Impact of the Hurricanes on Veterans with Mental Illness and Substance Abuse

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Impact of the Hurricanes on Veterans with Mental
Illness and SubstanceAbuse

• A Market Study on Service Utilization and Unmeet
  Needs

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Hurricanes Katrina and Rita

• More than 1700 persons died
• Billions of dollars of damage occurred
• VISN 16- New Orleans and Biloxi severely
  affected.

3
Before the Hurricanes New Orleans and Biloxi VA
Hospitals

• Served more than 88,000 veterans in FY 2004
• More than one in five veterans had a primary
  diagnosis of mental illness or substance abuse.
• New Orleans VAMC hospital is no longer functional
• Psychiatric division of the Biloxi VA (Gulfport
  Division) was completely destroyed.

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What happened to mentally illveterans in this
area?

• How many veterans with MI and SA died in the
  hurricane
• How many lost their homes, caregivers, or
  significant others
• Where they are currently living and under what
  circumstances
• Are they receiving MH care
• What are their current needs

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Study Members

• Principal Investigator Greer Sullivan, MD
• Co-Investigators
• Ellen Fischer, PhD
• Dean Blevins, PhD
• Mary S. Farmer, PhD Candidate
• Project Director Kristin Ward, MS
• VA Database Managers
• Teresa Hudson, PhD
• Rick Owen, MD
• Survey Development
• Dana Perry, MS

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Study Goals

• 1) Determine the current location of veterans
  with MI and SA diagnosis who were previously
  being served at the Gulf Coast Facilities.
• 2) Conduct a service utilization survey and
  needs assessment of a sub-sample of this group of
  veterans.

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Overview of the Study

• Telephone survey
• Experiences during after hurricanes
• Current health / mental health functioning
• Health beliefs
• Service use since the hurricanes
• Barriers to care
• 200 participants with pre-existing mental illness
  and/or substance abuse

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Participants

• 200 veterans aged 18 and over as of 8/29/05
• Received services at NO or Biloxi VAMC.
• Resided in affected area at time of hurricanes
• Mental health clinic between August 2004 and
  August 2005

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Methodology Goal I

• VA database to identify NO and Biloxi MI veterans
  who are currently receiving
• Services at NO or Biloxi
• Services at other VISN 16 healthcare facilities
• No VA services since the hurricane

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Methodology Goal IISubgroups

• Input to identify subgroups to include in the
  survey came from
• 1) Mental health QUERI
• 2) Substance abuse OUERI
• 3) SCVAHCN Mental Health Product line
• 4) Little Rock HSRD

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Methodology Goal IISubgroups

• Goal I Categories selected
• (1)  Serious Mental Illness (SMI) with ICD-9
  codes 295-298.
• (2) Methadone maintenance patients
• (3) Pre-existing PTSD patients
• (4) Participation in an inpatient or outpatient
  alcohol program.

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Methodology Goal II Purposeful Sample of the
Data Set

• Stratified purposeful sampling Illustrate
  characteristics of particular subgroups of
  interest
• Within the four identified groups Random
  purposeful sampling
• Approximately 200 respondents

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Survey Development

• Demographic Information
• Age, sex, ethnicity, marital status, education
• Employment/Income
• Status at time of Katrina, current status,
  changes
• Household Information
• Living situation pre-hurricanes and now

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Survey Development

• Katrina Trauma Severity
• Stressful events experienced
• Traumas during storm aftermath
• Alcohol and Drug Use
• Rand Houston Homeless Study Alcohol and Drug Use
  questions pre-Hurricane and now

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Survey Development

• Health Beliefs
• The Brief Illness Perception Questionnaire.
  (Broadbent, E., Petrie, K., Main, J., Weinman,
  J. , June 2006)
• Barriers to Care
• A Questionnaire for Assessing Barriers to
  Healthcare Utilization Part I (W. Pichert and
  Vanessa Jones Briscoe, 1997)

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Survey Development

• Physical Health
• SF-12 Health Survey
• Unmet Needs
• Rand San Diego SMI-HIV Study Unmeet Needs
  Section
• Service Utilization
• Rand Houston Homeless Study Service Utilization
  Study

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Methodology Goal II Pilot Survey

• Pilot study in March to test for
• Acceptability
• Feasibility
• Possible flaws.

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Methodology Goal II Interview Procedures

• Initial letters of introduction with an
  accompanying information sheet provides an
  opt-out postcard. This will precede phone
  contact by 2-3 weeks
• During the telephone call oral consent obtained
• The interviews, which are in-depth and structured
  with some open response items, will last
  approximately one hour
• All participants will receive monetary
  compensation of 25

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Security Issues

• New VA security directives
• New requirements for storing any identified data
  anywhere outside the VA
• Veterans names, addresses and SSNs may reside
  only on VA servers.
• The programmer for CATI and the management
  database will be provided a VA computer at our LR
  location.

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Timeline
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Final Thoughts

• These respondents will be located all over VISN
  16, so your patients could be contacted.
• If you have any questions contact
• Mary S. Farmer 501-257-1105
• Kristin Ward Project Coordinator 501-257-1236