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BACKGROUND: Mindfulness-based, in-person programs are effective at reducing stress and enhancing resilience in military and civilian samples, yet few studies have examined or compared training offered via real-time, interactive social media. Such a program would have a wider-reach and could include those unable to attend in-person. There is also interest in resolving ambiguity about the effects of mindfulness training on individual difference variables, such as self-compassion. OBJECTIVE: The purpose of this research was to compare pre/post self-compassion for three interventions; Mindfulness-based Stress Reduction delivered in-person (IP), mindfulness meditation training delivered via a Virtual World (VW), and a wait-list Control Group (CG) among active duty and veteran U.S. military. METHODS: A 2 (pre/post)×3 (group) factorial design was conducted with 250 active duty and veteran U.S. Military service members, with self-compassion measures as dependent variables. RESULTS: Self Compassion improved 10% for the IP group and 14% for the VW group, while the CG group did not improve. Combined treatment groups yielded a 10.3% improvement in self-compassion compared with no change in the CG and with a group×time interaction effect (p < 0.01). Participants with lower initial self-compassion experienced greater benefits than those with higher baseline self-compassion (p < 0.01). CONCLUSION: IP and VW Mindfulness Meditation training were equally effective in increasing self-compassion. Adding effective on-line mindfulness delivery will promote self-compassion among a more extensive audience, likely yielding improved coping, confidence, connectedness, cheerfulness, steadiness, and self-satisfaction, while lessening anxiety, fear-of-failure, and stress among participants. [ABSTRACT FROM AUTHOR]

Post-traumatic stress disorder (PTSD) and chronic low back pain (CLBP) are frequently co-morbid. Some research suggests that PTSD and CLBP may share common neurobiological mechanisms related to stress. Traditional biomedical education may be ineffective for PTSD and CLBP, especially when co-morbid. The purpose of this study is to determine if pain neuroscience education (PNE) is more effective than traditional education in reducing PTSD, disability, pain, and maladaptive beliefs in patients with CLBP. Participants with CLBP and possible PTSD/PTSD-symptoms were recruited for this study. Participants were randomly allocated to a PNE group or a traditional education group. The intervention included 30 minutes of education followed by a standardized exercise program once a week for 4-weeks with a 4 and 8-week follow-up and healthcare utilization assessed at 12-months. Forty-eight participants consented for this research study with 39 allocated to treatment (PNE n = 18, traditional n = 21). PNE participants were more likely to achieve a clinically meaningful reduction in PTSD symptoms and disability at short-term follow-up. At 12-months, the PNE group utilized healthcare with 76% lower costs. In participants with CLBP, PNE may reduce hypervigilance toward pain and improve PTSD symptoms. Participants who received PNE were more confident body-tissues were safe to exercise. These beliefs about pain could contribute to a decrease in perceived disability and healthcare consumption for CLBP. [ABSTRACT FROM AUTHOR]

Virtual reality (VR) represents a new way to deliver health interventions, but research is needed on experience and interest in using VR for health among important subgroups in the United States. This descriptive study examined these issues among low-income veterans in the United States. Data were analyzed from a nationally representative sample of 1,028 low-income veterans surveyed in late 2022-early 2023. The results showed that while only 10 percent of the sample had ever used a VR headset, 35 percent of veterans reported they would be "somewhat/very willing" to use VR for mental health or substance use problems. Veterans with higher levels of education (adjusted odds ratio [aOR] = 1.25, 95% confidence interval [CI] = 1.07–1.47), lower mental health functioning (aOR = 0.96, 95% CI = 0.94–0.98), and previous VR experience (aOR = 5.30, 95% CI = 2.96–9.48) were significantly more willing to use VR to treat their mental health or substance use problems. These findings suggest many veterans are willing to use VR to improve their mental health, and they could benefit from greater exposure and education about VR-based interventions. [ABSTRACT FROM AUTHOR]

