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8 Access to Care
Pages 149-174

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From page 149...
... and Department of Veterans Affairs (VA) are considered -- availability, accessibility, and acceptability.
From page 150...
... DEPARTMENT OF DEFENSE There is considerable variability in service members' access to PTSD treatments in military treatment facilities (MTFs) , in mental health clinics, and from TRICARE purchased care providers.
From page 151...
... About 28% of the 24,000 TRICARE beneficiaries in the survey reported problems in accessing mental health care: 45% of the respondents reported that mental health care providers would not take TRICARE payments, 25% reported that providers would not take new TRICARE patients, 24% reported that travel distances to providers willing to see them were too great, and 24% reported that the wait for appointments was too long. The most common reason that providers cited for not accepting new TRICARE patients was a lack of awareness or knowledge about the TRICARE program (GAO, 2013)
From page 152...
... and Operation Iraqi Freedom (OIF) service members found that 17% of respondents reported receiving mental health care in the past year, either from a specialty mental health or primary care provider.
From page 153...
... Vet Centers have extended services to all military personnel who are or have been on active duty in OEF and OIF, not only those who served in combat. No data are available on the number of active-duty service members who are using Vet Centers, but almost a half-million OEF and OIF veterans had contact with a Vet Center as of 2010 (Fisher, 2014)
From page 154...
... . The DoD TRICARE Management Activity found that of 80,000 service members returning from OEF and OIF who used military health services, 20% had received mental health counseling for personal or family problems and of those 87% found the counseling helpful.
From page 155...
... Many service members and providers reported that they would like to have more family involvement in service members' PTSD treatment, including PTSD education programs, support groups for families, and couple and family therapy. Some specialized PTSD
From page 156...
... One is that many DoD mental health clinics and providers are at capacity for treating service members who have PTSD, and they do not have additional resources to offer education or other support programs to family members or to involve families more closely in service members' treatment. Higher levels of posttraumatic stress symptoms have been associated with lower couple functioning in Army couples (Melvin et al.
From page 157...
... Military liaisons (service branch representatives stationed in VA medical centers) , VA health care liaisons, and VA social workers and nurses who are responsible for patient issues are all coordinated by the Office of Care Management and Social Work Services.
From page 158...
... DEPARTMENT OF VETERANS AFFAIRS VA serves a highly diverse, although still largely male, population, many of whom receive care from VA for their entire lives after leaving military service. OEF and OIF veterans who have PTSD are accessing mental health care in VA in greater numbers than veterans of previous eras (Elbogen et al., 2013; Shiner et al., 2012)
From page 159...
... . The Veterans Health Administration Uniform Mental Health Services in VA Medical Centers and Clinics handbook requires that all VISNs provide timely access to residential services for PTSD (VA, 2008)
From page 160...
... (2012) found that among OEF and OIF veterans the median time from the end of last deployment until initiation of care was about 1.5 years for primary care, about 2 years for mental health outpatient care, and about 4 years for minimally adequate mental health care (defined as eight or more outpatient visits within a 12-month period)
From page 161...
... , but results as to its ease of use and effectiveness are not yet available. One study of 85 American Indian veterans who had PTSD and received services through rural telehealth clinics found that their use of general medical and mental health services, and use of psychotropic medications, was increased after receiving telehealth (Shore et al., 2012)
From page 162...
... . The VA handbook Uniform Mental Health Services in VA Medical Centers and Clinics and the VA/DoD Clinical Practice Guideline for Management of Post-Traumatic Stress both call for veterans and their providers to collaborate on decisions about particular treatments for a veteran's mental health conditions (VA, 2008; VA/DoD, 2010)
From page 163...
... Female veterans were more likely to want help with coping and functioning, self-concept, and sexual trauma, whereas male veterans wanted help with anger and sleep (Rosen et al., 2013)
From page 164...
... The 2008−2009 VA Survey of Women Veterans Health Programs found that 34% of the 195 reporting VA health care facilities had designated women's mental health providers in general outpatient mental health clinics and 48% had group therapy for women in these clinics; 24% of women's primary care clinics provided mental health services (Oishi et al., 2011)
From page 165...
... . VA acknowledges the importance of integrating racial, cultural, or ethnic group–specific needs of individual veterans into the clinical context by, for example, developing specific programming for American Indian veterans to address both the high proportion of rural residence of this group, which limits their potential access to mental health services, and their high rates of military service (OMHO, 2013b)
From page 166...
... For OEF and OIF veterans, special programs include Serving Returning Veterans -- Mental Health teams. The teams collaborate with the postdeployment integratedcare initiative teams, which are in primary care clinics throughout the VA system, to offer rapid, comprehensive assessment of and treatment for mental health, medical, and psychosocial needs of combat veterans.
From page 167...
... . Vet Centers provide social support to combat veterans and their families.
From page 168...
... MST services are available in all VA medical centers for both women and men, and each medical center has a dedicated MST coordinator, although adequate MST services are not always available. VA has only a few mental health programs that integrate the racial, cultural, or ethnic group–specific needs with clinical treatment; for example, specific programming has been developed for American Indian veterans and some programs are tailored to veterans who served in different eras.
From page 169...
... ": Reasons underlying treatment preferences between sertraline and prolonged exposure in posttraumatic stress disorder. Journal of Nervous and Mental Disease 201(8)
From page 170...
... 2013b. Report to Congress on the Institute of Medicine report "Treatment for posttrau matic stress disorder in military and veteran populations: Initial assessment." Washing ton, DC: Department of Defense, Undersecretary of Defense for Personnel and Readiness.
From page 171...
... 2011. Posttraumatic stress, family adjustment, and treatment preferences among National Guard soldiers deployed to OEF/OIF.
From page 172...
... 2008. Prior assault and posttraumatic stress disorder after combat deployment.
From page 173...
... 2012a. The Long Journey Home XXI: Treatment of posttraumatic stress disorder (PTSD)


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