Expanding Access to Help for Veterans in Crisis: The Veterans Online Self-Check Quiz & the Interactive Screening Program Meeting the Needs of SUNY Veterans May 24 th, 2013 Maggie Mortali Manager of the ISP & Prevention Programs American Foundation for Suicide Prevention
Perceived Need for and Use of Mental Health Services among Soldiers and Marines Whose Survey Responses Met the Screening Criteria for Major Depression, Generalized Anxiety, or PTSD Need Outcome Before Deployment to Iraq (N=233) Army Study Groups After Deployment to Afghanistan (N=220) After Deployment to Iraq (N=151) Marine Study Group After Deployment to Iraq (N=127) Acknowledged a problem 184 (86%) 156 (81%) 104 (78%) 91 (86%) Interested in receiving help 85 (40%) 75 (38%) 58 (43%) 47 (45%) Received professional help In the past month Overall (from any professional) 61 (28%) 46 (23%) 56 (40%) 33 (29%) From a mental health professional 33 (15%) 26 (13%) 37 (27%) 24 (21%) In the past year Overall (from any professional) 39 (18%) 34 (17%) 44 (32%) 23 (21%) From a mental health professional 24 (11%) 25 (13%) 29 (21%) 16 (14%) *Hoge et al., Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care. The New England Journal of Medicine, 2004 2
Perceived Barriers to Seeking Mental Health Services among All Study Participants (Soldiers and Marines) Perceived Barrier Respondents Who Met Screening Criteria for a Mental Disorder (N=731) Respondents Who Did Not Meet Screening Criteria for a Mental Disorder (N=5422) I don t trust mental health professionals 241 (38%) 813 (17%) I don t know where to get help 143 (22%) 303 (6%) I don t have adequate transportation 117 (18%) 279 (6%) It is difficult to schedule an appointment 288 (45%) 789 (17%) Difficulty getting time off work for treatment 354 (55%) 1061 (22%) Mental health care costs too much money 159 (25%) 456 (10%) It would be too embarrassing 260 (41%) 852 (18%) It would harm my career 319 (50%) 1134 (24%) Members of my unit might have less confidence in me 377 (59%) 1472 (31%) My unit leadership might treat me differently 403 (63%) 1562 (33%) My leaders would blame me for the problem 328 (51%) 928 (20%) I would be seen as weak 413 (65%) 1486 (31%) Mental health care doesn t work 158 (25%) 444 (9%)
Overview of Crisis Services for Veterans Veterans Crisis Line Began in 2007 Collaboration between Department of Veterans Affairs and the National Suicide Prevention Lifeline Target groups: Veterans, active duty military, and families 1-800-273-TALK (8255) Press 1 Calls directed to VA in Canandaigua, NY 16,000+ calls per month 500 per day 4
Veterans Chat Service Began in 2009 Attraction of online option: greater anonymity and control Challenges of written vs. verbal communication getting started conceptualizing /expressing problems, feelings, concerns absence of Counselor probes 5
Veterans Self-Check Quiz Fall 2010 VA contracted AFSP to build an online interactive assessment as a prelude to Veterans Chat Goals offer a structured way for users to communicate give Counselors a clearer sense of users needs bring more users into Chat improve quality and productivity of Chats Model: AFSP s Interactive Screening Program (ISP) 6
Core ISP Aims Complete user anonymity Personalized contact with real counselors Interactive engagement between user and counselor Respond to user s experience rather than suggesting diagnosis Identify and resolve user s barriers to treatment. 7
Adaptations Added PTSD and TBI items to ISP assessment questionnaire Redesigned program for 24/7/365 coverage Changed response time from 24 hrs. (colleges/workplaces) to 10-15 minute Developed While you are waiting webpages to keep users on line (educational videos, resources) 8
Adaptations Replaced self-assigned User ID/password with computerassigned Reference Number Replaced email notifications to Counselors with audio alerts Linked the Self-Check Quiz website to the Veterans Chat software 9
2-Year Pilot Test of Veterans Self-Check Quiz Trained 75 Chat Counselors (5 per 8-hr. shift) soft launch in April 2011 (end-date: April 2013) Very little advertising Initial access only via National Suicide Prevention Lifeline website Later, link placed on www.veteranscrisisline.net 10
13
14
Results in First 2 Years 26,799 Self-Check Quizzes submitted Average of 1,117 per month; average of 37 per day Gender Female = 8156 (30%) Male = 18,260 (68%) Transgender = 187 (2%) 16
Results Continued Are you... N = 26,799 Veteran 70% Active Duty Service Member 7% National Guard/Army Reserve 6% Other 17% Spouse/Partner/Family Member 6% Friend/VA Personnel 2% No Relation 9% 17
Results Among those with Military Service Military Era(s) Served N = 20,817 (%) OEF/OIF/OND 48% Desert Storm 24% Post Vietnam 12% Vietnam 14% Korea 1% WWII 1% Deployed to a combat zone Yes 54% No 46% 18
Results Symptom Severity N=26,799 (%) Tier 1A (mention of suicide) 81% Tier 1B (severe distress) 14% Tier 2 (mild-moderate distress) 4% Tier 3 (no significant distress) 1% Average PHQ-9 Score = 18 (on a scale of 0-27) Clinically significant level of depression 19
Results Percentage who accessed Counselor s response Overall 71% Tier 1A 82% 57% of users who accessed the Counselor s response (40% of all users) engaged in 1-50 separate Chats 10,747 new users of Veterans Chat Service 84% were Tier 1A users Over 13,600 separate Chats generated 20
Unanswered Questions How many users followed up on Counselors referrals to local services? How many actually received services? What were the outcomes for those who got services? What happened to the others? 21
What Worked Clear acceptability among target population Technical aspects worked well Counselors had strong buy-in, ownership Overwhelmingly credited the Self-Check Quiz with improving their ability to understand and help users 57% of users who reviewed Counselor response entered an online Chat Users overwhelmingly expressed gratitude for personal contact, support, advice 22
What Worked Strong collaborative resources AFSP provides software, Counselor training, ongoing technical assistance and website monitoring VA provides the Counselors and the referral/provider network (via the national system of VA Medical Centers, Vet Centers and related VA facilities) Joint collaboration in the pilot test evaluation 23
Challenges Outcomes of Chat not possible to ascertain 29% of users (18% of Tier 1A) did not review the Counselor s response Some family members used service to report own problems Advertising the Veterans Self-Check Quiz likely to generate enormous demand 24
Advertising First 2 weeks of May 2013 1,557 Self-Check Quizzes Over 50% increase Tier 1A = 87% Tier 1B = 9% Tier 2 = 3% Tier 3 = 1% Average PHQ-9 Score = 19 (scale of 0-27) 25
Implications Self-Check Quiz is a promising tool for engaging Veterans/military personnel in identifying needs and exploring options for getting help Integrating locally-based service delivery systems w/in the online system may: Enhance seamlessness of transition from online to in-person services Facilitate entry into treatment and collection of followup data 26
Campus ISP ISP is a promising tool for engaging student Veterans/military personnel in identifying needs and exploring options for getting help ISP based in the counseling center work with student Veteran groups to reach out to student Veterans on-campus 27
Campus ISP 70 Colleges/Universities nationwide 10 sites currently asking U.S. Veteran: Yes/No University at Albany, SUNY Farmingdale State College, SUNY Potsdam College, SUNY 28
Contacts Maggie Mortali mmortali@afsp.org 888.333.2377 x2034 29