Service Veterans Research Articles

Screening, brief intervention, and referral to treatment for pain management for veterans separating from military service: study protocol of a hybrid type 2 study testing implementation facilitation versus training-as-usual.

Veterans transitioning to civilian life often have chronic pain from service-related musculoskeletal disorders (MSD) with higher risk for substance misuse. Many seek VA (Department of Veterans Affairs) compensation for MSD. Use of Screening, Brief Intervention, and Referral to Treatment for Pain Management (SBIRT-PM) by VA Post-9/11 Military2VA (M2VA) case managers presents an opportunity to engage these veterans in VA pain care and address substance misuse. Implementation facilitation might help case managers use SBIRT-PM and engage veterans in services to improve outcomes. This study is a 2-cohort multisite cluster-randomized hybrid type 2 effectiveness-implementation trial. Within 2 separate cohorts of 14 VA sites each, sites will be allocated to receive an implementation strategy through the use of a constrained randomization procedure: virtual implementation facilitation or training-as-usual. Sites and M2VA case managers will receive the assigned implementation strategy to support use of SBIRT-PM. Recently discharged veterans (n = 1848) claiming service-connected MSD will be recruited, with case managers blind to veterans' study enrollment. The proportion of participants who receive any SBIRT-PM will be the primary implementation outcome. Veteran participants will complete baseline, 12-week, and 36-week assessments, irrespective of whether case managers conduct SBIRT-PM with them (intent-to-treat). Pain intensity and interference will be the primary clinical outcomes. The study emphasizes pragmatic over explanatory methodological features. This pragmatic trial will examine implementation facilitation versus training-as-usual in implementing SBIRT-PM to promote veteran engagement in nonpharmacological pain services. Using innovative methods to train and support VA case managers in SBIRT-PM, study outcomes could have broad implications for case management systems of care across the VA.

Feasibility, acceptability, and initial outcomes of a psychological adjustment and reintegration program for transitioned military veterans

BackgroundReintegration and adjustment to civilian life after military service is crucial for veterans’ mental and physical health. However, there is a lack of evidence-based interventions in Australia that specifically address the psychological and cultural factors associated with improved adjustment and mental health in this group. The aim of this study was to evaluate the feasibility, acceptability, and initial outcomes of a novel group intervention program, developed to address this gap in supports and services for Australian veterans.MethodsA non-controlled, within-subjects longitudinal design was employed with a feasibility framework including assessment of demand, implementation, integration, experience, perceived effectiveness, and burden or discomfort. The program included eight weekly 2.5-hour group sessions using cognitive-behavioural and acceptance and commitment therapy techniques. Participants included 24 transitioned veterans who completed the Military-Civilian Adjustment and Reintegration Measure, Quality of Life Enjoyment and Satisfaction Questionnaire–Short Form, Depression Anxiety Stress Scale-21, and PTSD Checklist for DSM-5 at pre-intervention, post-intervention, and three-month follow-up.ResultsHigh participant ratings of engagement, experience and usefulness of the program were found, as well as perceived improvement in adjustment to civilian life as a result of the program. Sound program retention (82.8%), completion (87.5%), and manual adherence rates (89.6%) were also found. Significant improvements were found in adjustment and reintegration scores from pre-intervention to post-intervention (p = < 0.001) and from pre-intervention to follow-up (p = < 0.05), with large effect size (ηp2 = 0.344). All participants who completed the program reported they would recommend the program to another veteran.ConclusionThis study demonstrated the feasibility and acceptability of a novel group intervention program designed for military veterans in Australia. The program showed promising initial evidence of effectiveness in improving adjustment and reintegration to civilian life and provides an essential first step towards addressing a substantial gap in services for veterans struggling to adjust to civilian life. A randomised controlled trial may be an appropriate next step.ANZCTR registration numberACTRN12622000172707.Date of registration02/02/2022.Type of registrationRetrospectively registered.

