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CDA 08-013 – HSR&D Study

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CDA 08-013
Evaluation of Family Outreach Mental Health Programs for OEF/OIF Veterans
Heather S Reisinger PhD
Iowa City VA Health Care System, Iowa City, IA
Iowa City, IA
Funding Period: October 2008 - September 2011

BACKGROUND/RATIONALE:
OIF/OEF veterans have as high or higher rates of PTSD, TBI and other mental health and cognitive problems than veterans of prior conflicts for several reasons. OIF/OEF veterans have experienced multiple deployments, urban combat, and threats from improvised explosive devices (IEDs) and roadside bombs, and are more likely to survive after being seriously wounded. Moreover, current prevalence estimates of TBI and PTSD, signature injuries of OIF/OEF, likely represent the tip of the iceberg. Health screenings for returning soldiers are necessary but insufficient method for assisting them into needed health care, because screenings do not detect all symptoms or conditions. Therefore, continued monitoring and outreach is essential.

These issues are exacerbated by the reliance in OIF/OEF on the Reserve and National Guard (R/NG) service members, who face potential access barriers. R/NG veterans lead more civilian-oriented lives beyond centralized bases and traditional military networks and were previously ineligible for VHA care unless called up for active duty for at least 24 consecutive months. Because of these barriers, only 20% of R/NG returnees have accessed VHA services.

Many VAMCs have instituted family-outreach programs that seek to contact family members of deployed personnel before the veteran returns home. The focus on families reflects the fact that family members are often the first to recognize mental health and cognitive problems and can then encourage veterans to access VHA services to address these problems.

Reaching out to R/NG OIF/OEF veterans is an important first step, but no evidence-based programs exist for guidance. The research proposed here involves an initial qualitative formative evaluation of mental health family-outreach efforts targeted at family members of returning R/NG OIF/OEF veterans, and systematically brings together the perspectives of veterans, their families, VAMC outreach personnel, and VHA mental health providers who serve veterans once they access care.



OBJECTIVE(S):
Aim 1: Examine the facilitators and barriers to participation in family-outreach programs among family members of returning R/NG OIF/OEF service members via in-depth interviews with R/NG veterans and their family members.

Aim 2: Characterize ways that R/NG veterans learn about and decide whether to use VHA services via in-depth interviews with R/NG veterans and family members.

Aim 3: Formatively evaluate how the Iowa City VAMC mental health family-outreach efforts meet the mental health and readjustment needs of R/NG veterans via participant observation at outreach meetings/events, and in-depth interviews with veterans, family members, and VHA personnel.

METHODS:
The study employs an ethnographic approach to formative evaluation. Data collection includes: organizational documents; field notes of observations of outreach events; and transcripts from semi-structured interviews with outreach personnel, service members and family members. Observations were conducted at four family outreach events in four different communities. The outreach events primarily targeted family members of currently deployed Army Reserve, National Guard, and Navy Reserve units. Twelve dyads (service and family member) are participating in the study, which includes a series of in-depth interviews (after a family outreach event held during deployment and then approximately 1 month, 6 months and 12 months after the service member returns from deployment). In-depth interviews are also being conducted with VA and DoD personnel and veteran-centric organization personnel (n=11; target=25). All textual data is being content analyzed for top-level codes and more detailed coding is completed through subcoding and matrix analyses. Data collection and analysis is ongoing.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
On-going feedback and evaluation to the local VA medical center was an important aspect of this research, particularly since evidence-based practice for outreach was not defined and the local program had to develop content to fit both national guidelines and local needs. However, the study suggests local evaluation and feedback works best within coherent guidelines that define expectations and support local programming.

PUBLICATIONS:

Journal Articles

  1. Chang NN, Reisinger HS, Schweizer ML, Jones I, Chrischilles E, Chorazy M, Huskins C, Herwaldt L. Hand Hygiene Compliance at Critical Points of Care. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2021 Mar 1; 72(5):814-820.
  2. Chen LF, Vander Weg MW, Hofmann DA, Reisinger HS. The Hawthorne Effect in Infection Prevention and Epidemiology. Infection control and hospital epidemiology. 2015 Dec 1; 36(12):1444-50.
  3. Leykum LK, Chesser H, Lanham HJ, Carla P, Palmer R, Ratcliffe T, Reisinger H, Agar M, Pugh J. The Association Between Sensemaking During Physician Team Rounds and Hospitalized Patients' Outcomes. Journal of general internal medicine. 2015 Dec 1; 30(12):1821-7.
  4. Ono S, Dziak K, Wittrock SM, Buzza C, Stewart K, Charlton ME, Kaboli PJ, Reisinger HS. Treating Dual-Use Patients Across Two Health Care Systems: A Qualitative Study. Federal practitioner : for the health care professionals of the VA, DoD, and PHS. 2015 Aug 1; 32(8):32-37.
  5. Cheney A, Reisinger HS, Booth B, Mengeling M, Torner J, Sadler AG. Servicewomen’s strategies to staying safe during military service. Gender Issues. 2015 Mar 1; 32(1):1-18.
  6. Polacco MA, Shinkunas L, Perencevich EN, Kaldjian LC, Reisinger HS. See one, do one, teach one: hand hygiene attitudes among medical students, interns, and faculty. American journal of infection control. 2015 Feb 1; 43(2):159-61.
  7. McAllister C, Leykum LK, Lanham H, Reisinger HS, Kohn JL, Palmer R, Pezzia C, Agar M, Parchman M, Pugh J, McDaniel RR. Relationships within inpatient physician housestaff teams and their association with hospitalized patient outcomes. Journal of hospital medicine. 2014 Dec 1; 9(12):764-71.
  8. Gaglioti A, Cozad A, Wittrock S, Stewart K, Lampman M, Ono S, Reisinger HS, Charlton ME. Non-VA primary care providers' perspectives on comanagement for rural veterans. Military medicine. 2014 Nov 1; 179(11):1236-43.
  9. Wittrock S, Ono S, Stewart K, Reisinger HS, Charlton M. Unclaimed health care benefits: a mixed-method analysis of rural veterans. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association. 2014 Jul 22; 31(1):35-46.
  10. Reisinger HS, Hunt SC, Burgo-Black AL, Agarwal MA. A population approach to mitigating the long-term health effects of combat deployments. Preventing chronic disease. 2012 Feb 9; 9:E54.
  11. Reisinger HS, Brackett RH, Buzza CD, Páez MB, Gourley R, Weg MW, Christensen AJ, Kaboli PJ. "All the money in the world …" patient perspectives regarding the influence of financial incentives. Health services research. 2011 Dec 1; 46(6pt1):1986-2004.
  12. Buzza C, Ono SS, Turvey C, Wittrock S, Noble M, Reddy G, Kaboli PJ, Reisinger HS. Distance is relative: unpacking a principal barrier in rural healthcare. Journal of general internal medicine. 2011 Nov 1; 26 Suppl 2:648-54.
  13. Alleman BW, Luger T, Reisinger HS, Martin R, Horowitz MD, Cram P. Medical tourism services available to residents of the United States. Journal of general internal medicine. 2011 May 1; 26(5):492-7.
  14. Mitchell SG, Morioka R, Reisinger HS, Peterson JA, Kelly SM, Agar MH, Brown BS, O'Grady KE, Schwartz RP. Redefining retention: recovery from the patient's perspective. Journal of Psychoactive Drugs. 2011 Apr 1; 43(2):99-107.
  15. Buzza CD, Williams MB, Vander Weg MW, Christensen AJ, Kaboli PJ, Reisinger HS. Part II, provider perspectives: should patients be activated to request evidence-based medicine? A qualitative study of the VA project to implement diuretics (VAPID). Implementation science : IS. 2010 Mar 18; 5:24.
  16. Pilling SA, Williams MB, Brackett RH, Gourley R, Weg MW, Christensen AJ, Kaboli PJ, Reisinger HS. Part I, patient perspective: activating patients to engage their providers in the use of evidence-based medicine: a qualitative evaluation of the VA Project to Implement Diuretics (VAPID). Implementation science : IS. 2010 Mar 18; 5:23.
  17. Green KM, Doherty EE, Reisinger HS, Chilcoat HD, Ensminger M. Social integration in young adulthood and the subsequent onset of substance use and disorders among a community population of urban African Americans. Addiction. 2010 Mar 1; 105(3):484-93.
  18. Peterson JA, Schwartz RP, Mitchell SG, Reisinger HS, Kelly SM, O'Grady KE, Brown BS, Agar MH. Why don't out-of-treatment individuals enter methadone treatment programmes? The International Journal On Drug Policy. 2010 Jan 1; 21(1):36-42.
  19. Laroche HH, Davis MM, Forman J, Palmisano G, Reisinger HS, Tannas C, Spencer M, Heisler M. Children's roles in parents' diabetes self-management. American journal of preventive medicine. 2009 Dec 1; 37(6 Suppl 1):S251-61.
  20. Katz D, Vander Weg M, Fu S, Prochazka A, Grant K, Buchanan L, Tinkelman D, Reisinger HS, Brooks J, Hillis SL, Joseph A, Titler M. A before-after implementation trial of smoking cessation guidelines in hospitalized veterans. Implementation science : IS. 2009 Sep 10; 4:58.
  21. Mitchell SG, Kelly SM, Brown BS, Reisinger HS, Peterson JA, Ruhf A, Agar MH, Schwartz RP. Incarceration and opioid withdrawal: the experiences of methadone patients and out-of-treatment heroin users. Journal of Psychoactive Drugs. 2009 Jun 1; 41(2):145-52.
  22. Kelly SM, Schwartz RP, O'Grady KE, Mitchell SG, Reisinger HS, Peterson JA, Agar MH, Brown BS. Gender Differences Among In- and Out-of-Treatment Opioid-Addicted Individuals. The American journal of drug and alcohol abuse. 2009 Jan 1; 35(1):38-42.
  23. Schwartz RP, Kelly SM, O'Grady KE, Peterson JA, Reisinger HS, Mitchell SG, Wilson ME, Agar MH, Brown BS. In-treatment vs. out-of-treatment opioid dependent adults: drug use and criminal history. The American journal of drug and alcohol abuse. 2008 Mar 19; 34(1):17-28.
Magazine/Popular Press Articles

