Cover: Ready to Serve

Ready to Serve

Community-Based Provider Capacity to Deliver Culturally Competent, Quality Mental Health Care to Veterans and Their Families

Published Nov 12, 2014

by Terri Tanielian, Coreen Farris, Caroline Batka, Carrie M. Farmer, Eric Robinson, Charles C. Engel, Michael W. Robbins, Lisa H. Jaycox

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RAND Survey of Behavioral Healthcare Providers: Overview of Measures

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Research Questions

  1. What are the key factors in providing veteran-friendly, high-quality mental health care?
  2. How well is this need being met in the civilian sector?

Ensuring that military veterans and their families have access to high-quality mental health care is a national priority. Over the past several years, the Departments of Defense and Veterans Affairs have increased the number of mental health professionals working within their facilities and have rolled out training and quality improvement initiatives designed to promote the use of evidence-based treatments. Despite these important efforts, research continues to demonstrate that many veterans prefer to seek services outside the Department of Defense and/or the Department of Veterans Affairs. Thus, providers working in the civilian sector are an increasingly important part of the overall workforce addressing veterans' mental health needs. To better understand a key aspect of our nation's ability to provide veterans and their families with access to high-quality mental health care, RAND conducted a survey of civilian mental health providers to gather information about their competency with military and veteran culture and their training and experience treating posttraumatic stress disorder and depression. This report provides the results of that survey. The findings and recommendations from this study should be relevant to individuals, organizations, and policy officials concerned about the capacity of the civilian health care sector to deliver culturally competent, high-quality services to veterans and their families.

Key Findings

Cultural Competency May Be a Key Factor in Facilitating Care for Veterans and Their Families

  • Provider cultural competency involves a level of familiarity with military and veteran culture along with a degree of comfort in working with military veterans and their families.
  • Experience plays a large role in competency: Providers who work primarily in a military or VA setting were significantly more likely to meet criteria for being culturally competent (70 percent); providers who indicated they were registered within the TRICARE network were more likely to meet criteria (24 percent) than those who were not affiliated at all (8 percent).

Quality of Care Hinges on Several Factors

  • High-quality care is defined as care that has been demonstrated to be effective (i.e., evidence-based), safe, patient-centered, timely, efficient, and equitable.
  • Evidence-based techniques tend to be employed more often by providers who have been extensively trained in such practices.

Overall, Few Civilian Providers Are Prepared to Serve Military Populations

  • Only 13 percent of surveyed civilian providers met all the readiness criteria.
  • Providers who met the threshold for cultural competency did not necessarily meet the other threshold for providing evidence-based care.
  • Providers who work primarily in a military or VA setting were significantly more likely to meet all criteria than providers who do not.

Recommendations

  • Conduct better assessments of civilian mental health provider capacity — organizations that maintain registries or networks of providers should assess factors related to access and quality of care within these networks.
  • Assess the impact of trainings in cultural competency on mental health provider capacity — training in military and veteran culture may not be enough to ensure competency and comfort; experience working with the population may be required.
  • Expand access to effective trainings in evidence-based approaches for posttraumatic stress disorder and depression — training in such approaches is associated with subsequent use, but incentives for attaining such trainings may be needed.
  • Facilitate providers' use of evidence-based approaches in their practice settings — further interventions may be required to ensure that provider employ evidence-based approaches regularly.

This research was sponsored by the United Health Foundation in collaboration with the Military Officers Association of America and conducted within RAND Health.

This report is part of the RAND research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

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