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

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。然而，精神健康的短缺 超过50%的美国农村县的提供者危及这些地区获得心理服务的机会。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，以利用其与社区利益相关者的关系来 制定创新战略，改善农村退役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精神卫生保健的现状 并建立一个使用社区参与战略来支持社区提供商提供 高质量关爱农村退役军人。这项工作最初将重点放在农村退伍军人身上 军人性创伤(MST)。这些退伍军人代表着高度优先、研究不足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)，并与高 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 与城市退伍军人相比，农村退伍军人接受心理治疗的可能性更小。关于专门性的研究 农村退伍军人精神卫生保健方面的障碍和差距是非常需要的。 创新：项目创新包括：(1)瞄准具有以下历史的高度优先的农村退伍军人群体 MST，(2)从退伍军人和前线社区提供者那里获得意见，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方面的差距。CEP是一个以社区为基础的 参与式研究战略，旨在提高社区提供者在提供 循证护理和建设社区服务网络。 具体目标/方法：在VHA访问模式的指导下，目标1将使用定性访谈和 二次数据分析以检查MST的VCCP精神卫生保健。对退伍军人的定性采访将 了解这项护理的可获得性、质量和满意度。对VHA的再分析 行政和社区护理数据将评估VCCP交付和获得结果(例如，任命 等待时间、会话长度和持续时间)。AIM 1的数据将支持到第3年进行的HSR&D IIR提案 MST相关精神卫生保健的VCCP交付的深入评估。这些数据还将告诉我们 目标2和目标3中加强MST社区关怀计划的发展：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 向农村退伍军人提供与MST相关的心理保健。该计划将教育社区提供者 关于循证MST相关的临床实践，并提供小组咨询，以方便他们使用 这些做法。小组协商还将包括有组织的活动，以帮助提供者制定 MST相关服务的协作社区网络。目标3将试验以下项目的可行性和可接受性 提议的计划。根据AIM 3的调查结果，PI将提交一份HSR&D试点文件，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)。 下一步：实现研究目标并促进PI向独立的VHA卫生服务过渡 作为研究人员，CDA将提供定性数据分析、社区参与研究等方面的高级培训 方法，以及计划的开发和评估。这些培训目标将通过正式的 课程工作、指导，以及参加培训研讨会、研讨会和会议。专业知识 从培训和研究活动中获得的收益将使PI能够执行一系列与VHA一致的研究 《优先获得护理/农村服务和传教法》。

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.