Current strategies for teaching evacuation methods in private seniors' residences (PSR) and long-term care (LTCH) homes may pose risks to people with disabilities (PWD) and seniors' physical and psychological health. This study aimed to address the following questions: (1) Which are the current fire evacuation learning strategies used with PWD or seniors? (2) What are the barriers and facilitators for PWD and seniors' during fire evacuation and learning strategies in PSR and LTCH? (3) What is the existing equipment that could be used with PWD seniors?. A scoping review of grey and scientific literature was done in six databases and Google scholar. Additional information was found on Québec government websites. This review identified 13 scientific papers and 22 documents. Twenty barriers (personal = 9, environmental = 11), and 14 facilitators (personal = 4, environmental = 10) were extracted. The current fire evacuation learning strategies currently used can be grouped into three categories: drills; training; promotion of a fire safety plan. Six types of evacuation equipment were found; however, their use has been scarcely documented. Safety for seniors during fire evacuation is still an important issue to be improved. Increasing awareness and creating new practices and tools that consider the strengths and difficulties of seniors seems to be a promising avenue for improving evacuation. [ABSTRACT FROM AUTHOR]

US female veterans have higher rates of mental health (MH) disorders compared to US civilian females and, consequently, are at risk for poor MH outcomes during pregnancy. This study evaluated the MH burden and identified the prevalence of antidepressant prescription and discontinuation among pregnant veterans (PGVets). The electronic health records (EHR) of PGVets using the US Veterans Administration's (VA) maternity care benefits over a two-year period were retrospectively reviewed. Inclusion criteria for this study were a current MH diagnosis of depression, anxiety, or posttraumatic stress disorder (PTSD) at the onset of pregnancy (n=351). Outcomes examined included antidepressant use prior to pregnancy, the use and discontinuation of antidepressants during pregnancy, and risk factors for discontinuation. PGVets had a high MH burden, as indicated by multiple comorbid diagnoses of unipolar depression, anxiety, and PTSD in 67% of the sample. At the onset of pregnancy, 163 (46%) were treated with an antidepressant. Only 56 (34%) continued using antidepressants through the pregnancy. Self-discontinuation (34%) and VA provider discontinuation (31%) of antidepressants were found. Among PGVets with documented past suicidal behaviors, 90% discontinued their active antidepressants. PGVets with indicators for more severe MH diagnoses were most likely to discontinue. The MH burden of PGVets and high rates of antidepressant discontinuation have implications for engaging this population in a higher level of perinatal monitoring and intervention. The findings suggest that VA providers and veterans would benefit from risks and benefits education regarding antidepressant use during pregnancy as well as the provision of alternative therapies. [ABSTRACT FROM AUTHOR]

As we have advanced the concept of Whole Health (WH) in the Veterans Administration over the past 10 years, we have had the unique advantage of working in a health care system in which a wide range of WH services—ranging from acupuncture to coaching to yoga and Tai Chi to nutrition classes to peer-facilitated empowerment and skill-building groups—are fully covered by the system as part of standard medical benefits. This has given us the opportunity to evaluate both the process and the outcomes of offering this type of Whole Person care on a system-wide scale. This article will review some of the lessons learned from that ongoing evaluation process in the areas of integration of complementary/integrative health approaches as well as health coaching and peer-led groups, WH education, employee well-being, cost impacts, and whole-system transformation. This is not a systematic review, as we will touch on numerous questions and lessons learned rather than dive deeply into the literature seeking the answer to one narrower question. Hopefully the narrative review approach taken here will stimulate further discussion in the field regarding what we are learning and what we can continue to learn from this large scale innovation. [ABSTRACT FROM AUTHOR]

The prevalence of intimate partner violence (IPV) is higher among Veterans than civilians. The Veteran Health Administration's IPV Assistance Program has been key in rolling out a universal screening tool within the Department of Veterans Affairs (VA) to help identify Veterans who experience IPV; however, treatment options beyond safety planning, resources, and referrals are limited, and those that exist are primarily individual interventions, which may not be preferred or feasible in all settings. This paper describes the development and initial implementation of a new virtual group intervention, the "Windows" program, for women Veterans who have experienced or are experiencing IPV. Windows is based around an eight-week trauma-informed, recovery-oriented therapeutic group curriculum. The group's structure and implementation prioritize group members' safety and the ability to flexibly respond to members' needs. Initial observations and feedback from the first three participants are included, with the goal of informing future directions for the development of services for this population. [ABSTRACT FROM AUTHOR]

