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Symposia

Couples / Close Relationships

Session: From "Too Little, Too Late" to the Right Treatment at the Right Time: Toward a Stepped-Care Approach to Relationship Health

1 - (SYM 67) VA Couple and Family Service Access and Utilization in National Electronic Health Record Data

Saturday, November 18, 2023

10:30 AM – 12:00 PM PST

Location: Clallum (701), Level 7

Speaker(s)

KK

Kayla Knopp, Ph.D.

Research Psychologist
VA San Diego Healthcare System/University of California, San Diego
San Diego, California

Co-author(s)

GM

Grace McKee, Ph.D.

Statistician
San Francisco VA Medical Center
San Francisco, California
SG

Shirley Glynn, Ph.D.

Clinical Research Psychologist
Research Service, Veterans Affairs Greater Los Angeles Healthcare System
Los Angeles, California
SM

Scott McDonald, Ph.D.

SCI Neuropsychologist
Central Virginia VA Medical Center
Richmond, Virginia

Background: Relationship and family difficulties are common among military veterans, who can access family services (i.e., couple and family therapy) through the Veterans Affairs (VA) Healthcare System. This study examined demographic, mental health, military, and referral source variables associated with referral to and utilization of family services using a national VA electronic health record dataset of 22,969 veterans who were referred to family services from 2016-2019.

Method: Of those referred, 44% completed one or more family service sessions. The 10,196 veterans who initiated therapy attended M=6 sessions (SD = 9, range = 1-125), with only 31% attending five or more sessions and 37% attending a single session only. Logistic regression was used to evaluate predictors of completed referrals (i.e., attending at least one session) and of attending 5+ sessions of couple or family therapy.

Results: Veterans identifying as Black/African American or American Indian/Alaska Native were less likely to have a completed referral than non-Hispanic White veterans; further, veterans identifying as Black/African American or Hispanic were less likely to attend 5+ sessions. Lower likelihood of a completed referral was also associated with rural county residence, being separated, serving in the post-9/11 era, having a substance use disorder diagnosis, and being referred by a psychiatrist, neurologist, physician, or nursing staff rather than a psychologist. Lower likelihood of attending 5+ sessions was associated with a delay of 22 or more days to intake, an adjustment disorder diagnosis, and being referred from VA specialty care or by a psychiatrist or neurologist.

Discussion: Overall, these findings show that more than half of those referred for family services within VA never initiated services, and fewer than 15% of those referred completed a meaningful dose of treatment. Both demographic characteristics and referral sources were associated with likelihood of participating in family services, pointing toward potential intervention targets to improve outreach and referral processes in order to ensure equity in access to and utilization of family mental health care.