Understanding Community-based Mental Healthcare for Rural Veterans with Military Sexual Trauma

了解遭受军事性创伤的农村退伍军人的社区心理保健

• 批准号: 10425604
• 负责人: Derrecka M Boykin
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10425604
• 关键词: Address; Administrator; Affect; Appointment; Area; Award; Caring; Characteristics; Clinic; Cognitive; Communities; Communities That Care; Community Networks; Consultations; County; Cultural Backgrounds; Data; Data Analyses; Depression and Suicide; Development; Distal; Distress; Doctor of Philosophy; Educational workshop; Evaluation; Female; Funding; Future; Goals; Grant; Health Personnel; Health Services; Health Services Accessibility; Health Services Research; Healthcare; Improve Access; Institution; Interview; Knowledge; Length; Mental Health; Mental Health Services; Mental disorders; Mentorship; Methods; Military Personnel; Mission; Modeling; Outcome; Patient-Focused Outcomes; Patients; Post-Traumatic Stress Disorders; Program Development; Program Evaluation; Provider; Psychotherapy; Qualitative Methods; Quality of Care; Recording of previous events; Research; Research Activity; Research Personnel; Research Project Grants; Resources; Review Literature; Rural; Rural Community; Rural Health; Self Efficacy; Services; Structure; Surveys; Survivors; Testing; Texas; Training; Training Activity; Trust; Variant; Veterans; Veterans Health Administration; Wait Time; Woman; Work; acceptability and feasibility; base; care providers; clinical practice; community based participatory research; community engaged research; community engagement; community planning; design; evidence base; experience; gaps in access; health care availability; health care quality; health care settings; improved; innovation; male; medical specialties; mental state; method development; military veteran; novel; programs; psychologic; recruit; research and development; rural counties; rural healthcare; satisfaction; secondary analysis; sexual trauma; suicidal risk; symposium; trauma exposure; underserved community

Background/Significance: The 2018 MISSION Act allows Veterans to seek healthcare from non-VHA providers through the Veterans Community Care Program (VCCP). However, shortages of mental health providers in over 50% of U.S. rural counties jeopardize access to psychological services in these areas. These shortages indicate a growing need to bridge gaps in the provision of mental healthcare in rural communities. The VCCP presents a distinct opportunity for VHA to leverage its relationships with community stakeholders to develop innovative strategies to improve access to high-quality care for rural Veterans. Guided by the VHA state-of-the-art access model, this project seeks to understand the current state of VCCP mental healthcare and build a program that uses community engagement strategies to support community providers in delivering high-quality care to rural Veterans. This work will initially focus on rural Veterans who have experienced military sexual trauma (MST). These Veterans represent a high priority, understudied rural Veteran population. MST exposure is common among Veterans (25-33% of females, 1-3% of males) and associated with high rates of psychiatric distress and suicide risk. Preliminary data show that, despite equivalent rates of MST exposure, rural Veterans are less likely to receive psychotherapy than urban Veterans. Research on specific access barriers and gaps in mental healthcare for rural Veterans with MST is greatly needed. Innovation: Project innovations include: (1) targeting a high priority rural Veteran population with a history of MST, (2) obtaining input from Veterans and frontline community providers, and (3) novel use of community engagement and planning (CEP) to address gaps in rural mental healthcare. CEP is a community-based participatory research strategy designed to increase the capacity of community providers in delivering evidence-based care and building a community network of services. Specific Aims/Methods: Guided by the VHA access model, Aim 1 will use qualitative interviews and secondary data analysis to examine VCCP mental healthcare for MST. Qualitative interviews with Veterans will explore perceived accessibility, quality, and satisfaction with this care. A secondary analysis of VHA administrative and community care data will assess VCCP delivery and access outcomes (e.g., appointment wait time, session length and duration). Aim 1 data will support an HSR&D IIR proposal by year 3 to conduct an in-depth evaluation of VCCP delivery of MST-related mental healthcare. These data will also inform development of the Enhancing Community Care for MST Program in Aims 2 and 3. The proposed program aims to support VCCP and other community providers in aligning VHA and community resources to increase delivery of MST-related mental healthcare to rural Veterans. The program will educate community providers about evidence-based MST-related clinical practices and provide group consultation to facilitate their use of these practices. Group consultation will also include structured activities to assist providers in developing a collaborative community network of MST-related services. Aim 3 will pilot the feasibility and acceptability of the proposed program. Depending on Aim 3 findings, the PI will submit either an HSR&D pilot to refine the program or a larger research project (e.g., HSR&D IIR, VHA Office of Rural Health demonstration project). Next Steps: To achieve research aims and facilitate the PI’s transition to an independent VHA health services researcher, the CDA will provide advanced training in qualitative data analysis, community-engaged research methods, and program development and evaluation. These training goals will be accomplished through formal coursework, mentorship, and participation in training workshops, seminars, and conferences. The expertise gained from training and research activities will allow the PI to execute a line of research that aligns with VHA’s priorities of access to care/rural access and MISSION Act.

