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Health Services Research & Development

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HSR&D In Progress

November 2017

In this Issue: Improving Care of Mental Health Conditions
» Table of Contents

Motivational Coaching to Enhance Mental Health Engagement in Rural Veterans

Feature Article

Nearly 60% of VA-enrolled Veterans reside in rural areas and primarily receive care from VA community-based outpatient clinics (CBOCs). Compared to their urban counterparts, rural Veterans experience a significantly greater mental health burden and poorer outcomes. This may be due to the fact that rurality is one of the strongest predictors of poor engagement in treatment. A prior pilot study conducted by investigators, which included OEF/OIF/OND Veterans living in urban settings, demonstrated that telephone Motivational Interviewing (MI) delivered by research staff significantly improved mental health treatment initiation and retention in care. However, it is unknown whether telephone MI will have as strong an effect on mental health treatment engagement when the intervention is implemented in two geographically diverse sites, delivered by Veteran peer coaches – and is expanded to all-era Veterans as well as those residing in rural areas that use CBOCs.

The overall goal of this ongoing project (2014-2018) is to adapt, implement, and test an MI-based coaching intervention to improve mental health services engagement at CBOCs serving rural Veterans. Specific aims are to conduct:

  • A formative evaluation of perceived barriers to mental health treatment engagement –and adapting the MI-based treatment engagement intervention and implementation strategy to the needs of stakeholders;
  • A randomized multi-site pragmatic effectiveness trial comparing mental health referral alone with mental health referral plus MI-based coaching; and
  • An implementation-focused formative evaluation, and to use this information to make mid-course corrections to the implementation strategy based on stakeholder and key informant input.

Impact: This research will help close the knowledge gap about barriers to care and preferences for mental health services among Veterans residing in rural settings. In addition, information from this project will be used to develop implementation toolkits for mental health treatment engagement interventions for rural Veterans.

Principal Investigator:  Karen Seal, MD, MPH, is part of HSR&D’s CREATE: Improving Rural Veterans’ Access/Engagement in Evidence-Based Mental Healthcare.


Abraham T, Koenig C, Zamora K, et al., and Seal, K. Situating mental health work in place: Qualitative data from interviews with Veterans in Southeastern Louisiana and Northern California. Health & Place. September 2017;47:63-70.

Koenig C, Abraham T, Zamora K, et al, and Seal K. Pre-implementation strategies to adapt and implement a Veteran peer-coaching Intervention to improve mental health treatment engagement among rural Veterans. Journal of Rural Health. September 1, 2016; 32(4):418-428.

Motivational Coaching to Enhance Mental Health Engagement in Rural Veterans project abstract

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