Understanding Community-based Mental Healthcare for Rural Veterans with Military Sexual Trauma

Background/Significance: The 2018 MISSION Act allows Veterans to seek healthcare from non-VHA
providers through the Veterans Community Care Program (VCCP). However, shortages of mental health
providers in over 50% of U.S. rural counties jeopardize access to psychological services in these areas. These
shortages indicate a growing need to bridge gaps in the provision of mental healthcare in rural communities.
The VCCP presents a distinct opportunity for VHA to leverage its relationships with community stakeholders to
develop innovative strategies to improve access to high-quality care for rural Veterans. Guided by the VHA
state-of-the-art access model, this project seeks to understand the current state of VCCP mental healthcare
and build a program that uses community engagement strategies to support community providers in delivering
high-quality care to rural Veterans. This work will initially focus on rural Veterans who have experienced
military sexual trauma (MST). These Veterans represent a high priority, understudied rural Veteran population.
MST exposure is common among Veterans (25-33% of females, 1-3% of males) and associated with high
rates of psychiatric distress and suicide risk. Preliminary data show that, despite equivalent rates of MST
exposure, rural Veterans are less likely to receive psychotherapy than urban Veterans. Research on specific
access barriers and gaps in mental healthcare for rural Veterans with MST is greatly needed.
Innovation: Project innovations include: (1) targeting a high priority rural Veteran population with a history of
MST, (2) obtaining input from Veterans and frontline community providers, and (3) novel use of community
engagement and planning (CEP) to address gaps in rural mental healthcare. CEP is a community-based
participatory research strategy designed to increase the capacity of community providers in delivering
evidence-based care and building a community network of services.
Specific Aims/Methods: Guided by the VHA access model, Aim 1 will use qualitative interviews and
secondary data analysis to examine VCCP mental healthcare for MST. Qualitative interviews with Veterans will
explore perceived accessibility, quality, and satisfaction with this care. A secondary analysis of VHA
administrative and community care data will assess VCCP delivery and access outcomes (e.g., appointment
wait time, session length and duration). Aim 1 data will support an HSR&D IIR proposal by year 3 to conduct
an in-depth evaluation of VCCP delivery of MST-related mental healthcare. These data will also inform
development of the Enhancing Community Care for MST Program in Aims 2 and 3. The proposed program
aims to support VCCP and other community providers in aligning VHA and community resources to increase
delivery of MST-related mental healthcare to rural Veterans. The program will educate community providers
about evidence-based MST-related clinical practices and provide group consultation to facilitate their use of
these practices. Group consultation will also include structured activities to assist providers in developing a
collaborative community network of MST-related services. Aim 3 will pilot the feasibility and acceptability of the
proposed program. Depending on Aim 3 findings, the PI will submit either an HSR&D pilot to refine the
program or a larger research project (e.g., HSR&D IIR, VHA Office of Rural Health demonstration project).
Next Steps: To achieve research aims and facilitate the PI’s transition to an independent VHA health services
researcher, the CDA will provide advanced training in qualitative data analysis, community-engaged research
methods, and program development and evaluation. These training goals will be accomplished through formal
coursework, mentorship, and participation in training workshops, seminars, and conferences. The expertise
gained from training and research activities will allow the PI to execute a line of research that aligns with VHA’s
priorities of access to care/rural access and MISSION Act.

Grant Number: 5IK2HX003347-04
NIH Institute/Center: VA
Principal Investigator: Derrecka Boykin