This report on a quality improvement initiative describes a multi-professional approach to improving self-care behaviors and reducing hospitalizations in Veterans with heart failure (HF) by implementing virtual group appointments. Patients with HF are more susceptible to complications related to COVID-19 infection, creating the need for alternative communication methods for patient education during the social isolation and reduced health-care resources brought on by the global pandemic. From March 2020 to June 2021, 57 Veterans participated in 1 of 12 group appointments at the VA Portland Health Care System in Portland, Oregon. Each group was led by a multi-professional team who provided education on self-care behaviors, nutrition, medications, and mental health impacts of HF. Chart reviews and pre-/post-self-care behavior questionnaires showed that the virtual group HF appointments were associated with a decrease in hospitalizations, compared to previous data with the same population, and self-reported self-care behaviors improved from pre- to post-questionnaire. Group appointments offer a unique educational and motivational experience for those with HF and provide the ability to engage with each other during challenging times. [ABSTRACT FROM AUTHOR]

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes a feasibility study assessing a multidisciplinary, virtual weight and diabetes management program aimed at high-risk veterans with obesity and diabetes in Milwaukee, WI. [ABSTRACT FROM AUTHOR]

The article shares insight on the convergence of crises in the U.S. including the shortfall of veteran truckers, supply chain disruption and the metabolic syndrome prevalent among truckers. Emphasis is given on the need for structural and policy actions to enhance trucker health, build financial sustainability and improve working conditions. It discusses the importance of advocating metabolic risk mitigation educational programs that promote healthy diet, weight reduction and physical activity.

The Hearing Voices (HV) Movement promotes diverse understandings of voice-hearing and seeing visions, which mental health professionals commonly refer to as 'auditory hallucinations,' 'schizophrenia,' or 'psychosis.' Central to this movement are peer support groups through which attendees connect with others who have similar experiences. This paper describes an adaptation of a Hearing Voices group facilitation training at VA Greater Los Angeles (VAGLA) and discusses training modifications, along with trainee perceptions and implementation and intervention outcomes. This is a first step towards adapting HV-inspired groups to VA systems of care. Data collection involved surveys of trainees (n = 18) and field notes throughout the 24 h online training. Findings indicate high acceptability and appropriateness of the training and high feasibility in implementation, suggesting the training was well-adapted to VAGLA. This research contributes to global efforts to integrate the Hearing Voices approach in diverse settings and increase awareness about its benefits among providers. [ABSTRACT FROM AUTHOR]

Purpose: While rural veterans with trauma exposure report high rates of posttraumatic stress disorder (PTSD), depression, and functional impairment, utilization of health services is low. This pilot study used mixed qualitative and quantitative methods to evaluate the potential benefits of a transdiagnostic web‐based skills training program paired with telehealth‐delivered coaching to address a range of symptoms and functional difficulties. The study directed substantial outreach efforts to women veterans who had experienced military sexual trauma given their growing representation in the Veterans Healthcare Administration (VHA) and identified need for services. Methods: Participants were 32 trauma‐exposed veterans enrolled in rural‐serving VHA facilities who screened positive for either PTSD or depression. Symptoms of PTSD, depression, emotion regulation, and interpersonal problems were assessed at baseline, midpoint, posttreatment, and 3‐month follow‐up. Veterans completed exit interviews to identify benefits and limitations of the program. Results: Intent‐to‐treat analyses revealed significant symptom reduction for all outcomes, with large to moderate effect sizes at 3‐month follow‐up. Outcomes did not differ by gender or military sexual trauma status. Veterans' rating of the therapeutic alliance was high and interview responses indicated that the presence of the coach was critical to success in the program. Conclusion: This remotely delivered transdiagnostic intervention provided significant benefits across a range of symptoms and functional outcomes and was viewed positively by veterans. The results indicate that further research (ie, a randomized controlled trial) is warranted. Attention to the role of the coach as a means by which to increase engagement and retention in technology‐delivered interventions is warranted. [ABSTRACT FROM AUTHOR]

Despite billions of dollars invested in educational benefits for veterans and active-duty military families under the U.S. Post-9/11 GI Bill, many prospective students are not forging pathways through public institutions of higher education, and funding is disproportionately spent on for-profit colleges. To reveal patterns of lack of access and opportunity, we propose a novel, robust analysis tailored to the situation of veterans and military families in the southern United States. This methodology delineates education deserts using fuzzy algorithms and multivariate spatial analysis to move beyond simple "hotspot" identification of distance from university locations. Results and comparisons of four models confirm different patterns for veterans versus nonveterans and show dynamic regional changes from 2005 through 2017 that reflect shifting demographics, economics, and educational offerings. These insights could inform a roadmap for outreach that accounts for shifting education deserts and potentially workforce opportunities through geographic analysis. This approach represents a potential first step for academic actors, especially in the public sector, who play a role in advancing science, technology, engineering, and math; geography; and geographic information systems to enable veteran and military families to better achieve equitable rates of educational attainment. [ABSTRACT FROM AUTHOR]

The article focuses on informative history of veterans' educational benefits in the U.S. It explains how for-profit schools of higher education, motivated to be the ultimate beneficiaries of government provided educational funds and engaged in predatory and abusive recruiting methods towards veterans and often then provide inferior education at high prices. It also mentions making lump-sum tuition payments directly to veterans to better incentivize them.