背景/意义：2018 年使命法案允许退伍军人向非 VHA 寻求医疗保健 通过退伍军人社区关怀计划 (VCCP) 提供服务。但心理健康水平仍存在不足 美国超过 50% 的农村县的心理服务提供者无法获得这些地区的心理服务。这些 短缺表明越来越需要弥合农村社区精神卫生保健提供方面的差距。 VCCP 为 VHA 提供了一个独特的机会，可以利用其与社区利益相关者的关系， 制定创新战略，改善农村退伍军人获得高质量护理的机会。由 VHA 指导 最先进的访问模式，该项目旨在了解 VCCP 心理保健的现状 并制定一个计划，使用社区参与策略来支持社区提供者提供 为农村退伍军人提供高质量的护理。这项工作最初将重点关注经历过的农村退伍军人 军事性创伤（MST）。这些退伍军人代表了高度优先、未被充分研究的农村退伍军人群体。 MST 暴露在退伍军人中很常见（25-33% 的女性，1-3% 的男性），并且与高风险相关 精神困扰和自杀风险的比率。初步数据显示，尽管 MST 的比率相当 暴露，农村退伍军人比城市退伍军人接受心理治疗的可能性较小。具体研究 迫切需要消除接受 MST 的农村退伍军人在心理保健方面的障碍和差距。 创新：项目创新包括：(1) 针对具有退伍军人历史的高度优先的农村退伍军人群体 MST，(2) 获取退伍军人和一线社区提供者的意见，以及 (3) 社区的新颖使用 参与和规划（CEP），以解决农村精神卫生保健方面的差距。 CEP 是一个以社区为基础的 参与式研究策略，旨在提高社区提供者提供服务的能力 循证护理和建立社区服务网络。 具体目标/方法：在 VHA 访问模型的指导下，目标 1 将使用定性访谈和 用于检查 MST 的 VCCP 心理保健的二次数据分析。对退伍军人的定性采访将 探索对这种护理的可及性、质量和满意度的感知。 VHA的二次分析 行政和社区护理数据将评估 VCCP 的交付和访问结果（例如，预约 等待时间、会话长度和持续时间）。目标 1 数据将在第 3 年支持 HSR&D IIR 提案，以开展 对 VCCP 提供 MST 相关心理保健的深入评估。这些数据还将告知 制定目标 2 和 3 中的加强 MST 社区关怀计划。 拟议计划 旨在支持 VCCP 和其他社区提供商协调 VHA 和社区资源，以增加 为农村退伍军人提供与 MST 相关的心理保健服务。该计划将对社区提供者进行教育 关于基于证据的 MST 相关临床实践，并提供小组咨询以促进他们使用 这些做法。团体咨询还将包括结构化活动，以协助提供商制定 MST 相关服务的协作社区网络。目标3将试点可行性和可接受性 拟议的计划。根据目标 3 的调查结果，PI 将提交 HSR&D 试点，以完善 计划或更大的研究项目（例如 HSR&D IIR、VHA 农村卫生办公室示范项目）。 后续步骤：实现研究目标并促进 PI 过渡到独立的 VHA 卫生服务 CDA 将提供定性数据分析、社区参与研究方面的高级培训 方法、计划开发和评估。这些培训目标将通过正式的培训来实现 课程作业、指导以及参加培训讲习班、研讨会和会议。专业知识 从培训和研究活动中获得的成果将使 PI 能够执行与 VHA 一致的一系列研究 获得护理/农村获得和使命法案的优先事项。