524484
JHNXXX10.1177/0898010114524484Journal of Holistic Nursing / Vol. XX, No. X, Month XXXXDelivering Mental Health Services to Veterans / Signoracci et al.
161
Article
Delivering Mental Health Services to OEF/OIF Veterans A VHA Qualitative Study Gina M. Signoracci, PhD Nazanin H. Bahraini, PhD Bridget B. Matarazzo, PsyD Jennifer H. Olson-Madden, PhD Lisa A. Brenner, PhD, ABPP (Rp)
jhn
research-article2014
Journal of Holistic Nursing American Holistic Nurses Association Volume 32 Number 3 September 2014 161–172 © The Author(s) 2014 10.1177/0898010114524484 http://jhn.sagepub.com
Veterans Integrated Service Network 19 (VISN 19) Mental Illness Research, Education, and Clinical Center (MIRECC) School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
Purpose: Veterans Health Administration (VHA) mental health (MH) professionals are providing care to increasing numbers of veterans who served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). This study aimed to describe MH clinicians’ views of OEF/OIF veteran needs and how providers meet those needs within a large system of care. Design: Qualitative research methodology, specifically qualitative description, was used to explore VHA MH clinicians’ experiences providing MH services to OEF/OIF veterans. Methods: Thirteen VA MH providers participated in semistructured interviews, which included questions regarding the following areas: psychiatric needs of OEF/OIF veterans; collaboration and referral; needs and resources; and the personal/professional impact of providing services to this cohort. Findings: Themes emerged which highlighted complex challenges faced by OEF/OIF veterans, barriers associated with matching the unique needs of these veterans with existing treatments, and the challenges and rewards associated with providing care to members of this population. Conclusions: Capturing provider perspectives within MH services suggest potential areas for innovation aimed at providing patient-centered care to this cohort of veterans. Results may also inform future work aimed at meeting the needs of both OEF/OIF veterans and MH providers. Keywords: veterans; mental health; narratives
Introduction Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) service members are returning home with a range of deployment-related physical injuries and/or psychological symptoms. For many, these symptoms occur in the context of other readjustment issues (e.g., financial stress, changing roles and responsibilities within the family) and contribute to difficulties reintegrating into civilian life. In light of these issues, mental health (MH) providers within the Veterans Health Administration (VHA) are faced with the challenging task of meeting the complex needs of an ever-growing number of
OEF/OIF veterans (Burnam, Meredith, Tanielian, & Jaycox, 2009). Although the VHA has implemented initiatives focused on ensuring that OEF/OIF veterans receive services needed to facilitate recovery and
Authors’ Note: This study was supported by the VISN 19 MIRECC at the Denver VA and Advanced Fellowship Program in Mental Illness Research and Treatment. The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. Please address correspondence to Gina M. Signoracci, PhD, Clinical Research Psychologist, VISN 19 MIRECC, 1055 Clermont Street, Denver, CO 80220; e-mail: [email protected].
Downloaded from jhn.sagepub.com at East Carolina University on April 19, 2015
162 Journal of Holistic Nursing / Vol. 32, No. 3, September 2014
improve functioning (Burnam et al., 2009), a limited number of studies within VHA and military settings have examined the perspectives of clinicians delivering such services. Research that has examined the perspectives of those serving OEF/OIF veterans suggest that, as a cohort, OEF/OIF veterans are presenting with unique and challenging issues that may have implications for how providers approach treatment. For example, Friedemann-Sanchez, Sayer, and Pickett (2008) found that rehabilitation providers described OEF/OIF veterans as being different from other populations they have served and noted the complexity of their clinical needs. Findings also suggested that providers needed to seek additional education and training to have the skills necessary to meet the needs of severely injured OEF/OIF veterans. Finally, authors reported that providers treating this group described their work as both challenging and rewarding. In a similar study, Sayer et al. (2009) gathered information about challenges associated with providing care to returning veterans receiving polytrauma and posttraumatic stress disorder (PTSD) services. In this study, providers noted that veterans were coping with a variety of comorbid issues including psychiatric diagnoses and psychosocial challenges (e.g., vocation, family conflict). Results indicated that it can be challenging to engage this group of veterans in treatment. Additionally, authors reported variable collaboration between rehabilitation and PTSD teams across participating sites noting that clinicians often had to independently spearhead coordination of assessment and treatment for it to take place. These qualitative studies provided valuable information regarding both clinician and patient needs that may be used to identify strategies to improve the delivery of care to OEF/OIF veterans. As these studies were primarily focused on rehabilitation and PTSD providers, the purpose of this study was to obtain clinician perspectives to increase the understanding of this cohort’s overall MH needs and related service delivery. While surveys and other self-report measures can be useful to collect information related to provider experiences, these instruments are often highly focused and limit the ability to understand how and why people view things as they do. Therefore, use of a semistructured interview (Baumbusch, 2010; DiCicco-Bloom & Crabtree, 2006; Whiting, 2008)
Table 1. Professional Characteristics of VHA Provider Participants Professional Characteristics Psychologist Clinical Social Worker Registered Nurse Years working within VHA system (range) Years working within VHA system (mean) Years treating OEF/OIF veterans (range) Years treating OEF/OIF veterans (mean)
(n = 13) 6 5 2
JHNXXX10.1177/0898010114524484Journal of Holistic Nursing / Vol. XX, No. X, Month XXXXDelivering Mental Health Services to Veterans / Signoracci et al.
