VeCHAT: a proof-of-concept study on screening and managing veterans’ mental health and wellbeing
Felicity Goodyear-Smith 1 3 , Margot Darragh 1 , Jim Warren 21 Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
2 School of Computer Science, University of Auckland, Auckland, New Zealand
3 Corresponding author. Email: f.goodyear-smith@auckland.ac.nz
Journal of Primary Health Care 13(1) 75-83 https://doi.org/10.1071/HC20070
Published: 31 March 2021
Journal Compilation © Royal New Zealand College of General Practitioners 2021 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License
Abstract
INTRODUCTION: New Zealand veterans may have complex mental and physical complaints related to multiple exposures to war environments. They are entitled to, but often do not, access a range of physical, mental health and social services funded through Veterans’ Affairs New Zealand. eCHAT (electronic Case-finding and Help Assessment Tool) is a self-completed electronic holistic screen for substance misuse, problem gambling, anger control, physical inactivity, depression, anxiety, exposure to abuse; and assesses whether help is wanted for identified issues.
AIM: A proof-of-concept study was conducted to develop a modified version of eCHAT (VeCHAT) with remote functionality for clinical assessment of mental health and lifestyle issues of contemporary veterans, and assesses acceptability by veterans and Veterans’ Affairs staff, and feasibility of implementation.
METHODS: We used a co-design approach to develop VeCHAT. Veterans’ Affairs and service organisations invited veterans to remotely complete VeCHAT and a subsequent short online acceptability survey. Veterans’ Affairs medical and case manager staff underwent semi-structured interviews on feasibility and acceptability of VeCHAT use.
RESULTS: Thirty-four veterans completed VeCHAT. The tool proved acceptable to veterans and Veterans’ Affairs staff. Key emergent themes related to tool functionality, design, ways and barriers to use, and suggested improvements. Veterans’ Affairs staff considered VeCHAT use to be feasible with much potential.
DISCUSSION: Capacity of Veterans’ Affairs to respond if their engagement with veterans increases and employment of VeCHAT is scaled up, is unknown. Work is needed to assess how introducing VeCHAT as a standard procedure might influence Veterans’ Affairs case management processes.
KEYwords: Veterans; mass screening; mental health; risk-reduction behaviour; substance-related disorders; stress disorder, post-traumatic
References
[1] New Zealand Veteran Affairs. Our veterans. Wellington: New Zealand Government; 2016. [cited 2017 February 6]. Available from: http://www.veteransaffairs.mil.nz/[2] Fortney JC, Curran GM, Hunt JB, et al. Prevalence of probable mental disorders and help-seeking behaviors among veteran and non-veteran community college students. Gen Hosp Psychiatry. 2016; 38 99–104.
| Prevalence of probable mental disorders and help-seeking behaviors among veteran and non-veteran community college students.Crossref | GoogleScholarGoogle Scholar | 26598288PubMed |
[3] Trivedi RB, Post EP, Sun H, et al. Prevalence, comorbidity, and prognosis of mental health among US veterans. Am J Public Health. 2015; 105 2564–9.
| Prevalence, comorbidity, and prognosis of mental health among US veterans.Crossref | GoogleScholarGoogle Scholar | 26474009PubMed |
[4] Vincent C, Chamberlain K, Long N. Mental and physical health status in a community sample of New Zealand Vietnam war veterans. Aust J Public Health. 1994; 18 58–62.
| Mental and physical health status in a community sample of New Zealand Vietnam war veterans.Crossref | GoogleScholarGoogle Scholar | 8068796PubMed |
[5] Cox B, McBride D, Broughton J, et al. Health conditions in a cohort of New Zealand Vietnam veterans: hospital admissions between 1988 and 2009. BMJ Open. 2015; 5
| Health conditions in a cohort of New Zealand Vietnam veterans: hospital admissions between 1988 and 2009.Crossref | GoogleScholarGoogle Scholar | 26656012PubMed |
[6] Westermeyer J, Canive J, Thuras P, et al. Pathological and problem gambling among veterans in clinical care: prevalence, demography, and clinical correlates. Am J Addict. 2013; 22 218–25.