Forgotten Victims of War: A Rapid Review of Counseling Needs and a Proposed Intervention Model for Civilian Survivors

The counseling needs of civilian war victims, particularly those not classified as refugees, have been largely neglected in academic counseling research. This study addresses this gap by conducting a rapid literature review to evaluate the current state of counseling services available to these individuals. Using Google Scholar and Web of Science, we identified and reviewed studies on counseling services for war veterans, refugees, and civilians in conflict zones. This review revealed a significant lack of structured counseling support for non-refugee civilian war victims, despite their high vulnerability. Findings indicate that while substantial efforts have been made to support refugees and veterans, the mental health needs of civilians who remain in conflict areas are often unmet, with existing services being sparse and inadequately documented. To address this issue, we propose a preliminary model that includes culturally sensitive counseling programs, training for local counselors, and international collaboration to provide sustainable support. This study highlights the urgent need for focused research and practical interventions to develop comprehensive counseling programs for these overlooked victims of war, and encourages researchers to address this critical gap in mental health services.

Addressing the Complex Needs of Customers Who Contact the Veterans Crisis Line.

Since its creation in 2007, the Veterans Crisis Line (VCL) has provided 24/7, confidential crisis support services for Veterans, Service Members, and their families, supporting the VA's highest clinical priority of suicide prevention. As part of this effort, VCL created the Customers with Complex Needs (CWCN) program to manage the individual needs and operational impact of VCL customers who call at a high frequency, are abusive toward hotline staff, exhibit sexually inappropriate behavior, and/or make threats of violence. This paper describes the VCL CWCN program and customer characteristics. Call data from 2012 to 2022, including operational data for 1,096 CWCN customers identified from October 2017 to December 2020, were used for analysis. At the cohort's peak size in 2020, calls from CWCN customers accounted for 0.4% of all distinct phone numbers received by VCL and for 22.1% of total VCL call volume. Implementation of the CWCN program was associated with significant annual reductions in average individual call volume among high frequency callers. However, no change in call volume was observed among nonhigh frequency callers. Formative challenges and future directions for the CWCN program and implications for other crisis lines are discussed.

Predictors of enrollment in a virtual diabetes prevention program among women veterans: a retrospective analysis

BackgroundThe Diabetes Prevention Program (DPP) is a nationally disseminated lifestyle intervention shown to prevent type 2 diabetes (diabetes). However, enrollment in the program remains variable. We sought to identify patient characteristics associated with enrollment in a virtual DPP program among women Veterans to inform ongoing diabetes prevention efforts.MethodsWe conducted a retrospective analysis of 2021–2024 Department of Veterans Affairs (VA) data collected through the VA Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER) 2.0 Program, an effectiveness-implementation trial to expand access to preventative health services for women Veterans. We included women meeting DPP eligibility criteria (BMI ≥ 25 kg/m2 [or ≥ 23 if Asian] with ≥ 1 risk factor for diabetes [e.g., prediabetes]) who received care at six VA sites implementing virtual DPP. We used logistic regression to examine the association between DPP enrollment and prior use of VA preventive services for weight management or diabetes prevention including the VA MOVE! clinic, Whole Health visits, nutrition visits, weight loss medications, and/or metformin. We adjusted for sociodemographic factors, comorbidities, number of DPP recruitment contacts, and site.ResultsA total of 1473 women Veterans received DPP outreach. On average, their age was 53 years (range 20–96), BMI 34 kg/m2, HbA1c 5.9%, 0.7% were Asian, 44% Black, 2% Hispanic, and 44% White. In our adjusted models, prior use of VA preventative services was not significantly associated with DPP enrollment. Younger women (OR:0.97, p = 0.002) and those who received more recruitment contacts (OR:2.63, p < 0.001), were significantly more likely to enroll in DPP. Women with housing instability were significantly less likely to enroll (OR:0.44, p = 0.029).ConclusionsWe found no difference in women Veterans’ enrollment in DPP based on prior use of VA weight management and prevention services. Frequency of outreach by VA sites may increase engagement in lifestyle interventions. Virtual DPP may support engagement in preventive lifestyle interventions for diverse groups of women Veterans, as a first program or as a complement to other VA services.Trial registrationClinicalTrials.gov, NCT05050266. Registered on 20 September 2021.

