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: 10597537
• 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/10597537
• 关键词: Address; Administrator; Affect; Appointment; Area; Award; Caring; Characteristics; Clinic; Cognitive; Communities; Communities That Care; Community Health; Community Healthcare; Community Networks; Consultations; County; Cultural Backgrounds; Data; Data Analyses; Development; Distal; Distress; Doctor of Philosophy; Educational workshop; Evaluation; Female; Funding; Future; Goals; Grant; Health Personnel; Health Services Accessibility; Health Services Administration; Health Services Research; Healthcare; Homogeneously Staining Region; Improve Access; Institution; Interview; Knowledge; Length; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mentorship; Methods; Military Personnel; Mission; Modeling; Outcome; Patient-Focused Outcomes; Patients; Post-Traumatic Stress Disorders; Program Development; 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; clinical practice; community based participatory research; community building; 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; men; 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年的使命法案允许退伍军人从非VHA寻求医疗保健 通过退伍军人社区护理计划（VCCP）提供者。然而，心理健康的短缺 超过50%的美国农村县的心理服务提供者危及这些地区的心理服务。这些 短缺表明，越来越需要弥补农村社区提供精神保健方面的差距。 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。在VHA的指导下， 国家的最先进的访问模式，这个项目旨在了解目前的状态VCCP精神卫生保健 并建立一个使用社区参与战略的计划，以支持社区提供者提供 为农村退伍军人提供优质服务。这项工作最初将集中在农村退伍军人谁经历了 军事性创伤（MST）这些退伍军人代表了一个高度优先，研究不足的农村退伍军人人口。 MST暴露在退伍军人中很常见（25-33%的女性，1-3%的男性）， 精神压力和自杀风险的比率。初步数据显示，尽管MST的发病率相当， 暴露，农村退伍军人不太可能比城市退伍军人接受心理治疗。研究具体 农村退伍军人MST的精神卫生保健的准入障碍和差距是非常需要的。 创新：项目创新包括：（1）针对具有以下历史的高度优先农村退伍军人群体： MST，（2）从退伍军人和一线社区提供者那里获得输入，以及（3）社区的新用途 参与和规划（CEP），以解决农村精神卫生保健的差距。CEP是一个基于社区的 参与性研究战略，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， 二次数据分析，以检查VCCP精神保健MST。与退伍军人的定性访谈将 探索感知的可及性、质量和对这种护理的满意度。VHA的二次分析 行政和社区护理数据将评估VCCP的提供和获得结果（例如，任命 等待时间、会话长度和持续时间）。目标1数据将支持HSR&D IIR提案， 深入评估VCCP提供的MST相关的精神卫生保健。这些数据也将告知 制定目标2和3中的“加强社区对最低标准技术方案的照顾”。拟议程序 旨在支持VCCP和其他社区提供者调整VHA和社区资源， 为农村退伍军人提供MST相关的心理保健。该计划将教育社区提供者 了解以证据为基础的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。小组磋商还将包括结构化的活动，以协助供应商制定一个 MST相关服务的协作社区网络。目标3将试验 拟议的计划。根据目标3的研究结果，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农村卫生示范项目办公室）。 下一步：实现研究目标，促进PI向独立VHA医疗服务的过渡 研究人员，CDA将提供定性数据分析，社区参与研究， 方法，以及程序开发和评估。这些培训目标将通过正式的 课程、指导和参加培训讲习班、研讨会和会议。的专门知识 从培训和研究活动中获得的信息将使PI能够执行与VHA的 获得护理/农村获得护理的优先事项和《使命法》。