Post-traumatic stress disorders (PTSD) is a psychiatric disorder that develops among people exposed to various traumatic events ranging from natural disasters, combat, accidents or near-death experiences (Way et al., 2019). A positive diagnosis is provided by a qualified healthcare professional when a patient shows symptoms such as emotional numbness, lack of sleep, increased aggression and re-experiencing trauma through nightmares and flashbacks for more than a month. Additional PTSD symptoms include irritability and avoidance behavior on people, places or activities that serve as reminders of the traumatic event.
According to Richardson et al. (2010), combat-related PTSD in the United States affects 3-17% of veterans, and as such, military veterans are a high-risk group. Preston (2018) suggests that PTSD among veterans triggers fear and anxiety due to prolonged exposure to combat-experiences. The veterans’ health administration (VHA), which administers the integrated health care system of the Department of Veteran Affairs (VA), offers qualified veterans an array of medical services that inhibit PSTD symptoms. The services include inpatient, outpatient, and residential mental health care services aimed at reducing harmful effects of PSTD among veterans (Finley et al., 2019). The creation of emergency services in the VHA centers helps veterans access proper PSTD therapy. Examining the role of VHA in provision of PTSD therapy among veterans as well as strategies to improve services and programs is explored below.
Currently, VA centers in the United States face major challenges in terms of service provision and formulation of programs targeting PTSD among veterans. Hence, the need to introduce mechanisms that improve service delivery among programs targeting PTSD in veterans. Suggested changes include increasing the number of inpatient and outpatient clinics dealing with the condition to reduce long queues in the VA centers, engaging in de-stigmatization campaigns, increasing access to mental care services for all veterans, and transforming the functioning of VA.
What measures should VA centers put in place to improve the services and programs offered to veterans with PSTD?
VA is one of the instrumental offices delivering veteran programs in the U.S. The department has three distinctive offices located in Washington. As an organization, VA is instrumental in providing healthcare services to veteran soldiers, especially those diagnosed with various mental illnesses and PSTD. The introduction of modern technology across VA centers is an example of a renewed approach in handling veterans with PSTD. For instance, the introduction and the use of mobile technology may be the major reason behind the improved quality of services offered in different VAs in the nation currently. Additionally, the use of telehealth facilities is essential in following up patients and reminding patients of the need to visit their nearest VA medical center for the required checkups.
The VA’s National Center for PSTD in conjunction with the VA’s office of the Mental Health and Suicide Prevention and the Defense Health agency have developed more than 15 mobile applications meant to address the needs and concerns of veterans with PSTD in American society (Finley et al., 2019). The applications offer the required medical services to veterans with PSTD. The range of applications includes therapy or counseling sessions, consultations sessions, follow-up sessions, quality assurance ratings and regular information to both patient and physician. The applications have proved essential since patients directly connect with their relevant physicians, thus making the treatment process easy and effective (Burnam et al., 2009). Furthermore, the approach has eliminated existing barriers related to presentation of the patient in physical sites. Research in use of telehealth services in managing PTSD is extensive due to the ever-growing pieces of evidence illustrating the effectiveness of developed applications in reducing the symptoms of PSTD. The applications are effective due to their simplicity and advantageous to traditional care without the application of the latest technology. For instance, due to the speed and efficacy of modern technology, the applications can give instant answers to the victims, hence reducing the time and speed of visiting a nearby VA center for help.
The applications value the veterans’ privacy and restrict access to personal information to public domains. The VA and Department of Defense (DoD) are working together on provider-grounded implementation networks to allow physicians to optimize the development of mobile technologies in care. Although technicians have encountered various hardships such as cost and privacy in implementing mobile technologies, the technologies have proved effective for doctors and veterans in dealing with PSTD (Miller et al., 2019). The military health system is one of the instrumental offices in the military responsible for improving the readiness of military personnel through improving their physical and mental wellness through assessing and providing the required medications, especially for the PSTD veterans. Moreover, the department ensures that the veterans are well guided and given the required medical attention to hamper symptoms of PSTD that have proven dire to many individuals.