Role of homelessness and psychiatric disorders in suicide deaths among veterans: A four-way decomposition analysis

Homelessness and suicide are top priorities in the U.S. Department of Veterans Affairs (VA). This study examined the various pathways involving homelessness, substance use, and mental health disorders in relation to suicide deaths among veterans in the VA healthcare system. A retrospective cohort study was conducted among 6,128,921 veterans—399,125 homeless and 5,729,796 non-homeless—followed-up between 2017 and 2021 using VA/Department of Defense linked databases. Multivariable Cox regression was applied for homelessness and psychiatric disorders as predictor of suicide deaths, sequentially controlling for demographic, clinical, substance use, and mental health characteristics. Four-way decomposition analysis was used to calculate proportions of suicide deaths mediated and/or moderated by homelessness, substance use, and mental health disorders. The relationship between homelessness and suicide-specific mortality risk was reduced from 40 % greater risk in unadjusted to 9 % greater risk in fully-adjusted models. Nearly 26 % of the total effect of homelessness on suicide-specific mortality risk was mediated by substance use disorders, whereas 49 % was mediated and 36 % was moderated by mental health disorders. In conclusion, excess suicide-specific mortality risk in homeless veterans is partly explained by substance use and mental health disorders, highlighting the importance of wrap-around health and social services for homeless veterans in mitigating suicide risk.

Natural Language Processing Methods Application in Defense Budget Analysis

Abstract Transferring to economy 5.0 makes a great emphasis on Artificial Intelligence technologies implementation in civil and military areas. The aim of the article is to model relation between the Ukrainian Ministry of Defense budget programs and strategic goals and tasks. The classical budget analysis methodology is extended with NLP technics. The analysis is performed for defense budget program 2101020 - Ensuring the activities of the Armed Forces of Ukraine, training of personnel and troops, medical support of personnel, military service veterans and their family members, and war veterans. Either TF-IDF or more advanced NLP methods are used along with Python libraries and packages. It is found that some goals intersect with each other by semantic similarity. Despite the lack of data, we build proof of concept machine learning model and proved its effectiveness.

A rapid review of the barriers and facilitators of mental health service access among Veterans and their families.

Transitioning to civilian life after military service can be challenging for both Veterans and their families. Accessible mental health services are crucial during this period to provide support. The objective of this review was to conduct a rapid review to capture the barriers and identify facilitators that influence access to mental health services for Veterans and their families during the post-service transition period. This review was conducted using the Cochrane Handbook for Systematic Reviews of Interventions as a methodological framework and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Rapid Review (PRISMA-RR). A total of 60 articles and 67 independent samples were included in the final data analyses. Across the included articles, this review identified 23 barriers and 14 facilitator themes. Issues navigating the mental health care system was identified as the main challenge among Veterans and their families, and those who received support navigating the system identified this as a significant facilitator. Applying the Theoretical Domains Framework, most of the identified barriers and facilitators were categorized into environmental context and resources domain. The heterogeneity in Veterans' and Veteran families' experiences with mental health care-seeking may suggest that access to mental health care for Veterans and Veteran families cannot be solved by addressing one type of barrier alone. Instead, coordinated efforts to address prioritized systemic, logistical, social, and inter-/intrapersonal obstacles are essential for improving access and optimizing mental health care outcomes. These insights underscore the complexity of considerations for Veterans and families accessing mental health care.

Examining the Psychological Measures and Feasibility of Recreational Trail Rides in Reducing Cravings for Addictive Substances among Veterans: A Replication Pilot Study.

