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2023 HSR&D/QUERI National Conference Abstract

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5003 — Leveraging Community Outreach and Veteran Peers to Enhance Mental Healthcare Access for Rural, Racially Diverse Women Veterans

Lead/Presenter: Chasity Wohlford
All Authors: Mark, A (Houston COIN) Woods, K (Houston COIN) Rodrigues, M (Baylor College of Medicine) Dindo, L (Houston COIN) Boykin, D (Houston COIN)

Objectives:
To identify effective strategies to improve access and engage rural and racially diverse women veterans in mental health treatment.

Methods:
Women veterans endorse high rates of mental health challenges associated with military service and duty-related stressors. While the Veterans Health Administration (VHA) is a national leader in providing evidence-based treatment, women veterans are often hesitant to seek care at VHA facilities. Many women experience negative military events and trauma that make them feel less comfortable in typically male-dominated health settings. Telehealth has become a much-used platform during the COVID-19 era that alleviates many barriers to care for women veterans. However, rural veterans often report limited access/ownership of a computer, tablet, or smartphone and broadband issues. To meet the needs of rural women veterans, treatment models are needed that leverage community resources to fill gaps in care. In this 2-year pilot study, we partnered with VHA and veteran service organizations (VSOs) and integrated veteran peer specialists into our project team to facilitate recruitment of rural and racially diverse women veterans. Collaborating with VSOs expanded our ability to fully address the emotional and social needs of women veterans (e.g., difficulties from past trauma, lack of food and transportation). We prioritized collaborations with rural-based VSOs to help address distance, time, and other challenges (e.g., dependent care, work obligations) that impact access.

Results:
We partnered with several VHA and VSOs to identify rural women veterans experiencing psychological distress and engage them in a 1-day Acceptance and Commitment Training (ACT) workshop. Interested women were screened and only excluded if they self-reported serious mental illness, uncontrolled substance/alcohol use, or acute suicidality. Workshops were held via telehealth or in rural community settings. They were co-facilitated by licensed clinicians and a veteran peer. We collected measures of distress (Outcome Questionnaire-45), trauma symptom severity (PTSD Checklist-5), and psychological flexibility (Action and Acceptance Questionnaire-II) at baseline, 1-month, and 3-months post-workshop. Additionally, open-ended questions assessed workshop satisfaction and acceptability.

Implications:
Data collection is ongoing. To date, we have screened 88 women veterans. Sixty (of 84) eligible women completed baseline assessments with 47 women (40% rural, 66% women of color) completing a 1-day ACT workshop. Preliminary findings are based on the 24 women veterans (54% rural) who have completed follow-up assessments. Women showed improvements in psychological distress (d = -0.21), trauma symptom severity (d = -0.43), and psychological flexibility (d = -0.09) from baseline to 3-months. A similar pattern emerged among the subset of 13 rural women (d = -0.22 for psychological distress, d = -0.48 for trauma symptom severity, d = -0.10 for psychological flexibility). Overall, women veterans were satisfied with the workshops and felt it was “awesome” to have a peer facilitator.

Impacts:
Partnering with VHA and VSOs has been instrumental in expanding mental health care access to rural and racially diverse women veterans. Working closely with veteran peers and community organizations allowed women to be transparent about their needs and get connected with desired resources.