The VA should adapt Eye Movement Desensibilization and Reprocessing (EMDR) as one of the appropriate mechanisms of dealing with PSTD veterans in society. The method is considered effective as it uses eye contact mechanism to recall traumatizing situations. As a result, doctors use theories to advise patients on appropriate ways of fighting stress (Preston, 2018). The major theory surrounding the treatment criterion is focusing on other stimuli while revisiting the previous experiences, which help the patients to eliminate some of the traumatizing events from their minds. The method helps the veterans to reprocess some of their traumatic information in their minds until they no longer become psychological troublesome.
Pharmacotherapy is another approach used to manage PTSD, especially although veterans do not respond well to non-drug treatment of the disorder (Burnam et al., 2009). Consequently, pharmacotherapy affects the levels of various neurotransmitters and with time reduces levels of stress. Physicians tend to prescribe different medicine at specific counseling stages. For instance, physicians may introduce the patient to medicine as well as offering psychological counseling to eliminate some of the harmful effects of the condition. The treatment method serves as a first-line approach for PSTD. Selective Serotonin Reuptake Inhibitors are among the pharmacological strategies that the VA centers should introduce to treat PSTD among veterans (Way et al., 2019). The approach suitable and involves intake of antidepressants, which are used to heal the harmful effects of PSTD symptoms. Sertraline and paroxetine are the currently authorized drugs by the Food and Drug Administration used for the treatment of the condition (Burnam et al., 2009). Other medications include venlafaxine and SSRI fluoxetine, which relieve the effects of PSTD (Finley et al., 2019). Pharmacological treatment allows veterans to forget some of the tragic experiences while on the line of duty. The medications are regarded as suitable because they are responsible for curing about 60% of PSTD conditions among the veterans.
Veterans with depressive disorder, panic disorder, and generalized anxiety are recommended to take the ER formulation of venlafaxine, as it is appropriate for treating those conditions (Miller et al., 2019). Many therapists dislike the second-line therapies for curing PSTD because they are less supported by evidence and for that reason, they may have adverse side effects to the patients. They include medications such as mirtazapine and tricyclic antidepressants, which block the noradrenergic stimulation of alpha-receptors in the body, hence ineffective in treating some of the PSTD’s symptoms such as nightmares. Although VA centers prefer the use of antidepressants as the major cure for PSTD, physicians need to introduce alternative medicines that can heal effectively the condition as it has proved mutant to some medications. For instance, many researchers are looking at the effectiveness of gamma-aminobutyric acid in the treatment of the condition since many individuals have suggested how is effective in treating the disorder. The acids play an instrumental role in encoding fear in veterans, hence reducing the harmful effects of the condition.
Strategic Planning to Improving Services and Programs Provided for Veterans with PTSD within the VA Medical Center
Strategic planning allows organizations to set various priorities, energies, and resources towards a common goal and an established outcome. For the case of VA Medical Center, their energies and priorities should be directed towards reducing PTSD levels among veterans. Kurt Lewin’s change theory will be used to develop a strategic plan. The theory is composed of three key stages, including the unfreezing step where all current issues facing an institution or organization are identified followed by a change process that suggests new measures to address any existing deficiencies (Cummings et al., 2016). Lastly, the refreezing step identifies ways in which the change process is enshrined in the future (Cummings et al., 2016). Strategic planning will focus on four essential objectives. Firstly, increase timely access to mental care to military veterans with the sole purpose of reducing PTSD levels. Secondly, address individual and institutional factors that hinder access to mental care among veterans to reduce barriers to care. Thirdly, conduct regular performance checks across all facilities to ensure that the proper treatment is being administered and lastly reform the entire institution to be in line with its objectives, mission, and vision.