Equine-assisted services have been gaining popularity as complementary therapies for a variety of populations with a diversity of diagnoses. Interventions using equines might benefit the military Veteran population through building therapeutic alliance as well as reducing symptoms. This pilot observational study is primarily aimed to investigate safety, feasibility, and acceptability of equine-assisted services for Veterans with substance abuse disorders. It is the second pilot observational study, the first being completed in 2022. Secondary outcomes included recording the impact of trail riding on psychological measures among Veterans at a large Veterans Administration medical center. The study included a total of 32 Veterans who participated in trail riding sessions from May 4, 2022 to August 31, 2022. The study utilized the Positive and Negative Affect Scale, Adult Hope Scale, and Craving Experience Questionnaire to assess changes in positive affect, negative affect, hope components, and substance craving. The results indicated significant reductions in negative affect and substance craving after the first session, with positive effects observed in subsequent sessions. However, demographic and diagnostic variables did not predict significant changes in psychological instruments. Overall, the study demonstrated that trail riding was a safe and feasible intervention and may have potential benefits for improving emotional well-being and reducing substance cravings among Veterans. It is recommended that future studies research mechanisms of action, as well as conduct more rigorous investigations, including controlled trials using larger sample sizes and longitudinal research, to best determine lasting effects of these types of complementary therapies.

Staff and client preferences for the design and delivery of an outcomes monitoring system in a mental health service.

Outcome monitoring can support the delivery of quality service that meets the needs of clients, clinicians and services. However, few studies have examined client or staff perspectives on the design and implementation of outcomes monitoring within a service. Implementation of outcomes monitoring requires understanding the preferences and expectations of relevant stakeholders. Informed by the Consolidated Framework for Implementation Research, this study aimed to investigate the preferences and priorities of relevant staff, clients and family members to inform the design and implementation of an effective outcomes monitoring system in the context of a mental health service for military veterans and their families. Twenty-nine staff participated across five online focus groups, including clinical staff, peer workers, policy staff and supervisors. Ten clients participated in online or telephone semi-structured interviews. Thematic analysis was used to develop themes from the data. Clients and staff agreed that outcomes monitoring should cover more than symptoms, particularly by incorporating functional outcomes. Assessing mental health over time was considered a valuable tool for supporting treatment processes and providing actionable information. Challenges identified by clients and staff included the need for efficient processes, ensuring measures are relevant and acceptable, and maintaining client privacy. The ability to personalise data collection and have a streamlined, responsive system were key attributes of a quality outcomes monitoring framework. Findings suggest that an effective outcome monitoring framework should be client-led, tailored to the individual's needs, and provide feedback on progress. Outcomes monitoring should also be efficient, accessible and allow for safe information sharing.

Improving primary care access for rural women Veterans: the Boost Team.

To improve healthcare access for rural cisgender women and gender diverse Veterans, we created the "Boost Team," a clinician-driven telehealth outreach service to connect this population to Veterans Health Administration (VHA) services. Between 9/2021 and 2/2022, we conducted a needs assessment in the Veterans Integrated Service Network (VISN) 21 and used those data to develop an outreach intervention. We piloted a clinician-led outreach intervention in 3/2022, and formally deployed an outreach team in 9/2022. The needs assessment uncovered opportunities to educate Veterans, staff, and clinicians about available VHA women's health services, and a need for easily-accessible gender-sensitive services. During the pilot, 58% (7/12) rural cisgender women Veterans were successfully contacted, all reported positive experiences with the intervention. The formal outreach team launched in 9/2022 and consists of a nurse practitioner (NP), scheduler, Peer Support Specialist, and medical director. From 9/2022 to 12/2022 the Boost NP called 110 rural cisgender women and gender diverse Veterans and spoke to 65 (59%) of them. Common care needs identified and addressed included care coordination, new referrals, medication management, and diagnostics. Data from Boost show that clinician-led outreach can engage rural cisgender women and gender diverse Veterans in VHA services, there is a desire for more gender-sensitive services, and there is a need for systems-level improvements to allow for improved care coordination and decreased leakage outside of VHA. Using robust strategies grounded in implementation sciences, we will continue conducting a program evaluation to study the impact of Boost and scale and expand the program.

Use and Cost of Low-Value Services Among Veterans Dually Enrolled in VA and Medicare.

