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Midolo JP, Freytes IM, Wing KL, Uphold CR. Needs Assessment of Returning OEF/OIF Veterans in the United States Virgin Islands. Poster session presented at: VA Research in the Southeast RFPs to Outcomes: Translating Research to Practice Conference; 2010 Jul 21; Orlando, FL.
BACKGROUND: Currently the Veteran Affairs [VA] and other Veteran organizations have been implementing numerous reintegration efforts for returning Operation Enduring Freedom [OEF] and Operation Iraqi Freedom [OIF] Veterans to address issues such as access to healthcare and other VA benefits. However, few of these programs address under-represented, cultural sub-groups of returning Veterans. OBJECTIVES: The purpose of this study is to assess the needs of returning United States Virgin Islands [USVI] OEF/OIF Veterans, their families, and health providers so that we can create effective educational materials. METHODS: A secondary data search, evaluation of available Veteran services and resources, phone interviews with providers, and focus groups with Veterans and providers was conducted during the needs assessment. The VA providers were identified from the VA directory, and the subsequent US Army and local health providers were identified by USVI VA employees and an internet search. STATUS:We are currently in the final stages of designing our evidence-based, culturally competent educational guide. Once the guides are printed, we will deliver them to our collaborators and health providers in the USVI. We have developed and will administer a dissemination workshop for all health providers who will participate in disseminating the guides. Lastly, we will conduct a summative focus group with Veterans and providers to assist us in evaluating the effectiveness of the materials within the USVI Veteran community. FINDINGS: Provider Needs-Assessment Phone Calls: We interviewed seven USVI providers from four local USVI health service providers. The providers identified several barriers to accessing VA health services. However, the main barrier perceived among all providers was the "culture of privacy" among USVI residents. This in turn has had a detrimental effect on Veterans utilizing historically stigmatized services, such as mental health services. Furthermore, the providers identified mental health problems, violence, substance abuse, and homelessness as the top health concerns among returning Veterans in the USVI. Providers also identified a lack of unique educational materials as a hindrance to promoting positive health behaviors among Veterans in their communities. Lastly, networking among providers was non-existent prior to our study. Focus groups: Nine USVI service members participated in the Veterans focus group. We identified several barriers to the post-deployment community reintegration process. These included 1) perception of low support or recognition of their sacrifices from the USVI community, 2) limited family involvement within the local military community, 3) a lack of educational materials focused specifically on returning USVI service members and their needs, and 4) culture of privacy that inhibits Veterans from utilizing services. Service members also identified specific educational material needs that address 1) VA Women Veterans Health Services and 2) substance abuse. We also conducted a focus group of seven USVI Veteran service providers. They validated the findings found in the Veterans focus group. They also mentioned that the top health concerns for returning OEF/OIF Veterans are the increasing rate of 1) mental illness, 2) violence, and 3) substance abuse. They confirmed that mental health disorders are stigmatized and that USVI residents possess a "culture of privacy", which in-turn leads to further under utilization of mental health services. The Veteran service providers also reported a need for culturally competent educational materials. In addition, both focus groups also evaluated examples of our educational materials and helped us validate the effectiveness of the layout and content. Also they expressed that there is a widespread discontent among USVI Veterans and Puerto Rican based health services due to a language barrier [English vs. Spanish]. From these findings we identified several specific areas of need for returning OEF/OIF Veterans and their families in the USVI. The topics that should be addressed are; 1. Difficulties the Veteran and family will experience during reintegration 2. How to identify and seek treatment for mental illness, violence, and substance abuse 3. How to access healthcare and VA benefits. These findings also underscore the need to address cultural subgroups with culturally relevant educational materials in health practices. IMPACT:The need for culturally competent educational family materials was expressed by USVI Veteran health providers. The high rates of reported mental illness, violence, and substance abuse among returning USVI Veterans needs to be addressed by educating families and Veterans. These findings will lead to further research and the creation of culturally competent educational material to address the needs of Veterans, their families, and health providers in the USVI community.
