Evaluation of the Department of Veterans Affairs Mental Health Services (2018) / Chapter Skim
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Appendix A: Supporting Documentation for the Survey
Appendix A: Supporting Documentation for the Survey
Pages 335-416
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From page 335... ...
Westat will use the contact information to conduct data collection. The VA has provided Westat two data files.
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The proportions of veterans in the provided samples that have used VA mental health services in the last 24 months was 30 percent for deployed veterans and 11 percent for veterans who had not been deployed. Another medical variable that was present on both data files was OPALL_CNT24, the number of mental health outpatient encounters with a mental health diagnosis code in the last 24 months.
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For the strata containing users of VA mental health services, the primary sorting variables will be OPALL_CNT24, the number of mental health outpatient encounters with a mental health diagnosis code in last 24 months, and the secondary sorting variable will be the veteran's date of birth. For strata that do not contain users of VA mental health services, the sorting variables for deployed veterans will be military component (active or reserve)
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Our target number of completed surveys was 4,000 such veterans -- 2,000 veterans who need mental health services and are using VA mental health services and 2,000 veterans who also need mental health services but who have not elected to use the mental health services provided by the VA. We expect that in addition to the 4,000 veterans identified as having current mental health needs and who complete the survey there will be additional 4,900 veterans who will complete the screener but will not be identified as having a current need for mental health services.
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We determined the stratum sample sizes by first allocating the 4,000 + 4,900 = 8,900 screener completes to the major sampling strata, based on sex, deployment status, and usage of VA mental health services. The nonlinear-program solver in Excel was used to determine the allocation of the 8,900 screener completes to the major sampling strata so that the distribution of completed surveys indicated in Figure A-1 was achieved and desired oversampling -- described in more detail below -- was also achieved, yet the loss in precision for overall estimates was minimized.
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From page 340... ...
In this case, the same sampling fraction could be used for the two groups. However, the administrative data provided to us by the VA permitted us to estimate that only 18.5 percent of OEF/OIF/OND veterans were users of VA mental health services.
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For example, for comparing a proportion estimated from data for younger veterans to a proportion estimated from the data for older veterans, both Tables A-4 and A-6 indicate that the worst-case MDE over all possible TABLE A-5 MOEs for Estimated Proportions in Non-Specific Domains for Veterans Identified as Currently Needing Mental Health Services Estimated Proportion Prevalence of Domain in Population 50% 25% or 75% 10% or 90% 5% or 95% 10% 5.8% 5.0% 3.5% 2.5% 20% 4.1% 3.5% 2.5% 1.8% 30% 3.3% 2.9% 2.0% 1.5% 40% 2.9% 2.5% 1.7% 1.3% 50% 2.6% 2.2% 1.6% 1.1% 60% 2.4% 2.0% 1.4% 1.0% 70% 2.2% 1.9% 1.3% 1.0% 80% 2.0% 1.8% 1.2% 0.9% 90% 1.9% 1.7% 1.2% 0.8% 100% 1.8% 1.6% 1.1% 0.8%
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Table A-7 is from the appendix of the earlier version of this document, and it contains predicted maximum MOEs for estimated proportions and the associated worst-case MDEs for domains based on gender or the usage of VA mental health services, taking into account the decreases in precision due to over-sampling female veterans with an over-sampling factor of 2.0. The actual second-phase sample over-sampled females, deployed veterans, and users of VA mental health services by factors of 2.0, 1.6, and 1.5, respectively.
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MDE calculations are for two-tailed 95% confidence tests with 80% power. determine that male-versus-female differences are significantly different but has more power to test for significant differences between users and non-users of VA mental health services.
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, deployment status, and whether or not the veteran used VA-provided mental health care services. This first analysis will be included in the NRBA, and we will also use it to indicate which frame variables we will use in weighting to create post-stratification cells or to rake the second-phase base weights.
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The stratification variables for the second-phase sample were deployment status (2 levels: yes or no) , usage of VA mental health services (2 levels: yes or no/missing)
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Nevertheless, the leaves of the developed trees can still be used to define non-response adjustment cells, which a Westat-developed SAS macro, named CollAdj, will analyze in order to compute non-response adjustment factors based on weighted response rates and will compute metrics to allow Westat statisticians to determine if there should be any collapsing of cells.