Over half of veterans enrolled in the Veterans Health Administration (VA) are also enrolled in Medicare, potentially increasing their opportunity to receive low-value health services within and outside VA. To characterize the use and cost of low-value services delivered to dually enrolled veterans from VA and Medicare. Retrospective cross-sectional. Veterans enrolled in VA and fee-for-service Medicare (FY 2017-2018). We used VA and Medicare administrative data to identify 29 low-value services across 6 established domains: cancer screening, diagnostic/preventive testing, preoperative testing, imaging, cardiovascular testing, and surgery. We determined the count of low-value services per 100 veterans delivered in VA and Medicare in FY 2018 overall, by domain, and by individual service. We applied standardized estimates to determine each service's cost. Among 1.6 million dually enrolled veterans, the mean age was 73, 97% were men, and 77% were non-Hispanic White. Overall, 63.2 low-value services per 100 veterans were delivered, affecting 32% of veterans; 22.9 services per 100 veterans were delivered in VA and 40.3 services per 100 veterans were delivered in Medicare. The total cost was $226.3 million (M), of which $62.6M was spent in VA and $163.7M in Medicare. The most common low-value service was prostate-specific antigen testing at 17.3 per 100 veterans (VA 55.9%, Medicare 44.1%). The costliest low-value service was percutaneous coronary intervention (VA $10.1M, Medicare $32.8M). Nearly 1 in 3 dually enrolled veterans received a low-value service in FY18, with twice as many low-value services delivered in Medicare vs VA. Interventions to reduce low-value services for veterans should consider their substantial use of such services in Medicare.

Barriers to accessing care among rural women veterans: A qualitative study with veterans, peer specialists, and primary care professionals.

Rural women veterans are less likely than men and nonrural veterans to access Veterans Health Administration (VHA) care. This qualitative study describes rural women veterans' barriers to accessing care and explores whether participants viewed a peer specialist intervention as having the potential to facilitate access to care. We recruited rural veterans who identified as women with psychological distress and social needs, women peer specialists, and VHA primary care professionals working with rural veterans. We conducted two veteran focus groups, two peer specialist focus groups, and 11 individual Patient Aligned Care Team professional interviews using semistructured interview questions. One of the veteran focus groups was exclusive to veterans of color. We used a rapid qualitative data analysis approach to analyze the results. Data analysis revealed barriers affecting perceived access to services for rural women veterans, especially veterans of color, including transportation, finances, childcare, long travel distance to clinics, lack of access to gender-specific services, ineligibility for services, and lacking information about available resources. Participants also reported challenges accessing community services outside of the VHA. The rural women veterans reported a strong preference for gender-specific services. Leveraging existing VHA resources with rural women veterans may mitigate some of the identified barriers. In particular, participants agreed that increasing availability of peer specialists who are both women and veterans could bridge some perceived barriers to accessing care among rural women veterans. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Visualizing veterans’ care: Understanding the breadth of older veterans’ paid and family support network and implications for cancer care in the older adult population.

e13777 Background: Many older adults rely on a complex network of paid and unpaid caregivers to age safely at home. Strong social networks have been long associated with improved cancer treatment outcomes in older adults. Yet medical records often only capture a primary family caregiver, and assessing support networks has not been a routine part of the equation in cancer treatment planning. We tested a novel visual tool, care mapping, with older veterans to better understand the scope of their caregiving networks. Methods: We created collaborative care maps with 10 dyads/triads of veterans and their primary paid and family caregivers receiving care at a large, urban, Veterans Health Administration medical center. Veterans were age 65+ and eligible for VA-paid home care. 50% of the veteran cohort had a cancer diagnosis. We compared the maps to veterans’ electronic medical records (EMRs) and assessed care network structure, function and adequacy. Results: For most veterans, care maps identified a larger number of care partners than EMRs alone. Functional, medical, socioemotional and spiritual supports included family, paid aides, neighbors, veteran service organizations and community groups. Unmet needs included inadequate home health workers to assist with functional decline associated with malignancy diagnosis. Veterans and caregivers largely described their networks as adequate, but mapping conversations surfaced a need for contingency care plans to relieve caregiver strain or if a caregiver could no longer provide support. Conclusions: Cancer care in older adults requires a broad, comprehensive approach and innovative ways to identify caregiver support. Such collaborative care maps can impact clinical outcomes by ensuring treatment adherence and symptom surveillance.