An introduction is presented in which editor discusses various articles within the issue on topics including how Judge William Hastie on discriminatory treatment of Blacks in the armed forces; information on Veterans treatment courts (VTCs) and history of veterans' educational benefits.

Medical schools are increasingly identifying military veteran applicants as a source of diversity, resiliency, and commitment—often derived from their personal experiences in the military. Yet, veterans remain significantly under-represented in entering classes; moreover, those veterans who do matriculate are not yet fully reflective of the diversity that the Armed Forces have to offer. Fortunately, specific measures have been shown to be effective at increasing both the number and diversity of student veterans in medical school. In 2019, there were less than 60 military veterans who entered the 144 civilian medical schools in the United States, according to the Association of American Medical Colleges. We identify common barriers faced by military veterans and propose best practices for medical schools to recruit and sustain them. We draw on the existing medical education literature about veteran support systems, and we underscore the unique challenges of veterans in medicine. Finally, we highlight innovative programs currently in place at several US medical schools that seek to address the needs of student veterans. This article provides a guide for how to recruit, assess, and nurture student veterans, suggesting a new way of thinking about this population of nontraditional medical students. This dearth of servicemembers significantly below what would be expected based on national demographic data is indicative of how medical schools offer few pathways to entry for military servicemembers—and far fewer for enlisted personnel and other populations traditionally under-represented in medicine. Should schools aim to recruit a veteran population that is truly representative of the military, additional measures need to be taken into consideration during the admissions review process. [ABSTRACT FROM AUTHOR]

Background: Up to 35% of veterans with opioid use disorder (OUD) are homeless, and veterans with OUD are nearly 29 times higher risk for homelessness; however, few are prescribed naloxone, an evidence-based intervention to reverse life-threatening opioid overdose. Local problem: Many housing facilities for homeless veterans contracted with the San Francisco Veterans Affairs Health Care System are located in neighborhoods with high rates of opioid overdose. No systematic interventions have been implemented to provide opioid overdose education and naloxone kits to veterans and staff at these facilities. This quality improvement (QI) initiative aimed to increase provision of opioid overdose education and naloxone for veterans and staff at contracted housing facilities. Methods: This was a prospective single-arm cohort QI intervention. All contracted veteran housing programs were included. Descriptive statistics evaluated results. Interventions: A total of 18 contracted veteran housing programs were contacted from July 2019 through January 2020 to schedule training. Results: Of those, 13 programs responded to outreach and 10 visits were completed at 8 housing facilities. Training was provided by pharmacist and nurse practitioner trainers to 26 staff members and 59 veterans. Naloxone was prescribed to 37 veterans. Conclusions: A pharmacist-led and nurse practitioner–led initiative was effective in increasing veteran and staff access to opioid overdose education and naloxone at >44% contracted veteran housing facilities. Challenges included lack of response from housing programs, low veteran turn out, and inability to provide naloxone to veterans not enrolled/ineligible for health care. Future initiatives should examine strategies to standardize access in homeless veterans' programs. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this article is to provide rehabilitation counselors an overview of the benefits of the community college system as an option that veterans with service-connected disabilities should consider in helping to make the transition from military to civilian life. We describe veterans with service-connected disabilities, the reasons to consider community colleges instead of 4-year universities, and community college supports for veterans with service-connected disabilities. Method: Through a narrative review approach, we synthesized a collection of research articles, government reports, and websites to describe the academic and career development needs of veterans with service-connected disabilities and how community colleges are an effective option to meet these needs. Our approach toward analyzing the article's source materials was informed in part by our military/veteran-related lived experiences. Results: We provide six recommendations for rehabilitation counselors who support veterans with service-connected disabilities with educational goals. These include gaining knowledge of community college options; understanding funding options for veterans; knowledge of military-friendly community college settings; collaborating with institutional colleagues; understanding on-campus supports for disability-related needs; and continuing education on veterans' issues. Conclusions: We conclude rehabilitation counselors should be familiar with the benefits of the community college setting for veterans with service-connected disabilities to facilitate educational goals and transition to civilian life. [ABSTRACT FROM AUTHOR]