In the above case, the major issues regarding PTSD treatment revolve around the inefficiencies surrounding VA Medical Centers. Although VA Medical Centers provide the appropriate mental care, military veterans still face numerous barriers in accessing PTSD treatment. The largest barrier singled out by most veterans is the lack of provider appointment availability due to the increased shortage of doctors within such centers combined with the ever-increasing number of military veterans resulting in long waiting lines (RAND Health, n.d.). Poor availability to mental care services across different parts of US especially among Afghanistan and Iraq veterans has been singled out (Anderson, 2014). In most cases, most mental health specialist concentrates in urban areas creating huge disparities. Some rural areas have even lack VA medical centers increasing the greater distance that military veterans have to cover in seeking the required mental care services (Doyle & Streeter, 2017). Another major issue identified by most military veterans as a barrier to accessing PTSD treatment is the social stigma linked to the disease. Most service members perceive mental illness as a sign of weakness and some attempt to toughen it out (Anderson, 2014). Apart from the issues above, which individually affects military veterans, issues directly affecting the entire organization have dominated headlines in recent years. US Government Accountability Office reported five key issues affecting VA medical centers, including inadequate oversight and accountability of the existing facilities, ambiguous policies and inconsistent processes, numerous information technology challenges, unclear resource allocation priorities as well as inadequate staff training (US Government Accountability Office, 2019). Such factors make up the core of the freezing or ongoing practices at VA Medical Center that significantly limit the better mental health practices. Thus, in formulating a strategic plan to improve access to mental care services, the identified key issues need to be addressed in the changes process.
The change process within VA medical center should start by planning on methods, which will increase timely mental care access to military veterans. The approach is two-fold: reducing stigmatization of PTSD and increasing access to VA medical centers across the country. One key approach that could be used to reduce stigmatization rates among veterans would be the need to initiate care services that not only integrate physical health but also mental health. Additionally, the VA in collaboration with individual medical services should start various outreach initiatives through social media platforms allowing veterans who have in the past experienced PTSD to guide on seeking care as well as overcoming the condition. The use of telehealth services is one of the most effective strategies, which could be implemented to improve behavioral health services considering the low number of VA medical centers and veterans diagnosed with PTSD. Individual units of VA Medical Centers could apply telehealth as a convenient and destigmatizing mental care especially among the rural areas, which has a significantly high number of VA enrollees diagnosed with PTSD. An evidence-based study indicates that rural veterans with PTSD showed positive effects while receiving psychotherapy through methods such as video conferencing and telehealth services (Fortney et al., 2015). Telehealth services could be used to ensure adherence appropriate treatment. Additionally, Fortney et al. (2015) showed that receiving telehealth services resulted in greater reductions in PTSD in approximately six months compared to one-year programs offered on-site with the telehealth services promoting self-care services. VA should identify new and unique strategies that could be used to identify veterans who have not enrolled in the current system and who might be at risk of PTSD.
The second essential strategic planning aspect related to provision of better healthcare practices would be the hiring of more doctors and physicians by the VA to individual VA Medical Centers especially those in the rural set-up. The Veteran Access Choice and Accountability Act enacted in 2014 requires that VA offer to purchase case to veterans who live more than 40-mile drives for a reasonable amount of time (Ohl et al., 2018). Although such the act is encouraged, there is an intricate need to decentralize mental health psychotherapists and physicians from the urban areas to low areas, as the number of enrolled affairs in rural areas is significantly higher while the number of professionals serving the veterans is significantly lower. By increasing the number of physicians and psychotherapists, veterans diagnosed with PTSD will regularly access mental care services, and the appropriate measures in improving their health will be instituted. Additionally, the long waiting lines, which serve as a poor-quality indicator, will change gradually. The rise in suicide rates across most states has been directly linked to unresolved mental health issues (York et al., 2013). Therefore, by increasing the number of healthcare professionals who can directly attend to veterans a decline in mental health issues especially those revolving around PTSD will decrease. Apart from increasing the number of healthcare professionals, VA should continuously assess the functioning of all VA Medical Centers and urge for the development of internal quality control systems, which ensure that quality standards are maintained. All VA Medical Centers across all states should be rated and ranked according to the quality of services offered with centers that report below-average scores being expected to either benchmark from other centers or change various processes within their units (Rugen et al., 2014). Apart from increasing the patent’s access to care, VA and individual centers should be willing to conduct follow-up treatment and checking on the patient and report all outcomes (Cai et al., 2018). There is a need to equip the research and development team to evaluate the effectiveness of various PTSD programs and include disseminate their findings across various centers. Furthermore, all centers should be expected to conduct regular PTSD screening at least once on an annual basis for all of its service members as well as those under different programs.
