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November 12, 2014

Veterans

Ready to Serve

Understanding Community-Based Provider Capacity to Provide High Quality Mental Health Care to Service Members, Veterans, and Their Families

Capt. Elrico Hernandez, battalion physician assistant for 2nd Battalion, 3rd Infantry Regiment, 3rd Stryker Brigade Combat Team, 2nd Infantry Division, discusses a training scenario as part of a primary care behavioral health seminar.

Photo by Pvt. Zachary Zuber/U.S. Army

Addressing the mental health needs of military service members, veterans, and their families remains a national priority and has been the focus of many federal, state, and local efforts. Recently, Congress passed legislation that greatly expands the ability of eligible veterans to seek care outside the Department of Veterans Affairs (VA). This raises questions about the capacity of the civilian mental health workforce to meet the unique needs of our veteran population.

A new RAND study examined the potential readiness of mental health providers working in the community -- in local civilian health clinics, as opposed to VA or DOD facilities -- to deliver high quality, culturally competent care to the veteran population.

The authors conducted a web-based survey of behavioral health providers to gather information about their knowledge, attitudes, and preferences for delivering services to veterans and their families, as well as their behaviors related to treating posttraumatic stress disorder and depression. Based on the survey responses, researchers constructed overall measures of cultural competency and use of evidence-based therapy and then combined them for a measure of overall readiness to deliver competent, high quality care to veterans and their families. Access to culturally competent providers is important because it can help facilitate the development of therapeutic rapport and improve treatment receptivity.

Findings:

  • The report found that only 19 percent of participating providers met the threshold as competent in military and veteran culture.
  • Providers who spend at least some time working in military or VA settings scored higher, suggesting that experience working with the military and veteran population is an important contributor to cultural competency.
  • The study also found that 65 percent of psychotherapists reported that they had not received the training or supervision necessary to deliver even one evidence-based treatment for posttraumatic stress disorder or major depressive disorder, mental health disorders common among veterans seeking mental health care.
  • Of the population in the survey that had appropriate training, only 41 percent reported actually delivering evidence-based care to most of their patients.
  • In terms of over all provider readiness to deliver both culturally competent and high quality care, the researchers found that 13 percent of participating providers met the threshold.

Though exploratory in nature, these findings shed light on the current state of readiness among civilian behavioral health providers to deliver care to veterans and their families and have implications for the development and implementation of additional programs to build the mental health workforce.

Recommendations:

  • Improve assessments of the workforce providing mental health care: Organizations that maintain registries or networks of providers should conduct assessments to determine the level of access and quality of care available.
  • Determine the impact of cultural-competence training for providers:Training in military and veteran culture may not be enough to ensure cultural competency. Further evaluations of the effectiveness of these programs may be needed to ensure competency is achieved.
  • Expand access to effective trainings in evidence-based approaches for PTSD and MDD therapies:Training in such approaches predicted subsequent use, but incentives for providers to attain such trainings may be needed.
  • Facilitate providers' use of evidence-based therapies: While training was predictive of use, many trained providers still did not use these approaches with most of their patients. Further interventions may be needed to ensure that high quality care is delivered in practice settings.

Read the full report »

For questions or an opportunity to discuss this or other RAND research, please contact me at Jayme_Fuglesten@rand.org or at (703) 413-1100, ext. 5363.

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