Background: With more than two million veterans returning from the wars in Iraq and Afghanistan, programs are needed that prepare veterans for careers in civilian life. Veterans desire to continue their education and require assistance accessing their GI Bill, other financial benefits, receipt of college credit for military training and experience, and adapting to the college environment. Method: A veterans baccalaureate nursing (VBSN) program addresses the challenges of veterans getting into and staying in school. This VBSN program was developed to provide academic structure and support from a dedicated veteran case manager. Policies were created to address the need for student veterans to petition for course credit based on their military training and experience. Results/Conclusion: The VBSN program has been successful, growing from three students to 29 currently enrolled and 34 graduates. This program meets the needs of student veterans while adding to the nursing workforce. [J Nurs Educ. 2021;60(11):646–650.] [ABSTRACT FROM AUTHOR]

Equipoise, feasibility, and fidelity were studied for the control condition of an occupational therapy driving intervention in a randomized controlled trial. We ranked equipoise and feasibility of six traffic safety education methods and created an implementation fidelity competency checklist. Education method selection was informed using the proportion of concordant ranks analysis while literature and a peer review informed competency checklist development. A proctored-online course delivery had the highest rater agreement (equipoise =.96 [.87–1.00]; feasibility =.99 [.97–1.00]). Implementation fidelity was supported by a 19-component training and evaluation checklist. This study supports promoting the scientific rigor of the RCT via - equipoise, feasibility, and implementation fidelity. [ABSTRACT FROM AUTHOR]

The Department of Veterans Affairs and Department of Defense (VA/DoD) Clinical Practice Guideline for PTSD recommends against the use of benzodiazepines. Despite the recommendation, clinicians continue potentially inappropriate benzodiazepine prescribing practices for veterans with PTSD. We designed an educational product aimed at decreasing benzodiazepine use in PTSD care. Using VA data, the booklet was mailed to over 1300 New England veterans. Veterans were advised to discuss the booklet's information with their medical provider on their next appointment. The intervention resulted in a significant decrease in benzodiazepine use in veterans with PTSD, with 66% of the sample showing a dose reduction from pre- to post-booklet time points. Longitudinal analyses noted that rural veterans were significantly more likely to reduce benzodiazepine use than those in urban settings. Direct to consumer education appears to be an effective strategy to empower rural veterans to improve benzodiazepine prescribing safety and quality. [ABSTRACT FROM AUTHOR]

Mindfulness training is effective in recovery from substance use disorders; however, adoption can be difficult due to environmental and personal distractions. Virtual reality (VR) may help overcome these challenges by providing an immersive environment for practicing mindfulness, but there is currently limited knowledge regarding patient and provider perceptions of VR-based tools. The present study investigated the feasibility and acceptability of VR mindfulness training for veterans in residential substance use treatment as well as potential benefits of VR mindfulness interventions in this population. We conducted a pilot feasibility/acceptability study as a first step toward conducting a larger randomized controlled trial (RCT). The study recruited participants (N = 32) from a 30-day residential substance use program and collected both qualitative and quantitative feedback on the VR mindfulness intervention using a mixed-methods approach. Patients (n = 20) and providers (n = 12) rated the acceptability, usability, and satisfaction of the intervention. Using a within-subjects design, patients provided pre-post emotion ratings and reported on state mindfulness and VR presence after completing a single-session self-guided VR mindfulness intervention. Patients provided qualitative interview data on their overall impressions, while providers gave the same information via survey. Both patients and providers reported high satisfaction and confidence in the intervention. Moreover, within subjects t -tests showed that patients experienced significant reductions in negative affect and significant increases in positive affect from pre-post, along with high levels of state mindfulness and presence. Results of thematic analysis revealed that the intervention facilitated focused attention on the present moment, induced a state of calm and relaxation, and reduced negative thoughts and emotions. Participants requested improvements such as better integration of audiovisual elements, a more personalized and longer intervention, and more comfortable fitting headset. Finally, the intervention presented with several advantages compared to other mindfulness experiences including reduced distractions and a sense of safety and privacy. Self-guided VR mindfulness intervention is feasible and acceptable to patients and providers. VR mindfulness training provides an immersive experience that uplifts mood and reduces distractions. VR may provide a scaffolding tool to set the stage for deepening mindfulness skills. Results of the present study could inform further development and tailoring for future interventions. • The present study examined the feasibility and acceptability of a self-guided virtual reality mindfulness training intervention for veterans in residential substance use treatment. • Participants (N = 32) were recruited from a 30-day residential substance use program and provided both qualitative and quantitative feedback on the VR mindfulness intervention using a mixed-methods approach. • Both patients and providers reported high satisfaction and confidence in the intervention. • Patients experienced reduced negative affect and increased positive affect from pre-post intervention, as well as state mindfulness and sense of presence. • Thematic analysis of qualitative interviews revealed that the intervention facilitated a state of mindfulness, a calming and relaxing experience, reductions in negative thoughts and emotions, and focused attention on the present moment. • Self-guided VR mindfulness training is feasible and acceptable, and may increase positive mood states and deepen mindfulness skills. [ABSTRACT FROM AUTHOR]