The last component under the change process addresses the management of the VA system. The US Government Accountability Office (2019) reported that the management had significantly failed in addressing essential issues related to the functions of VA. In case, the current issues that range from inadequate oversight and accountability of the existing facilities to inadequate staff training. If such issues continue to persist, then new management should be enacted to address existing challenges. VA could opt to have a subunit that oversees and ensures that all VA Medical Centers are accountable, train professionals within the system, improve the information communication system, develop clear policies and eliminate ambiguities in the system (Sullivan et al., 2018). Once the top management reforms such issues, an operational command structure should be established to pass the information to the other systems. Implementing such practices would significantly improve care provided to veterans especially in managing conditions like PTSD. Additionally, the VA system should lobby the government to increase investment in the system, which could be used to hire, train and pay healthcare professionals at better rates, thus resulting in high retention rates.
After the implementation of most measures in the change process, the last component, the refreezing steps, ensures that the instituted measures become part of the organization’s culture. To assess the effectiveness of various strategic plans indicated above, VA should develop clear strategic maps on various outcomes including increasing the number of veterans registered for mental care services, increasing the number of VA Medical Center facilities in urban areas, reducing stigmatization of military veterans, and assessing the effectiveness of various interventions used to manage PTSD. Additionally, the VA should attempt to implement all measures reported by the US Government Accountability Office and regularly perform assessments to individual centers to check if the quality of healthcare provided as per the required standards. Lastly, the management of VA should identify new methods to lobby for increased funding considering the increase in number of veterans reporting mental care issues over the last decade. The lobbied funds would greatly improve the quality of service provided and serve to retain numerous professionals. The strategic plan for the organization should outline specific principles that the management and all centers are supposed to adhere especially in improving the welfare of veterans.
For the proposed plans to be successful, it is essential to analyze key areas where VA could maximize resources. The major strength of the proposed program is the established network of the VA medical center facilities across the United States. The presence of such networks allows for easier implementation of the proposed plans including the use of telehealth services in increasing veteran’s access to mental health care services from various parts. VA medical centers can rely on their existing established networks, such as mobile clinics, which provide access to care without VA centers (Drebing et al., 2018). The Veterans Hospital Administration is the largest integrated health care system in the United States with approximately 80,000 registered nurses and more than 1,600 sites of care. The size and scope of care provided under VHA accord it an opportunity for more funding, expansion, and collaboration with governmental and non-governmental organizations. Another major strength of the organization is the brand of the organization, which has been developed specifically over the years to address issues relating to veterans.
The major weakness in improving services and programs provided for veterans with PSTD within the VA medical center is the lack of appropriate facilities to facilitate the plan. Therefore, some VA centers give referral letters to veterans with severe PSTD symptoms, as they are unable to deal with the condition. Another weakness in VA is nepotism, which has undercut the fabric of the organization over the years. Furthermore, this has threated cultural competency and multiculturalism in patient care delivery, hence adversely affecting help-seeking behavior among veterans due to cultural and ethnic stereotypes attached to PTSD. Although the current plans recommend accountability, other aspects including poor leadership and failure to address the needs of the veterans should be prioritized. Another major obstacle faced by VA is lack of sufficient funds to implement all its programs successfully.
The opportunity in the program is the introduction of new treatment mechanisms such as Mental Health Strategy 2011, which may propagate the issuance of both therapeutic and medical treatments to veterans with PSTD. Moreover, the introduction of telehealth may aid in reaching victims from various parts of the nation (Finley et al., 2019). Another opportunity provided by an improved veteran health program includes the ability to reach out to more patients with PTSD by increasing the number of registered nurses. The VA travel nursing agency enables healthcare providers to travel globally and provide care to veterans without losing grade. Additionally, the proposed plan could exploit the use of evidence-based practice in dealing with mental issues. In the end, privatization of the VA could be considered as an alternative approach if the current issues persist.
Succession planning was not a feature in the organization until a few years ago. Despite being a major employer for healthcare professionals, VA has not effectively addressed their needs including lack of in-house per diem for RNs. It poses a major threat to the quality of care provided. In addition, lack of cooperation from the affected veterans is a primary threat to the program given that a substantial number do not report cases of PTSD to the department of Veteran Affairs for treatment. Another threat to provision of care under the VHA is the Affordable Care Act (ACA). Veterans who receive care under VA suffer from fragmentation of care leading to poor health outcomes and reduced quality of life. The program has incorporated VA’s vision of taking care of all veterans through expanding benefits to the family members. For that reason, the finances may be used to take care of PSTD victims in society. The program is in line with the VA’s goal of delivering appeal decisions to PSTD veterans’ claims. The program, for instance, aims to deliver more 81,000 appeals verdicts on financial and medical benefits for PSTD veterans in society (Gaddy, 2018). The program is in line with the VA’s strategic plan of making its electronic and online information accessible to people with PSTD disorder about section 508 of the Rehabilitation Act, which was amended in 1999 (Haefner et al., 2019). Consequently, the center has established mobile application apps to connect with veterans with PSTD across the nation.