  1. Reisinger HS, Sobo EJ. Anthropologists Research Veteran Health. Anthropology News. 2009 May 1; 50(5):26.
VA Cyberseminars

  1. Perencevich EN, Reisinger HS. Hand Hygiene: State of the Art. National Teleconference for the VA Infection: Don't Pass it On Campaign. [Cyberseminar]. 2012 Feb 23.
  2. Reisinger HS. A Mixed Methods Evaluation of Challenges and Opportunities in the Care of Rural Veterans: An Overview. [Cyberseminar]. 2010 Aug 26.
Conference Presentations

  1. O AM, Johnson L, Vaughan-Sarrazin MS, Cram PM, Reisinger HS. Quantifying Telemedicine Intensive Care in the Veterans Health Administration (VHA). Paper presented at: Joint Statistical Annual Meeting; 2015 Aug 8; Seattle, WA.
  2. Moeckli J, Goedken CL, Thomas JT, Cram PM, Reisinger HS. Teamwork and ICU Telemedicine. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.
  3. Reisinger HS, Goedken CL, Thomas JT, Perencevich EN. Variation among Hand Hygiene Programs in the Veterans Health Administration. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.
  4. Thomas JT, Moeckli J, Goedken CL, Bunch J, Cram PM, Reisinger HS. The ICU Telemedicine Black Box: Qualitative Analysis of Telemedicine Utilization in VA Intensive Care Units. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.
  5. Reisinger HS, Goedken CL, Thomas JT, Perencevich EN. Variation among Hand Hygiene Programs in the Veterans Health Administration. Poster session presented at: Society for Healthcare Epidemiology of America Spring Conference; 2015 May 16; Orlando, FL.
  6. Moeckli J, Thomas JT, Goedken CL, Cram PM, Reisinger HS. "We’ll call you if we need you": Regulating teamwork in virtual ICUs. Paper presented at: Society for Applied Anthropology Annual Meeting; 2015 Mar 26; Pittsburgh, PA.
  7. Reisinger HS. Not Quite a Lifer: Reflections on 20 Years under the Influence of Dr. Tony Whitehead and CuSAG. Paper presented at: Society for Applied Anthropology Annual Meeting; 2015 Mar 26; Pittsburgh, PA.
  8. Reisinger HS. You Want to measure What? Working in an Interdisciplinary Team to Develop Quality Indicators for Telemedicine Intensive Care Units. Paper presented at: American Anthropological Association Annual Meeting; 2014 Dec 5; Washington, DC.
  9. Reisinger HS, Dukes K, Schweizer ML, Braun B, Hafner J, Moody J, Ward MM, Richards C, Perlin J, Septimus E, Herwaldt L. Facilitators and Barriers to SSI Bundle Implementation in Select Surgical Procedures. Paper presented at: ID Week: A Joint Meeting of IDSA, SHEA, HIVMA, and PIDS; 2014 Oct 10; Philadelphia, PA.
  10. Cheney AM, Booth BM, Schacht Reisinger H, Mengeling MA, Torner JC, Sadler AG. OEF/OIF servicewomen's strategies to staying safe during deployment to Iraq or Afghanistan. Poster session presented at: VA HSR&D Enhancing Partnerships for Research and Care of Women Veterans Conference; 2014 Jul 31; Arlington, VA.
  11. Yin J, Reisinger HS, Vander Weg MW, Schweizer ML, Jesson A, Morgan DJ, Forrest G, Graham M, Pineles MA, Perencevich EN. Timing of the Emergence of the Hawthorne Effect in Hand Hygiene Surveillance: A Multicenter Prospective Cohort Study. Paper presented at: European Society of Clinical Microbiology and Infectious Diseases Annual European Congress of Clinical Microbiology and Infectious Diseases; 2014 May 12; Barcelona, Spain.
  12. Reisinger HS, Shinkunas L, Polacco M, Perencevich EN, Kaldjian L. To Work or Not to Work: Factors that Influence Presenteeism among Physicians and Medical Trainees. Paper presented at: Infectious Diseases Week; 2013 Oct 3; San Francisco, CA.