This article describes a funded grant project whereby 10 tips are shared for those considering starting a veterans' bachelor of science in nursing initiative: secure the support of the institution; establish a point person for the initiative; maximize student success resources; acknowledge past academic work and military experience; hire prior-service Armed Forces Nurse Corps officers as faculty; deliver training opportunities for nonmilitary faculty to learn about veterans; offer students the opportunity to learn and socialize with their noncivilian peers; capitalize on the assets veterans bring to the classroom; provide a structured learning environment; and generate data-based publications. [ABSTRACT FROM AUTHOR]

Background The Whole Health model of the U.S. Department of Veterans Affairs (VA) emphasizes holistic self-care and multimodal approaches to improve pain, functioning, and quality of life. w HOPE (Whole Health Options and Pain Education) seeks to be the first multisite pragmatic trial to establish evidence for the VA Whole Health model for chronic pain care. Design w HOPE is a pragmatic randomized controlled trial comparing a Whole Health Team (WHT) approach to Primary Care Group Education (PC-GE); both will be compared to Usual VA Primary Care (UPC). The WHT consists of a medical provider, a complementary and integrative health (CIH) provider, and a Whole Health coach, who collaborate with VA patients to create a Personalized Health Plan emphasizing CIH approaches to chronic pain management. The active comparator, PC-GE, is adapted group cognitive behavioral therapy for chronic pain. The first aim is to test whether the WHT approach is superior to PC-GE and whether both are superior to UPC in decreasing pain interference in functioning in 750 veterans with moderate to severe chronic pain (primary outcome). Secondary outcomes include changes in pain severity, quality of life, mental health symptoms, and use of nonpharmacological and pharmacological therapies for pain. Outcomes will be collected from the VA electronic health record and patient-reported data over 12 months of follow-up. Aim 2 consists of an implementation-focused process evaluation and budget impact analysis. Summary This trial is part of the Pain Management Collaboratory, which seeks to create national-level infrastructure to support evidence-based nonpharmacological pain management approaches for veterans and military service personnel. [ABSTRACT FROM AUTHOR]

In response to recommendations from the Special Committee on posttraumatic stress disorder (PTSD), the United States Department of Veterans Affairs, Veterans Health Administration (VHA) chartered a workgroup to identify strategies for improving the reach and fidelity of evidence-based psychotherapies (EBPs) implemented by VHA through clinician training initiatives. The workgroup, which comprised stakeholders in a variety of roles within the VHA, used an Intervention Mapping process, a practical approach to designing change strategies based on theory, evidence, and stakeholder input. High-level recommendations centered around implementation of recent VHA/Department of Defense (VA/DoD) treatment guidelines. In addition to recommended first-line and suggested second-line treatments, the guidelines include measurement-based care and shared decision making around EBPs and their alternatives to ensure that care is goal-oriented and patient-centered. To support increased reach and fidelity, the workgroup made four broad recommendations: (a) enhancing leadership support; (b) alignment of policies, programs, and processes that influence reach of EBPs as recommended in clinical practice guidelines, including implementation support to accompany EBP trainings; (c) use of clinical data to inform decision making at multiple levels, and to provide fidelity support when outcomes are lower than expected or desired; and (d) increasing veteran and stakeholder education and awareness of guideline recommendations and availability of EBPs. These recommendations accompanied a more detailed set of recommended steps for implementation. This article describes the Intervention Mapping process and a summary of resulting workgroup recommendations. [ABSTRACT FROM AUTHOR]

