Evaluation of the Department of Veterans Affairs Mental Health Services (2018) / Chapter Skim
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5 Methodology
5 Methodology
Pages 79-102
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From page 79... ...
, and Operation New Dawn (OND) veterans' access to the mental health services at the Department of Veterans Affairs (VA)
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From page 80... ...
The subcontractor chosen to assist the committee was Westat, a research corporation that consults in statistical design, qualitative and quantitative data collection and management, and research analysis work. Westat proposed a survey design that included a sampling plan, instrument development plan, a data collection plan, and a final analysis report based on the survey results.
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From page 81... ...
In preparing the first-phase sample files, the VA removed duplicate records that may have appeared in the multiple sources used. As described in Appendix A, ensuring that the combined data sources for the first-phase sample fully covered the target population of interest involved comparing the associated population size to VA projections of the number of OEF/OIF/OND veterans alive on September 30, 2015 (using Veteran Population Projection Model 2014)
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From page 82... ...
Two sections below, Final Survey Dispositions and Response Rate and Study Limitations, provide details about the final response rate for the committee's survey. Westat then provided the second-phase sample identifiers to the VA, which returned the identities and contact information for the veterans in the second-phase sample.
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From page 83... ...
The committee and Westat carefully reviewed those sources and selected the items that would appropriately address the study charge to examine unmet needs and barriers to receiving care among VAeligible OEF/OIF/OND veterans, some who use VA health services and some who do not. As discussed in the sections that follow, the survey questionnaire includes a subset of questions asking the veteran about his or her mental health and well-being and about wartime experiences.
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From page 84... ...
Veterans who answered affirmatively to having used mental or behavioral health care through their VA primary care provider, a VA mental health treatment facility, or a Vet Center in the past 24 months, or if they indicated they used the VA for any mental or behavior health services (inpatient, outpatient, group therapy, psychotherapy, social skills training, or rehabilitation programs) , were placed into the VA user group.
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From page 85... ...
METHODOLOGY 85 Flowchart of Questionnaire Modules Start of survey Military characteristics (Military History and Demographics – q1-8) Veterans demographics (Military History and Demographics – q9-19)
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The progressive incentive plan would allow us to target certain groups as required, based on differing response rates. In addition to a planned $2 pre-incentive, the initial data collection strategy included starting with a $5 promised incentive through the start of the CATI phase of data collection and increasing it to $20 during CATI.
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METHODOLOGY 87 FIGURE 5-2 Data collection plan as originally designed.
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Final Survey Dispositions and Response Rate Table 5-3 shows the final dispositions/result codes for all 19,400 sampled veterans at the completion of data collection. There were 3,061 Web surveys submitted as complete and 998 CATI interviews completed during data collection.
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From page 89... ...
Weighting Analytic weights are needed for the production of statistically valid estimates and analyses of the survey responses. For the survey, a three-component weight was generated that reflected • The selection probabilities of the sampled veterans by sampling stratum, called base weights; • A non-response adjustment to account for the differential non-response that was observed across strata and demographic and other characteristics of veterans; and • A final post-stratification adjustment to align the weighted totals from the sample to known distributions based on tabulations provided by the VA.
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From page 90... ...
The non-response adjustment calculation itself was straightforward. Within each weighting cell, the adjustment is the reciprocal of the weighted response rate of that cell using the base weights for the calculations.
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From page 91... ...
VA users indicated that they had received mental health care from VA primary care, VA mental health specialty care, Vet Centers, or any combination of the above in the past 24 months (Q22) ; or else they indicated that they had used the VA for mental or behavioral health services (inpatient, outpatient, group therapy, psychotherapy, social skills training, or rehabilitation programs)
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From page 92... ...
The committee was mindful that due to the nature of qualitative research, it is not appropriate to generalize information gathered from a small population sample to the broader veteran population. Data Collection Protocols Before conducting the site visits the committee and Westat staff developed standardized data collection instruments.
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bIncludes primary care–mental health integration (PC-MHI) team members, women's clinic staff, PTSD clinic staff, directors of telehealth services, and peer support staff, among others.
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February 9–13 Iowa City, IA NOTE: VA = Department of Veterans Affairs; VAMC = VA medical center; VISN = Veterans Integrated Service Network. Site Visit Planning Planning each site visit consisted of two major activities.
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From page 95... ...
Additional interviews, arranged as time allowed, included discussions with the primary care–mental health integration team members, women's clinic staff, PTSD clinic staff, directors of telehealth services, and peer support staff, among others. The next planning activity was the environmental scan, a comprehensive review of services available to OEF/OIF/OND veterans in the geographic area served by the target VAMC.
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From page 96... ...
were conducted.7 In each location staff began the site visit at the VAMC and spent the entire first day conducting interviews or focus groups with facility administrators, clinical staff, and veterans.8 Visits to local CBOCs generally involved interviews only with clinic staff, although in a few instances the staff had arranged for a small number of veterans to meet with the site visit team. The largest number of veteran interviews and focus groups was conducted at Vet Centers and community-based organizations.
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From page 97... ...
Field staff observed that approximately 40 percent of veteran participants were racial or ethnic minorities, and just under 20 percent were women. Figure 5-6 shows the branch of service for the ap 9 Vet Centers receive their funding from the Department of Veterans Affairs but do not share patient records with the VA unless they have explicit permission from the patient.
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From page 98... ...
Approximately three-quarters of the veteran participants reported that they were either currently receiving mental health services through the VA or had done so at sometime within the past 2 years. The remaining veterans were classified by study team members as non-users of VA mental health services; that is, they either had never accessed VA mental health services, or had done so but not within the past 24 months (although they may have been accessing counseling services through the Vet Centers)
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From page 99... ...
. STUDY LIMITATIONS As described above, the committee used three major types of sources to gather data for this study: conducting a survey of veterans who use and do not use VA mental health services; conducting multiple site visits around the nation to talk with veterans, their families and caregivers, and mental health providers about VA's mental health services; and conducting a review of literature that is relevant to the study task.
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From page 100... ...
Other possible explanations for not achieving the targeted response rate include veteran privacy and confidentiality concerns and low saliency of the survey topic for veterans who do not experience mental health symptoms or use VA services for physical or mental health care. The lower-than-expected response rate resulted in a final observed sample size of n = 4,059 cases as compared to the expected sample yield of n = 8,900 completed interviews.
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From page 101... ...
Additional analysis for veterans who are known users of VA services suggests that the weighting of the sample respondent data attenuates major differences on frequency and type of service use for the total eligible population of veterans who use these services. Despite these encouraging results from the nonresponse analysis, due to the low response rate for the survey the potential for non-response bias in survey results for different subpopulations and different variables remains a caution to note in the overall interpretation of study findings.
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From page 102... ...
Survey Research Center, Institute for Social Research, University of Michigan.
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