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

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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.