This article makes a fresh contribution to the literature on student funding and its history by drawing attention to a pioneering government initiative, launched in the aftermath of the Great War. From the winter of 1918–1919 until 1923, the Scheme for the Higher Education of Ex-Servicemen provided grants to university students in England and Wales. We argue that it amounted to a major educational reform venture: it supported students on an unprecedented scale, covering fees and maintenance across a broad range of courses and institutions. In order to produce an in-depth analysis of this scheme and its local operation, we have drawn on archival evidence from the Board of Education, the University of Liverpool, the University of Oxford and the University College of Wales, Aberystwyth. Our discussion addresses the application process, means-testing and funding decisions as well as the profiles and experiences of grant recipients. The scale and impact of the ex-service scheme raises wider questions about the societal value accorded to higher education within the context of reconstruction after the Great War. [ABSTRACT FROM AUTHOR]

Many of the more than 1 million military veterans who identify as lesbian, gay, bisexual, and/or transgender (LGBT) have encountered "rejecting experiences in the military" and stigma from prior "Don't Ask Don't Tell" policies. Associated minority stress and social isolation have been linked to a disproportionate risk for depression and suicide, as well as a reluctance to seek medical care at Veterans Health Administration (VHA) facilities. This paper describes feasibility and preliminary outcomes of the newly developed, Pride in All Who Served Health Education Group created to meet the unique needs of sexual and gender minority veterans. The 10-week, closed, health education group (e.g., continuums of identity, military culture) enables open dialogue, fosters social connectedness, and empowers veterans to be more effective self-advocates within the healthcare system. Feedback from formative evaluations (n = 29 LGBT veterans and n = 25 VHA stakeholders) was incorporated before conducting a small scale, non-randomized pilot. Preliminary pre-post surveys (n = 18) show promise (i.e., Cohen's d range ± 0.40 to 1.59) on mental health symptoms (depression/anxiety, suicidal ideation), resilience indicators (identity affirmation, community involvement, problem-focused coping), and willingness to access care within the VA system (satisfaction with VA services, perception of staff competence). Results suggest that the 10-week Pride Group may be an effective tool for addressing minority-related stress in LGBT veterans. A full-scale, randomized clinical trial of this intervention is needed to determine short and long-term impacts on clinical and healthcare access-related outcomes. [ABSTRACT FROM AUTHOR]

The identification of veterans receiving care in community-based settings is important and has implications for healthcare delivery and workforce training and development. As part of a larger collaboration regarding the delivery of behavioral health services, this project partnered a Midwest Veterans Affairs Medical Center with a state primary care association and large federally qualified health center (FQHC) to standardize the method in which veteran status is captured in clinic. Before adapting the screening item and implementing it as a required field in the electronic medical record, the number of veterans reported was 56, or 0.32% of total patients. After implementation, that number increased to 506, or 3.01% of total patients. This suggests there is a need to standardize the method in which veteran status is collected, which has implications for awareness of conditions likely to impact veterans and may inform opportunities for providers to engage in veteran-centric education and training. [ABSTRACT FROM AUTHOR]

The article offers information related to military veteran students in higher education in the U.S. It mentions about Servicemen’s Readjustment Act, a law that provided a range of benefits for returning World War II veterans; and also mentions about benefits of the act for the veteran students. It argues that disaggregating completion, time to degree, and engagement data by military-connected status is needed for institutions to understand the strengths and challenges.

Nurse educators must create meaningful learning for students while addressing the needs of a rapidly changing health care system. Academic-practice partnerships help ensure that students are up-to-date on current practices while faculty and students partner to support the needs of the practice institution. To address a health care system's high amputation rates, school of nursing faculty developed a concept-based learning activity to assess and educate patients at risk for amputation. Results included increased student learning that can be applied to other practice settings and improved outcomes for the health care system. [ABSTRACT FROM AUTHOR]