The game theory will be applied in dealing with the financial analysis of the organization and in looking for viable collaborators who will work hand-in-hand with the Department of Veteran Affairs to ensure the project is a success. The financial theory is applicable since it leads the organization into appropriate fiscal planning. The program may employ the force field analysis theory, which highlights the various necessities to regulate external forces such as poor technologies, which may hinder the success of the operations.
The program requires a large amount of money as it deals with veterans across the nation. For instance, huge financial expenditure is needed in the purchase of medical equipment as well as training physicians on the different ways to handle veterans with PSTD. Besides, more financial resources will be used in the establishment of mobile clinics meant to attend patients from various parts of the nation as one of the ways to ease them the task of traveling from one point to another to look for medical attention. VA is required to invest in raising awareness and promoting help-seeking behavior among veterans. Additionally, the VA is supposed to role an anti-stigmatization campaign against PTSD among military veterans. For that reason, VA may be compelled to employ strategies such as advertisements and social media to communicate with PSTD veterans from different parts of the nation. Additionally, the department may be compelled to use other ways of raising awareness such as organizing seminars in different parts of the nation (Miller et al., 2019). Consequently, such moves allow veterans with PSTD to recognize the various ways the administration is working hard to contain their conditions in society (Burnam et al., 2009).
Finley et al. (2019) observe that VA needs additional funding to create referral networks for easy attendance of veterans with PSTD in society. The move proposes the creation of emergency centers, at least in every VA center, to ensure veterans access the required mental health services. VA centers could collaborate with community health programs to create emergency centers to cater to people with severe PSTD symptoms. However, full implementation of the plan requires a hefty financial budget. Apart from the proposals mentioned above, VA needs to work with technology companies to introduce appropriate applications that may help connect PSTD veterans with their relevant physicians. For that reason, the department is required huge financial spending to ensure it has developed suitable applications that will reach the entire populace with PSTD in society. The federal government has significantly increased the budgetary allocation to the DoD. Consequently, the amount of funding provided to the VA should be increased to provide the necessary financial and fiscal support smooth running of operations especially in provision of PTSD therapy among veterans.
Administrative Global and Multicultural Approaches to the Changes
Cultural competence is critical for any program serving a multicultural society. The salad bowl theory is the most effective in implementing the program. The theory is more liberal compared to the melting pot theory to multiculturalism. According to the salad bowl theory, people do co-exist in a heterogeneous society without necessarily losing the unique characteristics of their traditional culture. Ideally, service delivery should not be based on a uniform approach but rather address the unique individual and cultural needs of the patients. A global and multicultural approach that VA can implement is multicultural collaboration between groups and organizations to provide a personalized experience for veterans receiving PTSD care under the VHA.
Various approaches global and multicultural approaches need to be taken to improve services offered to PSTD veterans in society. In this case, cognitive competence is crucial in asking the various veteran questions connected to their PSTD condition. The approach for the veterans means putting the client’s experience within the prescribed military traditions and identifying centrality of military recognition among veterans. The approach is appropriate to the change, as it gives the VA service providers the ability to recognize the veteran’s problem and attend to it accordingly. The approach is always to what is recommended by the DoD and VA. For instance, the VA recommends the application of Clinical Administered PSTD scale to heal the veterans (Davis et al., 2019). The program may use the primary mental ability theory, which majorly looks into a person’s mental system to comprehend the dire repercussions of PSTD. For instance, principle will lead the physicians to conclude whether the veteran is fit to live with other individuals in society. The three-stratum theory may be eligible in this case as it may be employed to determine the intelligence levels of a person, hence defining whether they may have suicidal thoughts.
