Advancing LGBT Health Care Policies and Clinical Care Within a Large Academic Health Care System: A Case Study.

Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.

The psychologist's role in transgender-specific care with U.S. veterans.

Psychologists are integral to the care of transgender individuals. This article details the many roles for psychologists in transgender-specific care, including diagnosing and treating gender dysphoria; providing treatment for comorbid conditions; referring to medical services such as gender confirmation surgeries, voice modification, and cross-sex hormone therapies; serving as consultants within health care systems; and advocating for addressing barriers in systems in which transgender individuals live and work. Transgender veterans have unique experiences and vulnerabilities related to their military service that are detailed from a review of the literature, and we make the case that Veterans Health Administration (VHA) and community psychologists are well-positioned to provide care to transgender veterans (trans-vets). In this article, the authors describe the experiences that many trans-vets have faced, identify the importance of treatment for gender dysphoria (and draw the distinction between gender identity disorder and gender dysphoria) as well as psychologists' roles, and clarify which transgender-related services are available to eligible veterans though VHA per policy and how VHA providers have access to training to provide that care. In addition, we describe how veterans can connect to the VHA, even if they have (and want to continue working with) non-VHA psychologists or other community providers.

Treatment of Women Veterans with Posttraumatic Stress Disorder and Serious Mental Illness in an Inpatient Mental Health Treatment Setting: A Case Study.

This article discusses the challenges of providing treatment for women with complex dual diagnostic mental health needs. In particular, the focus is on the intersections between posttraumatic stress disorder (PTSD), serious mental illness (SMI), female gender, and veteran status. Utilizing a clinical case example, we focus our discussion on psychotherapy goals and interventions, including the advisability of engaging in trauma-focused therapy on an inpatient unit with a patient who carries an SMI diagnosis. We also address benefits and challenges of providing this type of treatment, provider reactions including burnout and diagnostic bias, and recommendations for future care for persons with similar presentations and needs.

Are we there yet? The four-year impact of a VA fellowship program on the recovery orientation of rehabilitation programs.

OBJECTIVE: This study represents the first program evaluation of the impact of a Psychosocial Rehabilitation (PSR) fellowship program within the Veterans Health Administration (VHA). Specifically, it examines the recovery orientation of five mental health rehabilitation programs at the Edith Nourse Rogers Memorial VA Medical Center (ENRM VAMC) in Bedford, MA by comparing program stakeholder rating of the "recovery orientation" between the initial data and the four-year follow-up during which the PSR fellowship was in operation. The goal of this fellowship program is to increase the VHA's fidelity to recovery-oriented best practice recommendations. METHOD: Participants were mental health consumers and staff members within five key psychiatric rehabilitation programs at the ENRM VAMC. Perception of programs' recovery orientation was measured at the start of the fellowship (Time 1) and after the fellowship was in place for four years (Time 2). RESULTS: Results demonstrate that across the entire sample of stakeholders, perceptions of recovery orientation significantly improved from Time 1 to Time 2. Results also reveal a significant overall increase in program recovery orientation over time in three out of the five rehabilitation programs, with years of fellow involvement in particular programs significantly and positively correlating with increases in ratings of program recovery-orientation gains. DISCUSSION: Implications for using fellowships as agents of program change, and specifically, recovery-oriented change, are discussed.