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Quality Enhancement Research Initiative

QUERI E-news
February 2020

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Improving Access to Mental Health Services in Primary Care for Women Veterans

In 2014, almost half (48%) of all women Veterans using VA healthcare had at least one mental health condition. Depression was the most common condition (24%), followed by PTSD (14%) and anxiety (8%). Further, women Veterans are more likely than their male counterparts to have experienced military sexual trauma (MST), and/or intimate partner violence (IPV), as well as more than one mental health condition.

Takeaway: This QUERI project will tailor existing primary care-based mental health services for anxiety, depression, and/or PTSD for women Veterans, thereby improving the effectiveness of VA primary care-mental health integration (PC-MHI), as well as women Veterans’ engagement and retention in PC-MHI.

The delivery of mental healthcare differs widely across primary care and general mental health clinics. This variation challenges the system to engage and maintain women in healthcare. Women need to connect with providers who can support their engagement in medical and mental healthcare, while understanding their unique circumstances. Collaborative care has strong support for improving engagement and maintenance in primary care-based mental healthcare for depression. VA supports team-based medical and mental healthcare by co-locating mental health providers and using mental healthcare management. While co-location has been accomplished at many locations, use of care management has been limited, especially in women's clinics.

The Enhancing Mental and Physical health of Women through Engagement and Retention (EMPOWER) QUERI National Program is designed to improve women Veterans’ engagement and retention in evidence-based care, targeting three high-priority health conditions: pre-diabetes, cardiovascular risk, and mental health. Led by Drs. Alison Hamilton and Ariel Lang, one of EMPOWER’s primary projects, "Collaborative Care for Women Veterans," (CCWV) is an implementation study that aims to tailor existing PC-based mental health services for anxiety, depression, and/or PTSD for women by offering women Veterans the option to engage in "Coordinated Anxiety Learning and Management (CALM)," an evidence-based intervention for anxiety disorders that includes computerized cognitive behavioral therapy, and web-based patient tracking.

Currently, implementation processes are being evaluated to inform the spread of CCWV across the VA healthcare system, thereby improving the effectiveness of organizational primary care-mental health integration (PC-MHI), as well as women Veterans’ engagement and retention in PC-MHI. Results will be measured by engagement and retention in care, as well as changes in mental health symptoms, health-related quality of life, and satisfaction with care experiences.

For more information about EMPOWER or this project, contact Dr. Hamilton at alison.hamilton@va.gov.

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