For the Department of Veteran Affairs to effectively serve its target population, it is imperative to align its operations with the global standard practices of service delivery and medical research. Such initiatives will ensure that the treatment methods adopted do not only ensure cultural competence but also promote the quality of care received. For example, Gaddy (2018) suggests that several studies are investigating the effectiveness of vortioxetine and vilazodone in curing the condition since both medicines have been approved by the FDA in curing depression. The combination of pharmacotherapy and psychotherapy is crucial in treating PSTD among the veterans since the criteria combine both medicinal and therapeutic ways to heal PSTD (Way et al., 2019). Preston (2018) indicates how the combination of the two may be effective especially for individuals with severe symptoms of PSTD. For instance, various studies reveal that the combination of SSRIs and psychotherapy helps treat PSTD if the two methods are applied together.
The research aimed to explore ways to improve the services and programs offered to veterans with PTSD by the Department of Veteran Affairs. Given the high prevalence of PTSD among the veterans in the United States, among the changes recommended under the proposed programs include an expansion of the care delivery models to increase the number of veterans accessing treatment. It includes an increase in funding and number of available VA medical centers serving the veterans. Furthermore, the research has examined the use of mobile applications by the VA to reach out to more veterans who have PTSD across the country as well as treatment monitoring to improve patient outcomes.
The study has outlined several strategic plans in place including collaboration between the Department of Defense and the Veterans Affairs to increase accessibility to welfare programs. Furthermore, the collaboration creates a supportive interpersonal work environment for veterans. Financial analysis for the Department of Veterans Affairs demonstrates the need for extra sources of funds to finance some of the key programs that are in the process of being introduced to improve care delivery among veterans diagnosed with PTSD.
The study recommends a multicultural approach to the program as it will improve collaboration among various agencies, reach out to more veterans with combat-related PTSD symptoms, and increase help-seeking behavior. Furthermore, by aligning its operations with the global standards in care delivery, the VA will significantly improve the success of the programs targeting veterans with PTSD. The results from the SWOT analysis indicate that there are more opportunities for VA medical programs to expand across the country to reach out to more veterans in need of treatment and welfare services.
Anderson, B. M. (2014). Factors contributing to the delayed reporting of mental health needs for service members deployed after 9/11 to Iraq and Afghanistan. Dissertation Abstracts International: Section B: The Sciences and Engineering.
Burnam, M. A., Meredith, L. S., Tanielian, T., & Jaycox, L. H. (2009). Mental health care for Iraq and Afghanistan war veterans. Health Affairs, 28(3), 771-782. https://doi.org/10.1377/hlthaff.28.3.771
Cai, S., Grubbs, A., Makineni, R., Kinosian, B., Phibbs, C. S., & Intrator, O. (2018). Evaluation of the Cincinnati Veterans Affairs Medical Center hospital-in-home program. Journal of the American Geriatrics Society, 66(7), 1392-1398. https://doi.org/10.1111/jgs.15382
Cummings, S., Bridgman, T., & Brown, K. G. (2016). Unfreezing change as three steps: Rethinking Kurt Lewin’s legacy for change management. Human Relations, 69(1), 33-60. https://doi.org/10.1177/0018726715577707
Davis, L. L., Resnick, S. G., Maieritsch, K. P., Weber, K. C., Erbes, C. R., Strom, T. Q., McCall, K. P., & Kyriakides, T. C. (2019). Employment outcomes from VA vocational services involving transitional work for veterans with a diagnosis of posttraumatic stress disorder. Psychiatric Rehabilitation Journal, 42(3), 257-267. https://doi.org/10.1037/prj0000357
Doyle, J. M., & Streeter, R. A. (2017). Veterans’ location in health professional shortage areas: Implications for access to care and workforce supply. Health Services Research, 52, 459-480. https://doi.org/10.1111/1475-6773.12633
Drebing, C. E., Reilly, E., Henze, K. T., Kelly, M., Russo, A., Smolinsky, J., Gorman, J., & Penk, W. E. (2018). Using peer support groups to enhance community integration of veterans in transition. Psychological Services, 15(2), 135-145. https://doi.org/10.1037/ser0000178.
