA providers’ contextual understanding of the Black Veteran experience. Of note, the degree to which Black Veterans felt comfortable discussing racial trauma with a white provider differed based on whether the provider directly addressed racial trauma at the start of treatment or waited until after building rapport with the Veteran. Many veterans shared how experiences of racial trauma could be addressed in a group format in addition to individual PTSD EBP treatment.

Implications:
Qualitative interview themes indicate the importance of addressing racial trauma as part of PTSD EBP treatment, of directly asking about racial trauma experiences, and the need for education on the historical and contextual factors that can impact the experience of Black Veterans. Current PTSD EBPs should be examined for the degree to which the therapeutic approach and conceptualization meet the unique needs of Black Veterans.

Impacts:
In addition to combat-related (and other) traumatic events, many Black Veterans experience discrete or ongoing race-based traumatic experiences that should be directly addressed as part of their PTSD treatment. The inclusion of racial trauma as part of PTSD EBP treatment is essential in meeting the needs of Black Veterans and may help to current disparities in PTSD symptom improvement.