American Indian and Alaska Native Veterans are more rural than Veterans of any other race or ethnicity and face significant barriers to accessing care. Since 2001, the Tribal Veterans Representative (TVR) Program, a partnership between the U.S. Department of Veterans Affairs (VA) and tribal nations, has trained liaisons from tribal communities to facilitate access to VA benefits and services. We delineate the TVR program model alongside supporting data. We reviewed TVR training materials and program evaluations to identify components of the program essential for increasing access to VA services and benefits. We then report a quantitative assessment of benefits attained in one tribal community. The TVR model is characterized by the exchange of two sets of knowledge and resources—'institutional' and 'community'—during a co-sponsored educational program aiming to train community liaisons about the institution. The institution leads the program's content; the community's traditions inform its process. Following the program, liaisons use support networks comprising trainers, trainees and local organizations to teach other community members to access health care and benefits. In the evaluation community, one liaison has facilitated access for hundreds of Veterans, with financial compensation exceeding $400,000 annually. The TVR program has begun to demonstrate its utility for other rural populations, though further formal evaluation is recommended. Compared with similar models to increase rural populations' access to health care and benefits, the long-term support networks from the TVR model may be most useful when the institution must build trust and engage with the target population. [ABSTRACT FROM AUTHOR]

Background: Challenges remain for integrating Veterans into civilian occupations postservice. This article describes an innovative project affording military service personnel serving in health occupational specialties the opportunity for completion of a Bachelor of Science in Nursing (BSN) degree. Method: The Vets2BSN project, launched in July 2014, has achieved several years of enrollment and graduation success using standardized measures and assessment of student modifiers to establish project success. Results: Nearly 80 eligible students holding current or former rank as corpsmen or medics have enrolled in the program with 59 conferrals and an NCLEX pass rate of 98% (48 of 49). Prospective assessment of progress allows real-time intervention and remediation to achieve successful graduation rates. Conclusion: Collaboration of university administration and faculty has provided a foundation for reintegration of military health professionals possessing skills allowing for educational credit and acceleration of studies toward earning the BSN and joining the workforce as nursing professionals. Collaboration of university administration and faculty has provided a foundation for reintegration of military health professionals possessing skills allowing for educational credit and acceleration of studies toward earning the BSN and joining the workforce as nursing professionals. [[J Nurs Educ. 2019;58(8):444–453.] [ABSTRACT FROM AUTHOR]

Background: Veterans frequently report barriers to accessing and adhering to first-line treatments for posttraumatic stress disorder (PTSD). Online delivery of an evidence-based intervention by a peer-developed program may aid in overcoming these barriers. Purpose: This study evaluated the 'Post War: Survive to Thrive Program', an online, peer developed and delivered program, designed to assist with the management of commonly occurring mental health symptoms among veterans. Material and Methods: Former Australian Defence Force (ADF) members (n = 29) completed the program and were assessed at pre-intervention, three months post-commencement of the program (post-intervention) and six months post-commencement (follow-up). Changes in mental health symptoms were assessed using the DASS-21 and PTSD Checklist for DSM-5, and changes in overall levels of happiness were assessed using the Oxford Happiness Questionnaire. Results: Repeated measures ANOVAs indicated significant main effects across time for all constructs measured. Post-hoc comparisons indicated depression, anxiety, stress and posttraumatic stress symptoms were significantly lower at post-intervention and follow-up compared to pre- intervention. Happiness scores were significantly higher at post-intervention and follow-up compared to pre-intervention. There were no significant differences between post-intervention and follow-up, indicating maintenance of treatment gains. Conclusions: To the authors' knowledge, this is the first study to report an evaluation of an online therapy program utilising a peer developed and facilitated psychological intervention with a veteran population. Findings demonstrated a positive trend, indicating the Post War: Survive to Thrive Online Program may be beneficial for veterans; however, a controlled trial with a larger sample is required to determine effectiveness of the program. [ABSTRACT FROM AUTHOR]

There is debate in the literature as to whether military service is rewarded in the economy and the extent to which veterans receive either a wage premium or penalty. In this paper, we take a new approach to this question by conducting a wage decomposition of the veteran wage differential and decomposing the wage distribution of veterans and civilians instead of focusing only on the standard wage gap analysis at the averages. We find the veteran wage differential is driven by observable factors such as education, occupation, and industry, but also by location choice, a factor that has been previously overlooked in the literature. At the average, we find white men experience a veteran penalty whereas black men and women experience a veteran premium consistent with the bridging hypothesis. Additionally, we find that as we move along the wage distribution for all demographic groups, the veteran premium tends to become a veteran penalty, even after accounting for selection into military service. However, once we account for selection, we find that the premium for veteran black men disappears. [ABSTRACT FROM AUTHOR]