Examining the outcomes and acceptability of a peer-led spiritual intervention for moral injury in a veteran service organization.

The purpose of this proof-of-concept study was to examine the outcomes and acceptability of a spiritual intervention for moral injury led by veteran peers in a Veteran Service Organization (VSO), called "Heroes to Heroes." From baseline to 1-year follow-up, 101 veterans who participated in the intervention completed the evaluation surveys at four time points assessing psychological outcomes (moral injury, posttraumatic stress disorder [PTSD] symptoms, and life satisfaction), spiritual outcomes (spiritual struggles and spiritual transcendence), and their perceived helpfulness of the program. In addition, we conducted four focus groups with six to eight alumni to more fully understand veterans' views and experiences of the program. Focusing on the longitudinal surveys, latent growth modeling analyses revealed veterans generally improved across the psychological and spiritual outcomes in the study. Specifically, veterans reported steady decreases in moral injury outcomes, PTSD symptoms, and spiritual struggles along with increased life satisfaction and spiritual transcendence over the 1-year period. An inductive content analysis of veterans' responses to open-ended items in the surveys and focus group interviews revealed four possible mechanisms or facilitators of these outcomes: (a) social connectivity and belonging (e.g., shared vulnerability and camaraderie); (b) behavioral engagement in core aspects of their spirituality (e.g., sacred practices and visiting sacred places); (c) spiritual transformation and growth (e.g., closeness with God and divine forgiveness); and (d) appreciation for diversity (e.g., religious and military). Overall, these findings affirm the potential effectiveness and acceptability of the VSO's peer-led spiritual intervention for promoting the holistic healing among veterans who are contending with emotional and spiritual wounds of war. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Legal Services for Veterans (LSV): Protocol for evaluating the grant-based LSV initiative supporting community organizations' delivery of legal services to veterans.

1.8 million Veterans are estimated to need legal services, such as for housing eviction prevention, discharge upgrades, and state and federal Veterans benefits. While having one's legal needs met is known to improve one's health and its social determinants, many Veterans' legal needs remain unmet. Public Law 116-315 enacted in 2021 authorizes VA to fund legal services for Veterans (LSV) by awarding grants to legal service providers including nonprofit organizations and law schools' legal assistance programs. This congressionally mandated LSV initiative will award grants to about 75 competitively selected entities providing legal services. This paper describes the protocol for evaluating the initiative. The evaluation will fulfill congressional reporting requirements, and inform continued implementation and sustainment of LSV over time. Our protocol calls for a prospective, mixed-methods observational study with a repeated measures design, aligning to the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) and Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) frameworks. In 2023, competitively selected legal services-providing organizations will be awarded grants to implement LSV. The primary outcome will be the number of Veterans served by LSV in the 12 months after the awarding of the grant. The evaluation has three Aims. Aim 1 will focus on measuring primary and secondary LSV implementation outcomes aligned to RE-AIM. Aim 2 will apply the mixed quantitative-qualitative Matrixed Multiple Case Study method to identify patterns in implementation barriers, enablers, and other i-PARIHS-aligned factors that relate to observed outcomes. Aim 3 involves a mixed-methods economic evaluation to understand the costs and benefits of LSV implementation. The LSV initiative is a new program that VA is implementing to help Veterans who need legal assistance. To optimize ongoing and future implementation of this program, it is important to rigorously evaluate LSV's outcomes, barriers and enablers, and costs and benefits. We have outlined the protocol for such an evaluation, which will lead to recommending strategies and resource allocation for VA's LSV implementation.

A sex-disaggregated analysis of rank at release and health outcomes among Veterans of the Canadian Armed Forces

LAY SUMMARY This study examines relationships between military rank at release and various health indicators among Canadian Veterans, separately for males and females. These results provide new information about Veterans at greater risk of negative health outcomes, which could be used for targeted military health promotion as well as Veteran outreach and service delivery planning.

