Publication year
2012
Citation Title
Provider, veteran, and family perspectives on family education in Veterans Affairs community-based outpatient facilities.
Journal Name
Psychological Services
Journal Volume
9
Issue Number
1
Page Numbers
89-100
DOI
10.1037/a0027103
Summary
Focus group and interview data were utilized to examine perceptions of the benefits, feasibility, barriers and logistical considerations of implementing a family education program (SAFE: Support And Family Education) in rural outpatient clinics (CBOCs). The SAFE program focuses on the understanding of mental illness/posttraumatic stress disorder (PTSD) and coping strategies. Results indicate that although logistical concerns (e.g., childcare) and lack of training were seen as barriers, Veterans, their family members (spouses or parents), and service providers (psychologists or social workers) endorsed family education programs.
Key Findings
Veterans, their family members, and service providers all strongly endorsed education programs for family members of Veterans with mental illness/PTSD.
Family members and Veterans stressed the importance of programs to help children and adolescents understand mental illness. They identified the lack of child care, travel cost, time commitment, and Veterans fear of disclosure by family members as barriers to participation in family programs.
Service providers expressed a need for more training in family education and the need for administrative support in order to implement family programs (i.e., scheduled time for training and facilities to hold meetings).
Implications for Program Leaders
Offer online or telephone-based programming to meet the needs of military families living in rural communities
Provide education to military children and adolescents about mental health issues Service members may experience
Offer concurrent groups for children and for Service members and families to provide more family-geared programming
Implications for Policy Makers
Recommend that service providers working with military families receive additional training before implementing family education programs
Continue to support research focused on evaluating the effectiveness of family education programs for military families
Continue to support childcare services to help remove some barriers to participation in services and programs.
Methods
Semi-structured interviews were conducted in the context of separate focus groups with Veterans and their family members. Individual interviews were conducted with service providers.
Service providers were purposely selected from two CBOCs affiliated with the Oklahoma City VAMC, and Veterans and family members were recruited from three sites CBOCs of the VAMC.
To be eligible, Veterans had to have a mental health diagnosis, be receiving mental health services, live 90 miles from Oklahoma City, and have a family member willing to participate in the study.
Participants
The participants in the study included 26 Veterans and 23 family members (20 wives or live in female partners, one husband, one parent, one adult child).
Both Veterans and family members were mostly middle-aged (69% between the ages of 50 and 69 years) and White (69%). The majority of Veterans were male (96%) and the majority of family members were female (96%).
Service providers including one psychiatrist, one psychologist, two social workers, and a licensed practical nurse.
Limitations
Veterans who participated were primarily from the Vietnam-era; younger Service members may have different barriers to seeking services.
Lack of diversity in the participants may affect how the findings apply to other groups who may differ in their perceived benefits and barriers to family services.
Researcher subjectivity may have influenced the findings (i.e. the primary researcher of this study was also the person who developed the SAFE program that was evaluated).
Avenues for Future Research
Conduct a similar study with Veterans from more recent conflicts (i.e., Iraq and Afghanistan) as they may differ due to their age and family composition (i.e., have more minor children at home)
Assess family education needs of Service members and their families who are not currently receiving mental health services
Continue to evaluate the effectiveness of family education programs, like SAFE, with military families
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
The Veterans Affairs (VA) healthcare system is dedicated to providing high-quality mental health services to all veterans, including the nearly 40% of enrolled veterans living in rural areas. Family education programs regarding mental illness and posttraumatic stress disorder, mandated for delivery in all VA medical centers and some community-based outpatient clinics (CBOCs), have been developed and provided primarily in large, urban medical centers. This qualitative investigation involved interviews with CBOC providers and veterans and families who live in rural areas and/or seek care in CBOCs to ascertain their perceptions of the benefits, feasibility, structural and cultural barriers, and logistical preferences regarding family education. The perspectives and concerns that emerged in these interviews were combined with expert knowledge to identify the resources and considerations a VAMC would want to address when translating and implementing similar programming into CBOCs. Although institutional, logistic, and attitudinal challenges were described, all three stakeholder groups endorsed the need for family education, did not see the barriers as insurmountable, and provided creative solutions. Administrators and CBOC clinicians may benefit by anticipating and problem solving around the key issues raised when developing family programming.
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