Operations Enduring Freedom, Iraqi Freedom, and New Dawn have resulted in a significant burden of mental disorders in the population of Service Members and Veterans who have served in these conflicts. Frequently, however, OEF/OIF/OND personnel do not present for care, stay in treatment, or receive adequate care. If we are to improve health-care-seeking by OEF/OIF/OND Veterans with mental disorders, we must better understand community-level outreach programs and the local circumstances that impact health-care-seeking by these Veterans. Community-based participatory research (CBPR) has become an accepted research approach to be used when issues of community definition and community engagement are central to the focus and quality of the research.
Our objective was to describe health outreach activities being conducted for OEF/OIF/OND Veterans by the VA in the VISN 22 geographic area, including the organizational context within which outreach staff persons operate, the social context within which OEF/OIF/OND Veterans make health care decisions, and the characteristics of the interaction between outreach staff and OEF/OIF/OND Veterans. We sought to describe the outreach methods used and the types of outreach interactions that were perceived to be most effective. Our specific aims were the following: (1) describe more fully current outreach to OEF/OIF/OND Veterans; (2) delineate what outreach activities, strategies, messages, and communications media have been perceived to be the most effective at improving OEF/OIF/OND Veteran health-care-seeking; and (3) describe the organizational context within which outreach to OEF/OIF/OND Veterans occurs.
We conducted semi-structured interviews with six VA outreach staff persons and policy and administrative personnel important to health outreach to OEF/OIF/OND Veterans. The qualitative methodolog of Rapid Assessment Process guided the data collection.
Interviews were completed with six staff persons before sufficient qualitative saturation was achieved. Key findings include the following. The VA has hired outreach staff to work within and conduct outreach for the Vet Centers, the Veterans Health Administration, and the Veterans Benefits Administration. The outreach staff persons from each of these units coordinate their outreach activities in a geographic area, informing each other of outreach events and opportunities. Regardless of which VA unit an outreach staff person was affiliated with, interviewees reported spending much of their outreach time, energy, and resources conducting outreach presentations during "transition" events, including Yellow Ribbon Reintegration Program events for deploying or recently returned National Guard and Reserves members, Post-Deployment Health Reassessment events for recently returned service members, Transition Assistance Program (TAP) events for service members leaving active duty service, Demobilizations, and musters of Individual Ready Reserve troops. These events represent "bottlenecks" through which many Service Members and Veterans pass and are accessible to outreach staff persons. While these events are perceived as necessary and important outreach opportunities by outreach staff, interviewees expressed an awareness that Service Members and Veterans are inundated with information during such events and may not be able to take in and use outreach information delivered during them. Interviewees reported concern, however, that outside of these obvious "bottlenecks," there were few community locations and events where OEF/OIF/OND Veterans and Service Members could be located in large numbers, leading some interviewees to speculate that billboards and TV and radio advertisements could be effective. Interviewees emphasized the importance of personalized, face-to-face outreach, however. One interviewee recommended using the same outreach strategies used by military recruiters. Interviewees also identified family members as important outreach targets, as they often seem to be less burdened by stigma around help-seeking than the Service Member or Veteran. Interviewees expressed a desire to expand their outreach activities to community-based events, including fairs, athletic events, military air shows, and other large gatherings of community members. The greatest barrier to this expansion is the lack of adequate staff, per interviewees. Some outreach staff had expanded their activities to include events at colleges and universities, although this outreach had been low yield. Interviewees reported the following to be effective outreach strategies: veteran to veteran outreach; employment-related outreach; hiring outreach staff persons who are professional and empathic; and ensuring outreach staff have the ability to offer concrete help to a Veteran, Service Member, or family member.
The results of this study may be used by VA policy makers to guide future outreach activities within the VA, including what resources and staffing are provided for outreach activities, how outreach activities are coordinated across VHA, VBA, and the Vet Centers, and what outreach methods are used to reach OEF/OIF/OND Veterans.
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