  13. Reisinger HS. What it Takes: Educating Students to Excel in a Growing Anthropological Market. Paper presented at: Society for Applied Anthropology Annual Meeting; 2012 Mar 31; Baltimore, MD.
  14. Cretzmeyer MT, Reisinger HS, Mengeling M, Booth B, Torner J, Sadler AG. In Their own Words: Service Women's Perceptions of the Role of Alcohol in Sexual Assault in the Military. Paper presented at: Women's Research and Education Institute: Women in the Military Annual Conference; 2011 Oct 28; Arlington, VA.
  15. McClain MP, Cretzmeyer MT, Young LB, Mengeling M, Reisinger HS, Torner J, Booth BM, Sadler AG. Perceptions of Male Military Sexual Trauma Victimization. Poster session presented at: AcademyHealth Annual Research Meeting; 2011 Jun 12; Seattle, WA.
  16. Sadler AG, McClain M, Cretzmeyer MT, Young LB, Booth BM, Torner J, Reisinger HS, Mengeling M. Risk Factors for Sexual Assault in OEF/OIF Reserve and National Guard Servicemen. Poster session presented at: AcademyHealth Annual Research Meeting; 2011 Jun 12; Seattle, WA.
  17. Reisinger HS, Ono SS, Paez MB. National Policy, Local Implementation: Reaching Out to Returning Reserve and National Guard Members and Their Families. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2011 May 5; Phoenix, AZ.
  18. Cretzmeyer MT, Reisinger HS, Mengeling M, Sadler AG, Torner J, Booth BM. In Their own Words: Service Women’s Perceptions of the Role of Alcohol in Sexual Assault in the Military. Poster session presented at: Women's Health Annual Congress; 2011 Apr 1; Arlington, VA.
  19. Reisinger HS. Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) Service Members’ and Veterans’ Decisions to Access the VA. Poster session presented at: VA HSR&D National Meeting; 2011 Feb 17; National Harbor, MD.
  20. Wittrock SM, Ono SS, Charlton ME, Reisinger HS. Challenges and Barriers to Accessing the VA Healthcare System: VA Users vs. non-VA Users. Poster session presented at: VA Office of Rural Health / Veterans Rural Health Resource Center Eastern Region Winter Rural Consultants Biannual Meeting; 2011 Feb 9; Tampa, FL.
  21. Luger TM, Reisinger HS. Illness Representations of Acute Coronary Syndrome Patients: An Examination of Novel Causal Contributions. Poster session presented at: Gerontological Society of America Annual Scientific Meeting; 2010 Nov 21; New Orleans, LA.
  22. Reisinger HS, Ono S. Reaching Out to OEF/OIF Service Members and Their Families: An Ethnographic Study of a National Policy Mandate. Paper presented at: American Anthropological Association Annual Meeting; 2010 Nov 18; New Orleans, LA.
  23. Katz DA, Vander Weg MW, Holman JE, Nugent A, Baker L, Gillette M, Ono SS, Reisinger HS, Johnson SR, Titler M. Attitudes of Emergency Clinicians Toward the Delivery of Smoking Cessation Counseling. Poster session presented at: Society for Medical Decision Making Annual Meeting; 2010 Oct 24; Toronto, Canada.
  24. Cretzmeyer MT, Mengeling M, Booth B, Torner J, Reisinger HS, Sadler AG. Similarities and Differences in Perception of Sexual Harassment and Rape by Race among Female Reserve and National Guard Service Women. Poster session presented at: VA HSR&D Field-Based Equity Conference; 2010 Sep 13; Boston, MA.
  25. Reisinger HS. Involving Patients and Caregivers in KT Research: Issues and Perspective from a US KT Researcher. Paper presented at: Knowledge Utilization Annual Colloquium; 2010 Jun 11; Halifax, Canada.
  26. Buzza C, Noble M, Wittrock SM, Reisinger HS, Kaboli PJ. Distance is Relative: Unpacking a Principal Barrier in Rural Health Care: Highlights for a Mixed-Methods Evaluation of Challenges and Opportunities in the Care or Rural Veterans. Poster session presented at: Society for Applied Anthropology Annual Meeting; 2010 May 25; Merida, Mexico.