Department of Veterans Affairs Healthcare Provider Perceptions of Confidence Following a Wheelchair/Adaptive Tai Chi Chuan Training

The changing needs of our nation’s military veterans call for a change in the healthcare system delivery models providing their primary sources of care. The VA Healthcare System has incorporated a whole health movement emphasizing individualized approaches to healthcare by encouraging complementary and integrative programs. Wheelchair/Adaptive Tai Chi Chuan (W/A/TCC) is such program offering a transformative opportunity to programmatically enhance veteran healthcare services by enhancing the training of VA healthcare providers. This article explores the impacts of a 7-posture W/A TCC instructional training program for healthcare providers that has been facilitated throughout the VA healthcare system since 2016. The purpose is to better understand the impact this training has on healthcare providers, including Recreational Therapists (RTs). A mixed-methods design exploring participant perspectives showed increased confidence levels following training in several key areas and no statistically significant differences between RTs compared to all other healthcare providers. Meaningful impacts described by participants are explored. Overall discussion focuses on this specific training program’s unique applicability for directly influencing VA healthcare providers and the veterans being served. Overall results offer support for wheelchair/adaptive tai chi chuan training as one strategy that can be utilized to increase the success of holistic veteran healthcare.

Exploring the value of a structured trauma-pathway in improving traumainformed care within a Veterans’ High Intensity Service

IntroductionThe value of using trauma-informed approaches in the way services and systems deliver care is well recognised. This evaluation aimed to consider the value of using a structured ‘trauma pathway’ to improve trauma informed care within a veterans’ high intensity service.MethodA mixed-methods design was employed. Practitioners completed questionnaires via an online platform and also attended a focus group to share their views. Qualitative data were analysed using inductive thematic analysis.ResultsA total of 14 team members were eligible to take part. 14 submitted Pre data, and 8 submitted Post data. There were significant differences between pre and post data relating to consideration of trauma-informed care, and confidence in trauma assessment and intervention skills. However, levels of significance were not met for the differences in confidence around identifying pathways of care. From analysis of the qualitative data three main themes were identified 1) Quality of care and Trauma focus, 2) Practitioner experience and 3) Veteran Experience which are explored within the discussion.ConclusionsThe use of a structured pathway improved the delivery of a trauma-informed care approach within a high intensity service for veterans, with positive changes in both practitioner and veteran experiences

Data resource profile: nutrition data in the VA million veteran program.

The Department of Veterans Affairs (VA) Million Veteran Program (MVP) nutrition data is derived from dietary food/beverage intake information collected through a semiquantitative food frequency questionnaire (SFFQ). Estimates of dietary energy, nutrient, and non-nutritive food components intakes data were derived from an extensively validated SFFQ, which assessed the habitual frequency of consumption of 61 food items, added sugar, fried food frequency, and 21 nutritional supplements over the 12 months preceding questionnaire administration. Complete nutrition data was available for 353,418 MVP participants as of 30th September 2021. Overall, 91.5% of MVP participants with nutrition data were male with an average age of 65.7 years at enrollment. Participants who completed the SFFQ were primarily White (82.5%), and Blacks accounted for 13.2% of the responders. Mean ± SD energy intake for 353, 418 MVP participants was 1428 ± 616 kcal/day, which was 1434 ± 617 kcal/day for males and 1364 ± 601 kcal/day for females. Energy intake and information on 322 nutrients and non-nutritive food components is available through contact with MVP for research collaborations at www.research.va.gov/mvp. The energy and nutrient data derived from MVP SFFQ are an invaluable resource for Veteran health and research. In conjunction with the MVP Lifestyle Survey, electronic health records, and genomic data, MVP nutrition data may be used to assess nutritional status and related risk factors, disease prevalence, and determinants of health that can provide scientific support for the development of evidence-based public health policy and health promotion programs and services for Veterans and general population.