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Unweighted RR3 (%) OVERALL 20.4 22.0 STRATUM See Table 1 1 17.2 17.2 2 20.7 20.7 3 30.8 30.8 4 20.0 20.0 5 26.4 26.4 6 22.4 22.4 7 28.2 28.2 8 18.8 18.8 9 25.0 25.0 10 24.8 24.8 11 31.7 31.7 12 16.4 16.4 13 27.3 27.3 ANYMH24_R Use VA mental health services 1 26.1 26.1 Do not use VA mental health 14 19.2 20.6 services or missing ANYVAHLTH_R Use VA health services 1 27.3 27.2 Do not use VA health services or 14 17.8 19.1 missing ISCTYPE2, Type Enlisted, expiration of term of 1 21.1 21.8 of separation service Enlisted, early release 2 19.2 19.4 Enlisted, disability 3 18.1 19.9 Enlisted, unqualified 4 28.9 27.2 Enlisted, retirement 5 31.8 31.9 Enlisted, drugs 6 17.9 18.4 Enlisted, pregnancy or parenthood 7 24.4 25.0 Enlisted, other 8 20.4 21.2 Officer, expiration of term of service 9 30.2 27.3 Officer, voluntary release 10 31.7 31.0 Officer, retirement 11 40.4 40.5 Officer, other 12 24.9 30.0 Missing 14 19.6 21.1 RACE_R White 1 28.3 28.0 Black 2 28.1 28.9 Asian 3 25.9 25.6 Other 4 23.2 23.0 Missing 14 17.8 19.1 SEX_R Female 1 28.5 28.0 Male 2 24.5 24.2 Unknown 3 17.2 17.2 UNITCODE_R Active 1 23.6 23.9 Reserve 2 26.7 26.8 Missing 14 18.2 18.9 AGECAT_R <24 1 16.4 16.5 25–29 2 18.8 19.5 30–34 3 21.0 22.2 continued
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The bias in each second-phase-sample estimate was estimated by subtracting from the estimate the weighted estimate computed from the first-phase-sample base weights and the administrative data for all of the first-phase sample cases. Table A-13 compares the estimated biases for base-weighted and final-weighted estimated proportions computed for the following categorical variables present on the first-phase-sample file of VAprovided administrative data: 8 Lohr, S., V
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APPENDIX A 349 TABLE A-11 Test for Association Between Response Status and Levels of Sampling-Frame Categorical Variablesa Respondents Non-Respondents Variable Description Percentage Stdrd Err Percentage Stdrd Err CHISQ P_VALUE STRATUM See above 50.8 0.62 62.4 0.16 285.4580 <.0001 0.3 0.05 0.3 0.01 2.4 0.17 1.4 0.04 0.8 0.11 0.8 0.03 6.1 0.21 4.3 0.05 0.5 0.06 0.4 0.02 3.0 0.10 1.9 0.03 3.0 0.18 3.4 0.05 20.7 0.53 15.9 0.14 0.3 0.04 0.2 0.01 1.6 0.07 0.9 0.02 1.3 0.14 1.7 0.04 9.2 0.43 6.3 0.11 100.00 100.0 ANYMH24_R Use VA mental health 22.0 0.51 16.0 0.13 89.3850 <.0001 services Do not use VA mental 78.0 0.51 84.0 0.13 health services or missing 100.0 100.0 ANYVAHLTH_R Use VA health services 36.4 0.76 24.8 0.31 143.8640 <.0001 Do not use VA health 63.6 0.76 75.2 0.31 services or missing 100.0 100.0 Enlisted, expiration of term 10.0 0.46 9.6 0.14 83.3751 <.0001 of service ISCTYPE2, Enlisted, early release 0.9 0.11 1.0 0.07 type of Enlisted, disability 1.4 0.14 1.6 0.08 separation Enlisted, unqualified 0.6 0.10 0.4 0.04 Enlisted, retirement 4.7 0.23 2.6 0.08 Enlisted, drugs 0.5 0.09 0.5 0.06 Enlisted, pregnancy or 0.4 0.06 0.3 0.03 parenthood Enlisted, other 2.0 0.17 2.0 0.10 Officer, expiration of term 0.6 0.11 0.4 0.03 of service Officer, voluntary release 0.6 0.11 0.3 0.04 Officer, retirement 1.5 0.16 0.6 0.05 Officer, other 0.2 0.05 0.1 0.03 Missing 76.5 0.61 80.5 0.20 100.0 100.0 RACE_R White 22.4 0.69 14.5 0.26 170.7225 <.0001 Black 7.2 0.35 4.7 0.16 Asian 1.1 0.16 0.8 0.08 Other 5.6 0.37 4.8 0.17 Missing 63.6 0.76 75.2 0.31 100.0 100.0 continued
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• Use of VA Health Services. The proportion of veterans who use VA health services was more than 10 percentage points higher when estimated with the overall base weights than when estimated with the final weights due to the higher response rates of veterans who use VA health services.
