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This report identifies factors associated with changes in outcomes for soldiers who received Army behavioral health (BH) specialty care and provides recommendations to improve BH care and outcomes. RAND researchers identified three samples of soldiers who received Army BH care with diagnoses of posttraumatic stress disorder (PTSD), depression, or anxiety and whose symptoms were assessed during their care. Multivariate analyses included 141 patient and treatment variables to identify factors associated with symptom improvement. Analyses also examined patterns in how the symptoms changed over time. Analyses suggest that the Behavioral Health Data Portal, an online system that allows for collection of multiple patient- and clinician-reported measures, is widely used to track symptoms of PTSD, depression, and anxiety, but there are opportunities to expand symptom tracking. Two treatment factors—therapeutic alliance and receipt of benzodiazepines—were associated with treatment outcomes. Specifically, a stronger therapeutic relationship or alliance with providers, as reported by soldiers, was associated with improved PTSD, depression, and anxiety outcomes. Further, receipt of more than a 30-day supply of benzodiazepines was associated with poorer PTSD, depression, and anxiety outcomes. Many soldiers' trajectories of symptom change did not demonstrate improvement. Recommendations include providing feedback and guidance to providers on how to strengthen alliance with their patients, expanding tracking and feedback on benzodiazepine prescribing, and increasing provider use of measurement-based BH care.
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Veterans who have served in the military since September 11, 2001, are at particularly high risk for co-occurring substance use disorders (SUDs) and mental health disorders, such as posttraumatic stress disorder and depression. Many treatment facilities require abstinence from substances prior to admission for mental health care, but the combination of symptoms that these disorders present makes them difficult to treat separately. Thus, integrated care—in which both SUDs and mental health problems are addressed concurrently—is a recommended form of treatment for these veterans. To help improve access to effective treatment for these veterans, the authors review the literature on efficacious approaches to treating SUDs alone and alongside mental health disorders. They also present findings from an analysis of the availability of treatment centers that offer SUD care for veterans and from a series of interviews and site visits with treatment providers. The authors conclude with guidance and recommendations to support the delivery of quality care for veterans with SUDs and, ultimately, to help expand and enhance treatment opportunities for veterans with co-occurring SUDs and mental health disorders.
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Addressing the behavioral health needs of veterans and their families is a national priority. Over the past decade, multiple programs both within and outside of the federal government have been implemented to build additional capacity and expand access to high-quality behavioral health care for veterans and their families. Much of the nongovernmental effort has been funded by private philanthropy in an effort to build and expand public-private partnerships with the Department of Veterans Affairs. In 2012, Northwell Health, a private-sector, nonprofit health system, and the Northport Veterans Affairs Medical Center launched the Unified Behavioral Health Center for Military Veterans and their Families. This unique clinic, located in Bay Shore, New York, provides behavioral health services for both veterans and their family members. In 2014, the RAND Corporation was asked to design and conduct an evaluation of this model to document its structure, process, and outcomes of care in an effort to inform potential replications of this approach. This report presents the findings from this evaluation.
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