| Pathological and problem gambling among veterans in clinical care: prevalence, demography, and clinical correlates.Crossref | GoogleScholarGoogle Scholar | 23617862PubMed |
[7] Dickerson DL, O’Malley SS, Canive J, et al. Nicotine dependence and psychiatric and substance use comorbidities in a sample of American Indian male veterans. Drug Alcohol Depend. 2009; 99 169–75.
| Nicotine dependence and psychiatric and substance use comorbidities in a sample of American Indian male veterans.Crossref | GoogleScholarGoogle Scholar | 18845405PubMed |
[8] Edens EL, Rosenheck RA. Rates and correlates of pathological gambling among VA mental health service users. J Gambl Stud. 2012; 28 1–11.
| Rates and correlates of pathological gambling among VA mental health service users.Crossref | GoogleScholarGoogle Scholar | 21331515PubMed |
[9] Kausch O. Suicide attempts among veterans seeking treatment for pathological gambling. J Clin Psychiatry. 2003; 64 1031–8.
| Suicide attempts among veterans seeking treatment for pathological gambling.Crossref | GoogleScholarGoogle Scholar | 14628978PubMed |
[10] Kausch O. Patterns of substance abuse among treatment-seeking pathological gamblers. J Subst Abuse Treat. 2003; 25 263–70.
| Patterns of substance abuse among treatment-seeking pathological gamblers.Crossref | GoogleScholarGoogle Scholar | 14693255PubMed |
[11] Taft CT, Weatherill RP, Scott JP, et al. Social information processing in anger expression and partner violence in returning U.S. veterans. J Trauma Stress. 2015; 28 314–21.
| Social information processing in anger expression and partner violence in returning U.S. veterans.Crossref | GoogleScholarGoogle Scholar | 26201304PubMed |
[12] Taylor MK, Larson GE, Norman SB. Depression and pain: independent and additive relationships to anger expression. Mil Med. 2013; 178 1065–70.
| Depression and pain: independent and additive relationships to anger expression.Crossref | GoogleScholarGoogle Scholar | 24083919PubMed |
[13] Goodyear-Smith F, Warren J, Bojic M, et al. eCHAT for lifestyle and mental health screening in primary care. Ann Fam Med. 2013; 11 460–6.
| eCHAT for lifestyle and mental health screening in primary care.Crossref | GoogleScholarGoogle Scholar | 24019278PubMed |
[14] Goodyear-Smith F, Warren J, Elley C. The eCHAT program to facilitate healthy changes in primary care populations. J Am Board Fam Med. 2013; 26 177–82.
| The eCHAT program to facilitate healthy changes in primary care populations.Crossref | GoogleScholarGoogle Scholar | 23471931PubMed |
[15] Goodyear-Smith F, Arroll B, Coupe N. Asking for help is helpful: validation of a brief lifestyle and mood assessment tool in primary health care. Ann Fam Med. 2009; 7 239–44.
| Asking for help is helpful: validation of a brief lifestyle and mood assessment tool in primary health care.Crossref | GoogleScholarGoogle Scholar | 19433841PubMed |
[16] Arroll B, Goodyear-Smith F, Kerse N, et al. Effect of the addition of a “help” question to two screening questions on specificity for diagnosis of depression in general practice: diagnostic validity study. BMJ. 2005; 331 884
| Effect of the addition of a “help” question to two screening questions on specificity for diagnosis of depression in general practice: diagnostic validity study.Crossref | GoogleScholarGoogle Scholar | 16166106PubMed |
[17] Puddifoot S, Arroll B, Goodyear-Smith F, et al. A new case-finding tool for anxiety: a pragmatic diagnostic validity study in primary care. Int J Psychiatry Med. 2007; 37 371–81.