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TABLE A-12b Variables Selected by CHAID to Define the Classification Tree for Response by NonDeployed Veteransa Relative Variable Description Importance Importance Count AGECAT_R Age category 7.87 1.00 2 ANYVAHLT_R Use of VA health services 2.84 0.36 1 RACE_R Race 2.25 0.29 2 STRATUM Sampling stratum 1.46 0.19 1 SVCPCT2 Service disability percent 1.31 0.17 1 aImportance is a data-mining metric based on reduction of residual squared error. Count is the number of times a variable is used to define a split.
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−0.70 (0.10) <0.001 <0.001 services Do not use VA health 63.20 73.64 72.93 −9.73 (0.79)
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−0.41 (0.28) 3.8 <0.001 0.14 outpatient encounters with a mental health diagnosis code since separation OPMH_CNT24 The number of mental health 3.07 2.21 2.42 0.65 (0.23)
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354 EVALUATION OF THE DEPARTMENT OF VETERANS AFFAIRS MENTAL HEALTH SERVICES CHAID Tree for Responding Deployed Veterans. A node's proportion for Category 1 indicates the node's response rate.
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364 EVALUATION OF THE DEPARTMENT OF VETERANS AFFAIRS MENTAL HEALTH SERVICES CHAID tree for Responding Non-Deployed Veterans. A node's proportion for Category 1 indicates the node's response rate.
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From page 368... ...
The VA selected this sample from multiple administrative data sources, with a veteran's demographic variables being included on the file provided only if the veterans appeared in VA medical records. The VA did not provide Westat with any counts of the number of veterans present in the administrative data sources used to select the sample of non-deployed veterans nor the vintages of the administrative data sources.
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. For the purposes of increasing the precision of subpopulation estimates, female veterans, deployed veterans, and veterans who use VA mental health services were oversampled.
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This operation was conducted in a single step. To compute the needed sums of first-phase sample weights by cell, we used the scoring code from the CHAID analysis to assign each of the 1,195,344 veterans in the first-phase-sample file to a weighting cell and then summed to the cell level the associated first-phase-sample base weights.
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Raking to Population Totals To the raking cells for deployed veterans associated with the four interior cells of Table A-17, we added a fifth raking cell for non-deployed veterans, which contained the control total 2,898,952, obtained by multiplying the size of the first-phase sample for non-deployed veterans by 4. For this raking step, the sample file was subset to include only "respondents," with each "respondent" assigned to a raking cell based on the values of sex, deployment status, and the usage of VA mental health services during the past 24 months present on the VA-provided administrative data for the first-phase sample.
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The largest weights were for "respondents" in sampling stratum 1, which contains non-deployed veterans who had not used VA mental health services in the past 24 months. The smallest weights were for "respondents" in sampling strata 6 and 7, which contain deployed female veterans who had also not used VA mental health services in the past 24 months.
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Replication Taylor ANYMH24_R Use VA mental health services 16.3 0.30 0.53 Do not use VA mental health 83.7 0.30 0.53 services or missing ANYVAHLTH_R Use VA health services 26.4 0.10 0.70 Do not use VA health services 73.6 0.10 0.70 or missing RACE_R White 16.1 0.34 0.55 Black 4.8 0.22 0.28 Asian 0.9 0.13 0.13 Other 4.6 0.26 0.32 Missing 73.6 0.10 0.70 UNITCODE_R Active 19.3 0.37 0.59 Reserve 12.9 0.37 0.47 Missing 67.8 0.00 0.76 RANKD_R, pay grade E1-E3 9.8 0.25 0.44 E4 9.1 0.25 0.42 E5 4.4 0.07 0.26 Other enlisted 5.2 0.10 0.26 Warrant officers 0.3 0.05 0.06 Commissioned officers 3.4 0.10 0.21 Missing 67.8 0.00 0.76 TABLE A-20 Comparison of Calculated Standard Errors for Selected Continuous Variables Estimated Standard Error (%) Weighted Variable Description Proportion (%)
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374 EVALUATION OF THE DEPARTMENT OF VETERANS AFFAIRS MENTAL HEALTH SERVICES SURVEY ITEM SOURCES FOR THE OEF/OIF/OND VETERANS' ACCESS TO HEALTH SERVICES SURVEY Source Item References appear at the end of the table Q1. what component(s) have you served?