Finley, E. P., Mader, M., Haro, E. K., Noël, P. H., Bernardy, N., Rosen, C. S., Bollinger, M., Garcia, H. A., Sherrieb, K., & Pugh, M. J. V. (2019). Use of guideline-recommended treatments for PTSD among community-based providers in Texas and Vermont: Implications for the veterans choice program. The Journal of Behavioral Health Services & Research, 46(2), 217-233. https://doi.org/10.1007/s11414-018-9613-z
Fortney, J. C., Pyne, J. M., Kimbrell, T. A., Hudson, T. J., Robinson, D. E., Schneider, R., Moore, W. M., Custer, P. J., Grubbs, K. M., & Schnurr, P. P. (2015). Telemedicine-based collaborative care for posttraumatic stress disorder: A randomized clinical trial. JAMA Psychiatry, 72(1), 58-67. https://doi.org/10.1001/jamapsychiatry.2014.1575
Gaddy, M. A. (2018). Implementation of an integrative medicine treatment program at a Veterans Health Administration residential mental health facility. Psychological Services, 15(4), 503-509. https://doi.org/10.1037/ser0000189
Haefner, J., Abedi, M., Morgan, S., & McFarland, M. (2019). Using a veterans affairs posttraumatic stress disorder group therapy program with refugees. Journal of Psychosocial Nursing and Mental Health Services, 57(5), 21-28. https://doi.org/10.3928/02793695-20181220-02
Miller, K. E., Lindquist, J. H., Olsen, M. K., Smith, V., Voils, C. I., Oddone, E. Z., Sperber, N. R., Shepherd‐Banigan, M., Wieland, G. D., Henius, J., Kabat, M., & Harold Van Houtven, C. (2019). Invisible partners in care: Snapshot of well‐being among caregivers receiving comprehensive support from Veterans Affairs. Health Science Reports, 2(3). https://doi.org/10.1002/hsr2.112
Ohl, M. E., Carrell, M., Thurman, A., Weg, M. Vander, Pharm, T. H., Mengeling, M., & Vaughan-Sarrazin, M. (2018). Availability of healthcare providers for rural veterans eligible for purchased care under the veterans choice act. BMC Health Services Research, 18(1). https://doi.org/10.1186/s12913-018-3108-8
Preston, S. L. (2018). Veterans’ affairs and department of defense integrated systems of mental health care. In L. Weiss Roberts & C. H. Warner (Eds.), Military and veteran mental health (pp. 97-115). Springer.
RAND Health. (n.d.). Balancing demand and supply for veterans’ health care. https://doi.org/10.7249/rr1165.4
Richardson, L. K., Frueh, B. C., & Acierno, R. (2010). Prevalence estimates of combat-related post-traumatic stress disorder: Critical review. Australian and New Zealand Journal of Psychiatry, 44(1), 4-19. https://doi.org/10.3109/00048670903393597
Rugen, K. W., Watts, S. A., Janson, S. L., Angelo, L. A., Nash, M., Zapatka, S. A., Brienza, R., Gilman, S. C., Bowen, J. L., & Saxe, J. A. M. (2014). Veteran Affairs centers of excellence in primary care education: Transforming nurse practitioner education. Nursing Outlook, 62(2), 78-88. https://doi.org/10.1016/j.outlook.2013.11.004
Sullivan, J. L., Adjognon, O. L., Engle, R. L., Shin, M. H., Afable, M. K., Rudin, W., White, B., Shay, K., & Lukas, C. V. D. (2018). Identifying and overcoming implementation challenges: Experience of 59 noninstitutional long-term services and support pilot programs in the Veterans Health Administration. Health Care Management Review, 43(3), 193-205. https://doi.org/10.1097/HMR.0000000000000152
US Government Accountability Office. (2019). Managing risks and improving VA health care. https://www.gao.gov/key_issues/managing_risks_improving_va_health_care/issue_summary
Way, D., Ersek, M., Montagnini, M., Nathan, S., Perry, S. A., Dale, H., Savage, J. L., Luhrs, C. A., Shreve, S. T., & Jones, C. A. (2019). Top ten tips palliative care providers should know about caring for veterans. Journal of Palliative Medicine, 22(6), 708-713. https://doi.org/10.1089/jpm.2019.0190
York, J. A., Lamis, D. A., Pope, C. A., & Egede, L. E. (2013). Veteran-specific suicide prevention. Psychiatric Quarterly, 84(2), 219-238. https://doi.org/10.1007/s11126-012-9241-3