  27. Ono SS, Wittrock SM, Buzza C, Reisinger HS. How Far is Far?: Evaluating "Distance" as a Barrier to Accessing Rural Healthcare in VISN 23. Poster session presented at: VA HSR&D Rural Health / VA Office of Rural Health Field-Based Meeting; 2010 May 6; Portland, ME.
  28. Reisinger HS, Dziak K, Wittrock SM, Ono SS, Charlton ME. A Mixed-Methods Approach to a Needs Assessment of VA Health Care among Rural Veterans: Expanding Beyond VISN 23. Poster session presented at: VA HSR&D Rural Health / VA Office of Rural Health Field-Based Meeting; 2010 May 6; Portland, ME.
  29. Wittrock SM, Ono SS, Reisinger HS. Moving Beyond Distance & Unpacking the Black Box of "Access" to Health Care in Rural Areas: Emerging Trends from VISN 23 Needs Assessment. Poster session presented at: VA HSR&D Rural Health / VA Office of Rural Health Field-Based Meeting; 2010 May 6; Portland, ME.
  30. Sadler AG, Torner J, Mengeling M, Booth B, Reisinger HS. Post-deployment Adjustment and Barriers to Care for OEP/OIP Reserve and National Guard Servicewomen. Paper presented at: International Society for Traumatic Stress Studies Annual Meeting; 2009 Nov 7; Atlanta, GA.
  31. Mengeling M, Cretzmeyer MT, Booth B, Torner J, Reisinger HS, Sadler AG. Similarities in Perceived Stigma Related to Seeking Mental Health Treatment and Reporting Rape in the Military. Poster session presented at: International Society for Traumatic Stress Studies Annual Meeting; 2009 Nov 6; Atlanta, GA.
  32. Reisinger HS, Kaboli PJ. Challenges and Opportunities in the Care of Rural OEF/OIF Servicemembers. Poster session presented at: VA / DoD Evolving Paradigms II OEF / OIF National Conference; 2009 Sep 22; Las Vegas, NV.
  33. Sadler AG, Mengeling M, Torner J, Reisinger HS, Cretzmeyer MT, Franciscus CL, Silander AB, Booth B. Post-Deployment Adjustment and Cross-Leveling Concerns of Operation Enduring Freedom and Operation Iraqi Freedom Reserve and National Guard Servicewomen. Paper presented at: Department of Defense / Congressionally Directed Medical Research Programs Military Health Research Forum; 2009 Sep 1; Kansas City, MO.
  34. Messinger C, Martin RE, Kilburg MA, Reisinger HS. Reliability of Real-Time Coding for Post-MI Attributions: Intervention Implications. Poster session presented at: Midwest Nursing Research Society Annual Conference; 2009 Mar 28; Minneapolis, MN.
  35. Cretzmeyer MT, Mengeling M, Booth B, Torner J, Reisinger HS, Silander AB, Franciscus CL, Sadler AG. Similarities in Perceived Stigma Related to Seeking Mental Health Treatment and Reporting Rape in the Military. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 12; Baltimore, MD.
  36. Mengeling MA, Booth BM, Cretzmeyer MT, Reisinger HS, Silander AB, Torner J, Franciscus CL, Sadler AG. Barriers to DVA Access for Operation Enduring Freedom and Operation Iraqi Freedom Reserve and National Guard Servicewomen. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 11; Baltimore, MD.
  37. Sadler AG, Mengeling M, Torner J, Reisinger HS, Cretzmeyer MT, Franciscus CL, Silander AB, Booth B. Post-Deployment Adjustment Concerns of Operation Enduring Freedom and Operation Iraqi Freedom Reserve and National Guard Servicewomen. Paper presented at: VA HSR&D National Meeting; 2009 Feb 11; Baltimore, MD.


DRA: Military and Environmental Exposures, Health Systems, Mental, Cognitive and Behavioral Disorders
DRE: Treatment - Observational, Prevention
Keywords: Caregivers – not professionals, PTSD
MeSH Terms: none

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