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Please indicate if you experienced the following events during your deployments in support of OEF/OIF/OND since September 11, 2001, by selecting the response that best fits your answer. Never, Once or twice, Several times over entire employment, A few times each month, A few times each week, Daily or almost daily a.
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| | Some other race -- Specify race | | Q13. What is the highest degree or level of school you have 2010 National Survey of Veterans3 completed? Less than high school GED High school diploma S ome college credit, but less than 1 year of college credit 1 or more years of college credit, no degree A ssociate's degree (for example, AA, AS)
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Insurance purchased directly from an insurance company (by you or another family member) Insurance through HealthCare.gov or a state insurance marketplace or exchange Medicare, for people 65 and older, or people with certain disabilities Medicaid, Medical Assistance, or any kind of government assistance plan for those with low incomes or a disability TRICARE, TRICARE for Life, or other military health care Indian Health Service Any other type of health insurance or health coverage plan [specify]
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Mental or behavioral health care through a VA mental health treatment facility c. Mental or behavioral health care through a Vet Center d.
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AUDIT14 Never Monthly or less 2 to 4 times a month 2 to 3 times a week 4 or more times a week Q30. How many drinks containing alcohol do you have on a AUDIT14 typical day when you are drinking? 1 or 2 3 or 4 5 or 6 7, 8, or 9 10 or more Q31. How often do you have six or more drinks on one occasion?
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Never Less than monthly Monthly Weekly Daily or almost daily Q37. Have you or someone else ever been injured as a result of AUDIT14 your drinking? No Yes, but not in the last year Yes, during the last year Q38. Has a relative, friend, doctor, or another health professional AUDIT14 ever expressed concern about your drinking or suggested you cut down?
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. Remember that the questions do not include alcoholic beverages.
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Any other mental or behavioral health issue Q51. About how many miles from where you live is the nearest National Survey of Women Veterans,9 VA facility that offers mental health services? MODIFIED 0–10 miles 10–20 miles 21–30 miles 31–40 miles 41–50 miles More than 50 miles Not sure Q52. How long does it take to get from where you live to the New development nearest VA facility that offers mental health services?
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Ambulatory Care 2013,20 MODIFIED (to add does not apply type option) Never Sometimes Usually Always I have not tried to get an appointment with a VA mental health provider in the past 24 months Q57. the past 24 months, how often were you able to get the In Survey of Healthcare Experiences of Patients mental health care you needed from a VA facility during Ambulatory Care 2013,20 MODIFIED (to add evenings, weekends, or holidays?
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Specialized mental health services such as programs for treatment of PTSD, substance abuse, or other conditions Q60. Thinking about the past 24 months, how satisfied or New development dissatisfied are you with the availability of the following types of mental health providers at the VA? Very satisfied, Somewhat satisfied, Somewhat dissatisfied, Very dissatisfied, No opinion a.
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In the past Ambulatory Care 2013,20 MODIFIED (to be 24 months, did a VA mental health provider tell you there specific to mental health) was more than one choice for your treatment or health care?
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Privacy and confidentiality of medical records c. Ease of using VA mental health care d.
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d. You do not believe you are entitled to or eligible for VA mental health care benefits?
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Help scale,28 MODIFIED (response options Strongly agree, Somewhat agree, Somewhat disagree, modified to fit with similar questions in the Strongly disagree survey)
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Very likely Likely Somewhat likely Not likely at all Q84. Would you use VA mental health services by any of the New development following modes in the future? Definitely yes, Probably yes, Probably no, Definitely no a.
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2013. Are Iraq and Afghanistan veterans using mental health services?
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2001. Survey on disparities on quality of health care.
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This includes the time it will take to follow instructions, gather the necessary facts and respond to questions asked. The purpose of this web-based survey is to help the VA to better understand why Veterans choose to use or not use VA mental health services available to them.
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Sometimes people who answer questions about their experiences or how they are feeling would like to talk to a mental health specialist. If you feel this way at any time, click the "Mental Health Resource" button located at the bottom of each page.
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Doing so also implies your consent to participate in the survey. Derived variables to guide survey pathways, based on self-response: ALL RESPONDENTS WILL BEGIN WITH VAUSER = 0; CIVUSER = 0; AND POSSCRN = 0 [MONTH, YEAR]
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APPENDIX A 395 OEF/OIF/OND Veterans' Access to Health Services Survey Military History and Demographics The following questions ask some basic information about you and your military history.