| A new case-finding tool for anxiety: a pragmatic diagnostic validity study in primary care.Crossref | GoogleScholarGoogle Scholar | 18441626PubMed |
[18] Goodyear-Smith F, Arroll B, Coupe N, et al. Ethnic differences in mental health and lifestyle issues: results from multi-item general practice screening. N Z Med J. 2005; 118 U1374
| 15806177PubMed |
[19] Goodyear-Smith F, Arroll B, Tse S. Asian language school student and primary care patient responses to a screening tool detecting concerns about risky lifestyle behaviours. N Z Fam Physician. 2004; 31 84–9.
[20] Goodyear-Smith F, Coupe N, Arroll B, et al. Case-finding of lifestyle and mental health problems in primary care: validation of the ‘CHAT’. Br J Gen Pract. 2008; 58 26–31.
| Case-finding of lifestyle and mental health problems in primary care: validation of the ‘CHAT’.Crossref | GoogleScholarGoogle Scholar | 18186993PubMed |
[21] Shah K, Corter A, Bird A, et al. A primary care programme to improve identification and stepped-care support of Asians with mental health and lifestyle issues. J Prim Health Care. 2019; 11 39–46.
| A primary care programme to improve identification and stepped-care support of Asians with mental health and lifestyle issues.Crossref | GoogleScholarGoogle Scholar | 31039988PubMed |
[22] Bradford S, Rickwood D. Young people’s views on Electronic Mental Health Assessment: prefer to type than talk? J Child Fam Stud. 2015; 24 1213–21.
| Young people’s views on Electronic Mental Health Assessment: prefer to type than talk?Crossref | GoogleScholarGoogle Scholar | 25960628PubMed |
[23] New Zealand Government. Veterans’ Support Act New Zealand. Wellington: NZ Government; 2014; 56: 282.
[24] Patsopoulos NA. A pragmatic view on pragmatic trials. Dialogues Clin Neurosci. 2011; 13 217–24.
| A pragmatic view on pragmatic trials.Crossref | GoogleScholarGoogle Scholar | 21842619PubMed |
[25] Peters DH, Adam T, Alonge O, et al. Implementation research: what it is and how to do it. BMJ. 2013; 347 f6753
| 24259324PubMed |
[26] Prins A, Bovin MJ, Smolenski DJ, et al. The primary care PTSD screen for DSM-5 (PC-PTSD-5): development and evaluation within a veteran primary care sample. J Gen Intern Med. 2016; 31 1206–11.
| The primary care PTSD screen for DSM-5 (PC-PTSD-5): development and evaluation within a veteran primary care sample.Crossref | GoogleScholarGoogle Scholar | 27170304PubMed |
[27] Botero G, Rivera NI, Calloway SC, et al. A lifeline in the dark: breaking through the stigma of veteran mental health and treating America’s combat veterans. J Clin Psychol. 2020; 76 831–40.
| A lifeline in the dark: breaking through the stigma of veteran mental health and treating America’s combat veterans.Crossref | GoogleScholarGoogle Scholar | 31926023PubMed |
[28] Ministry of Social Development. Telephone and internet access in the household. The Social Report 2016 – Te pūrongo oranga tangata. Wellington: MSD; 2016.
[29] Houston TK, Volkman JE, Feng H, et al. Veteran internet use and engagement with health information online. Mil Med. 2013; 178 394–400.
| Veteran internet use and engagement with health information online.Crossref | GoogleScholarGoogle Scholar | 23707823PubMed |
[30] Seal KH, Abadjian L, McCamish N, et al. A randomized controlled trial of telephone motivational interviewing to enhance mental health treatment engagement in Iraq and Afghanistan veterans. Gen Hosp Psychiatry. 2012; 34 450–9.
| A randomized controlled trial of telephone motivational interviewing to enhance mental health treatment engagement in Iraq and Afghanistan veterans.Crossref | GoogleScholarGoogle Scholar | 22632925PubMed |
