BACKGROUND/RATIONALE:
Increasing numbers of veterans from Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF) are entering the VA system seeking care for mental disorders. VA medical centers are striving to provide mental health care for these veterans. However, the common clinical concerns and useful strategies in providing care for this population are unclear.

OBJECTIVE(S):
Our objective was to detect common clinical concerns and possible successful strategies in providing care to this population.

METHODS:
Four medical centers from each of three VISNs (16, 19, and 20) were chosen to include a mix of sites that have and have not received augmented funding for the OIF/OEF population, that are both large and small, and that operate in different geographic regions. Site managers for mental health and primary care were identified and recruited. A semi-structured phone-based survey asked the site manager to identify (1) the role of the OIF/OEF clinical reminder, (2) site of care, (3) barriers and facilitators to care, (4) collaborative relationships, (5) outcome data collection, (6) opinions on core components of care, (7) clinical challenges, (8) outreach efforts, (9) types of mental health diagnoses being made, and (10) model of care being used. By collecting information from a variety of clinical settings across multiple VISNs,

FINDINGS/RESULTS:
Phone-survey results were obtained from site managers from 11 of 12 primary care clinics and 12 of 12 mental health clinics. Though all of the sites are using clinical reminders, many sites report limited clinical utility with these reminders. More mental health clinics than primary care clinics were found to use standardized intake assessments; however, few sites use well-validated objective outcome measures. At the time of this data collection, few sites were using the 9-item Patient Health Questionnaire for depressive disorders, the PTSD Checklist for PTSD, or the Alcohol Use Inventory Test for detecting at-risk alcohol consumption. Commonly diagnosed mental disorders include PTSD, major depressive disorders and substance abuse disorders. Site managers noted that traditional models of mental health care and clinic hours seem less effective than ones that offer outreach activities, after-hours appointments, phone-based care, and individual therapy that include families and case management.

IMPACT:
Traditional models of mental health care seem to be less effective than alternative models that emphasize outreach, rapid access, flexible scheduling, phone-based care, individual therapy, case management, and involvement of families.

Results from this project will better inform the structure of care currently being delivered to treat the OIF/OEF veteran suffering from mental disorders.

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External Links for this Project

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PUBLICATIONS:

Conference Presentations

1. Felker BL, Jakupcak M, Stecker T, Hedeen AN, Staves P, Conybeare D, Li E. Providing Care for the OIF and OEF Veterans with Mental Disorders: Site Manager Survey Results from 12 Different VA Medical Centers. Paper presented at: VA HSR&D National Meeting; 2008 Feb 13; Baltimore, MD. [view]

DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders, Health Systems Science
DRE: Treatment - Observational
Keywords: Operation Enduring Freedom, Operation Iraqi Freedom, Access
MeSH Terms: none