161
Article
Delivering Mental Health Services to OEF/OIF Veterans A VHA Qualitative Study Gina M. Signoracci, PhD Nazanin H. Bahraini, PhD Bridget B. Matarazzo, PsyD Jennifer H. Olson-Madden, PhD Lisa A. Brenner, PhD, ABPP (Rp)
jhn
research-article2014
Journal of Holistic Nursing American Holistic Nurses Association Volume 32 Number 3 September 2014 161–172 © The Author(s) 2014 10.1177/0898010114524484 http://jhn.sagepub.com
Veterans Integrated Service Network 19 (VISN 19) Mental Illness Research, Education, and Clinical Center (MIRECC) School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
Purpose: Veterans Health Administration (VHA) mental health (MH) professionals are providing care to increasing numbers of veterans who served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). This study aimed to describe MH clinicians’ views of OEF/OIF veteran needs and how providers meet those needs within a large system of care. Design: Qualitative research methodology, specifically qualitative description, was used to explore VHA MH clinicians’ experiences providing MH services to OEF/OIF veterans. Methods: Thirteen VA MH providers participated in semistructured interviews, which included questions regarding the following areas: psychiatric needs of OEF/OIF veterans; collaboration and referral; needs and resources; and the personal/professional impact of providing services to this cohort. Findings: Themes emerged which highlighted complex challenges faced by OEF/OIF veterans, barriers associated with matching the unique needs of these veterans with existing treatments, and the challenges and rewards associated with providing care to members of this population. Conclusions: Capturing provider perspectives within MH services suggest potential areas for innovation aimed at providing patient-centered care to this cohort of veterans. Results may also inform future work aimed at meeting the needs of both OEF/OIF veterans and MH providers. Keywords: veterans; mental health; narratives
Introduction Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) service members are returning home with a range of deployment-related physical injuries and/or psychological symptoms. For many, these symptoms occur in the context of other readjustment issues (e.g., financial stress, changing roles and responsibilities within the family) and contribute to difficulties reintegrating into civilian life. In light of these issues, mental health (MH) providers within the Veterans Health Administration (VHA) are faced with the challenging task of meeting the complex needs of an ever-growing number of
OEF/OIF veterans (Burnam, Meredith, Tanielian, & Jaycox, 2009). Although the VHA has implemented initiatives focused on ensuring that OEF/OIF veterans receive services needed to facilitate recovery and
Authors’ Note: This study was supported by the VISN 19 MIRECC at the Denver VA and Advanced Fellowship Program in Mental Illness Research and Treatment. The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. Please address correspondence to Gina M. Signoracci, PhD, Clinical Research Psychologist, VISN 19 MIRECC, 1055 Clermont Street, Denver, CO 80220; e-mail: [email protected].
Downloaded from jhn.sagepub.com at East Carolina University on April 19, 2015
162 Journal of Holistic Nursing / Vol. 32, No. 3, September 2014
improve functioning (Burnam et al., 2009), a limited number of studies within VHA and military settings have examined the perspectives of clinicians delivering such services. Research that has examined the perspectives of those serving OEF/OIF veterans suggest that, as a cohort, OEF/OIF veterans are presenting with unique and challenging issues that may have implications for how providers approach treatment. For example, Friedemann-Sanchez, Sayer, and Pickett (2008) found that rehabilitation providers described OEF/OIF veterans as being different from other populations they have served and noted the complexity of their clinical needs. Findings also suggested that providers needed to seek additional education and training to have the skills necessary to meet the needs of severely injured OEF/OIF veterans. Finally, authors reported that providers treating this group described their work as both challenging and rewarding. In a similar study, Sayer et al. (2009) gathered information about challenges associated with providing care to returning veterans receiving polytrauma and posttraumatic stress disorder (PTSD) services. In this study, providers noted that veterans were coping with a variety of comorbid issues including psychiatric diagnoses and psychosocial challenges (e.g., vocation, family conflict). Results indicated that it can be challenging to engage this group of veterans in treatment. Additionally, authors reported variable collaboration between rehabilitation and PTSD teams across participating sites noting that clinicians often had to independently spearhead coordination of assessment and treatment for it to take place. These qualitative studies provided valuable information regarding both clinician and patient needs that may be used to identify strategies to improve the delivery of care to OEF/OIF veterans. As these studies were primarily focused on rehabilitation and PTSD providers, the purpose of this study was to obtain clinician perspectives to increase the understanding of this cohort’s overall MH needs and related service delivery. While surveys and other self-report measures can be useful to collect information related to provider experiences, these instruments are often highly focused and limit the ability to understand how and why people view things as they do. Therefore, use of a semistructured interview (Baumbusch, 2010; DiCicco-Bloom & Crabtree, 2006; Whiting, 2008)
Table 1. Professional Characteristics of VHA Provider Participants Professional Characteristics Psychologist Clinical Social Worker Registered Nurse Years working within VHA system (range) Years working within VHA system (mean) Years treating OEF/OIF veterans (range) Years treating OEF/OIF veterans (mean)
(n = 13) 6 5 2