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Please indicate if you experienced the following events during your deployments in support of OEF/OIF/OND since September 11, 2001 by selecting the response that best fits your answer. Several times Once or over entire A few times A few times Daily or Never 0 twice 1 deployment 2 each month 3 each week 4 almost daily 5 a.
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Select all that apply White RACE_1 Black or African American RACE_2 American Indian or Alaska Native -- Specify name of enrolled or principal tribe RACE_3 | | RACE_3SPEC Asian Indian RACE_4 Chinese RACE_5 Filipino RACE_6 Japanese RACE_7 Korean RACE_8 Vietnamese RACE_9 Other Asian -- Specify race, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, and so on RACE_10 | | RACE_10SPEC
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What is the highest degree or level of school you have completed? EDU Less than high school 1 GED 2 High school diploma 3 Some college credit, but less than 1 year of college credit 4 1 or more years of college credit, no degree 5 Associate's degree (for example, AA, AS)
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INS_3 Insurance purchased directly from an insurance company (by you or another family member) INS_4 Insurance through HealthCare.gov or a state insurance marketplace or exchange INS_5 Medicare, for people 65 and older, or people with certain disabilities INS_6 Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or a disability INS_7 TRICARE, TRICARE for Life, or other military health care INS_8 Indian Health Service INS_9 Any other type of health insurance or health coverage plan INS_10 [specify]
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Mental or behavioral health care through your VA Primary Care Provider MHSERV_1 ❍ ❍ b. Mental or behavioral health care through a VA mental health treatment facility MHSERV_2 ❍ ❍ c.
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APPENDIX A 401 Health and Well-being This next section asks about your health, well-being, and lifestyle. Remember, all of your answers are confidential.
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30. How many drinks containing alcohol do you have on a typical day when you are drinking?
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DRNK_6 Never 0 Less than monthly 1 Monthly 2 Weekly 3 Daily or almost daily 4 35. How often during the last year have you needed an alcoholic drink first thing in the morning to get yourself going after a night of heavy drinking?
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DRNK_10 No 0 Yes, but not in the last year 1 Yes, during the last year 4 MISSING = 0 FOR SCORING DO NOT SCORE IF MORE THAN 3 ITEMS IN DRNK_1 – DRNK_10 MISSING. IF DRNK_ SCORE ≥ 16, THEN POSSCRN = 1 The following questions concern information about your possible involvement with drugs not including alcoholic beverages during the past 12 months.
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APPENDIX A 405 43. In the past 12 months, have you ever felt bad or guilty about your drug use?
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VAMH_2 Less than 10 minutes 1 10 to 20 minutes 2 21 to 30 minutes 3 31 to 45 minutes 4 46 minutes to one hour 5 More than one hour 6 Not sure 97 53. Would you say that transportation to the nearest VA facility that offers mental health services is: VAMH_3 Very easy 5 Somewhat easy 4 Neither easy nor hard 3 Somewhat hard 2 Very hard 1 Not sure 97
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? VAMH_5 Very burdensome 1 Somewhat burdensome 2 Not very burdensome 3 Not burdensome at all 4 Not sure 97 Now, think about your experience with VA mental health services since [MONTH, YEAR]
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Thinking about the past 24 months, how satisfied or dissatisfied are you with the availability of the following mental health services at the VA? Very Somewhat Somewhat Very No Satisfied 4 Satisfied 3 Dissatisfied 2 Dissatisfied 1 Opinion 99 a.
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Think about your own experience with VA mental health services since [MONTH, YEAR]
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[POSSCRN = 1 OR VAUSER = 1] Either based on your own experiences or what you have heard from others, please rate your opinion of the following aspects of VA mental health care: Extremely Somewhat Somewhat Extremely Negative Negative Positive Positive 1 2 Neutral 3 4 5 a.
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[POSSCRN = 1 OR VAUSER = 1] VA mental health care providers give Veterans more than one choice for treatment or health care.
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REAS_11 ❍ ❍ Opinions About Mental Health Services [POSSCRN = 1 OR VAUSER = 1] For the next questions, think about mental health care both in the VA and outside of the VA.
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] In the past 24 months, how often did you have a hard time communicating with your mental health provider because of accents or language barriers?
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81. What are the reasons you do not plan to use VA mental health services in the future?
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RCCMD Very likely 4 Likely 3 Somewhat likely 2 Not likely at all 1 84. Would you use VA mental health services by any of the following modes in the future?
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