Partnership building for scale-up in the Veteran Sponsorship Initiative: Strategies for harnessing collaboration to accelerate impact in suicide prevention.

OBJECTIVE: To evaluate the implementation and trust-building strategies associated with successful partnership formation in scale-up of the Veteran Sponsorship Initiative (VSI), an evidence-based suicide prevention intervention enhancing connection to U.S. Department of Veterans Affairs (VA) and other resources during the military-to-civilian transition period. DATA SOURCES AND STUDY SETTING: Scaling VSI nationally required establishing partnerships across VA, the U.S. Department of Defense (DoD), and diverse public and private Veteran-serving organizations. We assessed partnerships formalized with a signed memorandum during pre- and early implementation periods (October 2020-October 2022). To capture implementation activities, we conducted 39 periodic reflections with implementation team members over the same period. STUDY DESIGN: We conducted a qualitative case study evaluating the number of formalized VSI partnerships alongside directed qualitative content analysis of periodic reflections data using Atlas.ti 22.0. DATA COLLECTION/EXTRACTION METHODS: We first independently coded reflections for implementation strategies, following the Expert Recommendations for Implementing Change (ERIC) taxonomy, and for trust-building strategies, following the Theoretical Model for Trusting Relationships and Implementation; a second round of inductive coding explored emergent themes associated with partnership formation. PRINCIPAL FINDINGS: During this period, VSI established 12 active partnerships with public and non-profit agencies. The VSI team reported using 35 ERIC implementation strategies, including building a coalition and developing educational and procedural documents, and trust-building strategies including demonstrating competence and credibility, frequent interactions, and responsiveness. Cultural competence in navigating DoD and VA and accepting and persisting through conflict also appeared to support scale-up. CONCLUSIONS: VSI's partnership-formation efforts leveraged a variety of implementation strategies, particularly around strengthening stakeholder interrelationships and refining procedures for coordination and communication. VSI implementation activities were further characterized by an intentional focus on trust-building over time. VSI's rapid scale-up highlights the value of partnership formation for achieving coordinated interventions to address complex problems.

Veteran participation in the integrative health and wellness program: Impact on self-reported mental and physical health outcomes.

Complementary and integrative health (CIH) services are being used more widely across the nation, including in both military and veteran hospital settings. Literature suggests that a variety of CIH services show promise in treating a wide range of physical and mental health disorders. Notably, the Department of Veterans Affairs is implementing CIH services within the context of a health care transformation, changing from disease based health care to a personalized, proactive, patient-centered approach where the veteran, not the disease, is at the center of care. This study examines self-reported physical and mental health outcomes associated with participation in the Integrative Health and Wellness Program, a comprehensive CIH program at the Washington DC VA Medical Center and one of the first wellbeing programs of its kind within the VA system. Using a prospective cohort design, veterans enrolled in the Integrative Health and Wellness Program filled out self-report measures of physical and mental health throughout program participation, including at enrollment, 12 weeks, and 6 months. Analyses revealed that veterans reported significant improvements in their most salient symptoms of concern (primarily pain or mental health symptoms), physical quality of life, wellbeing, and ability to participate in valued activities at follow-up assessments. These results illustrate the potential of CIH services, provided within a comprehensive clinic focused on wellbeing not disease, to improve self-reported health, wellbeing, and quality of life in a veteran population. Additionally, data support recent VA initiatives to increase the range of CIH services available and the continued growth of wellbeing programs within VA settings. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Integrative Health and Wellness Program: Development and Use of a Complementary and Alternative Medicine Clinic for Veterans.

CONTEXT: A movement exists within the Veterans Health Administration (VHA) toward incorporating complementary and alternative medicine (CAM) as an integrative complement to care for veterans. The Integrative Health and Wellness (IHW) Program is a comprehensive CAM clinic offering services such as integrative restoration (iRest) yoga nidra, individual acupuncture, group auricular acupuncture, chair yoga, qigong, and integrative health education. OBJECTIVES: The current study intended to detail the development of the CAM program, its use, and the characteristics of the program's participants. DESIGN: Using a prospective cohort design, this pilot study tracked service use and aspects of physical and mental health for veterans enrolled in the program. PARTICIPANTS: During the first year, the IHW Program received 740 consults from hospital clinics; 325 veterans enrolled in the program; and 226 veterans consented to participate in the pilot study. OUTCOME MEASURES: Outcome measures included data from self-report questionnaires and electronic medical records. RESULTS: Veterans enrolled in the program reported clinically significant depression, stress, insomnia, and pain-related interference in daily activities and deficits in health-related quality of life. Regarding use of the program services, individual acupuncture showed the greatest participation by veterans, followed by group auricular acupuncture and iRest yoga nidra. Of the 226 veterans who enrolled in the program and consented to participate in this study, 165 (73.01%) participated in >1 services in the first year of programming. Broadly speaking, enrollment in services appeared to be associated with gender and service branch but not with age or symptom severity. CONCLUSIONS: Results have assisted with a strategic planning process for the IHW Program and have implications for expansion of CAM services within the VHA.

Physical health, mental health, and utilization of complementary and alternative medicine services among Gulf War veterans.

BACKGROUND: Gulf War veterans represent a unique subset of the veteran population. It has been challenging to identify interventions that result in improvements in physical and mental health for this population. Recently, there has been recognition of a potential role for complementary and alternative medicine (CAM) interventions. OBJECTIVES: This paper examines the characteristics of Gulf War and non-Gulf War veterans referred to a CAM clinic, and explores the utilization of services by this population. METHOD AND SUBJECTS: Participants included 226 veterans enrolled in a CAM clinic at a Veterans Affairs medical center, 42 of whom were Gulf War veterans. Self-report measures of physical/mental health were administered, and service utilization was obtained from participants' medical records for a 6-month period. RESULTS: Gulf War veterans enrolled in the program reported more severe physical and mental health symptoms than non-Gulf War veterans. However, examining only veterans who participated in services in the 6 months following enrollment, the 2 groups reported similar symptom severity. Both groups were similar in their attendance of individual acupuncture and iRest yoga nidra, although Gulf War veterans attended fewer sessions of group acupuncture. CONCLUSIONS: Although Gulf War veterans who enroll in a CAM program may have more severe symptoms than non-Gulf War veterans, those who actually participate in services are similar to non-Gulf War veterans on these measures. These groups also differ in their pattern of service utilization. Future research should explore the reasons for these differences, and to identify ways to promote treatment engagement with this population.