December 2019

In This Issue: Advancements in VA Mental Healthcare
» Table of Contents

Interventions to Engage Service Men and Women in Post-Deployment Mental Healthcare

Feature Article

There is a significant disparity in the use of mental health (MH) care, as most recent war Veterans' don't seek needed care. Online health interventions have been shown to be preferred by Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) combat Veterans and have the potential to promote access to VA and engagement in MH care. Using feedback from Veterans, investigators in this study developed a web-based interface (WEB-ED) that screens for common post-deployment MH and readjustment concerns, provides tailored education about positive screens, and facilitates linkage to VA resources. Data from the investigators' prior studies demonstrate WEB-ED can be successfully implemented within VA and activate Veterans to seek needed care. Thus, researchers in the ongoing HSR&D study (June 2018 – May 2022) are working to:

• Gather qualitative information from key VA and Veteran informants to create an enhanced version (WEB-ED+) of the investigators' current WEB-ED that includes an eHealth (MyHealtheVet) with an enhanced shared decision-making interface;
• Test WEB-ED+ versus current WEB-ED in promoting engagement in VA mental healthcare of Veterans with positive MH screens through a randomized clinical trial (RCT); and
• Elicit feedback from key stakeholders in both arms of the RCT to:
  • assess the usefulness of an eHealth interface and the perceptions of how the interventions influenced patient access to and efficiency of VA patient-centered care delivery;
  • examine Veteran and provider satisfaction with shared decision-making educational materials, chart template, and clinical interface; and
  • document the processes Veterans used to enroll in VA and engage in MH care.

Study participants are being recruited from a community sample of male and female Veterans returning from deployment(s) in Iraq and/or Afghanistan during the preceding four years. In phase one of the study, key Veteran, provider, and other VA informants at five VA sites (Seattle, WA, Temple, TX, Minneapolis, MN, Albany, NY, and Miami, FL) will be engaged and interviewed. Investigators also will map a clinical workflow process on how to integrate WEB-ED+ into existing care delivery. In phase two, investigators will use a randomized controlled trial to compare MH care engagement differences between WEB-ED and WEB-ED+ study groups at the 5 original VA sites and an  additional five more. During the final phase of the study, investigators will conduct interviews in order to conduct the post-intervention process evaluation of Veterans and their providers who participated in the RCT.

Findings

None to report at this time.

Impact

This research will provide vital information to evaluate the processes needed to integrate WEB-ED+ into current VA systems to support efficient care delivery, facilitate patient-centered care, and address unmet need for MH care. WEB-ED+’s use of shared decision-making by both Veterans and providers is a key component for promoting these benefits. WEB-ED+ represents a readily implementable and cost-effective intervention that, with partner collaboration, can be integrated into the VA healthcare system.

Principal Investigator: Anne Sadler, PhD, RN, is part of HSR&D’s Center for Access & Delivery Research and Evaluation (CADRE) in Iowa City, IA.

View study abstract