Veterans Emergency Management Evaluation Center

Saint Helena, CA, United States

Veterans Emergency Management Evaluation Center

Saint Helena, CA, United States
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Kranke D.,Veterans Emergency Management Evaluation Center | Gable A.R.,Veterans Emergency Management Evaluation Center | Weiss E.L.,University of Southern California | Dobalian A.,University of California at Los Angeles
Social Work in Mental Health | Year: 2017

This qualitative single case study examines the lived experience of empowerment of a combat veteran with posttraumatic stress disorder (PTSD) who engages in volunteer, peer-led disaster response activities with Team Rubicon (TR), a nongovernmental organization. Team Rubicon members utilize unique skill sets of both military veterans and civilian first responders to rapidly deploy response teams to domestic and global emergencies. Minimal research to date disseminates experiences of empowerment among combat veterans. The single case study methodological approach offers a rich descriptive and contextual analysis for exploring implications for mental health stigma reduction in combat veterans through an empowerment lens. The study serves to: provide a preliminary foundation for continued theory building of empowerment in combat veterans through peer-led disaster relief settings, expand research, and offer practical implications for social workers in stigma reduction efforts. © 2017, Routledge. All rights reserved.


Gabrielian S.,Clinical Center | Gabrielian S.,University of California at Los Angeles | Yuan A.H.,Veterans Emergency Management Evaluation Center | Andersen R.M.,University of California at Los Angeles | And 2 more authors.
Medical Care | Year: 2014

BACKGROUND:: The US Department of Housing and Urban Development (HUD)-VA Supportive Housing (VASH) program - the VA's Housing First effort - is central to efforts to end Veteran homelessness. Yet, little is known about health care utilization patterns associated with achieving HUD-VASH housing. OBJECTIVES:: We compare health service utilization at the VA Greater Los Angeles among: (1) formerly homeless Veterans housed through HUD-VASH (HUD-VASH Veterans); (2) currently homeless Veterans; (3) housed, low-income Veterans not in HUD-VASH; and (4) housed, not low-income Veterans. RESEARCH DESIGN:: We performed a secondary database analysis of Veterans (n=62,459) who received VA Greater Los Angeles care between October 1, 2010 and September 30, 2011. We described medical/surgical and mental health utilization [inpatient, outpatient, and emergency department (ED)]. We controlled for demographics, need, and primary care use in regression analyses of utilization data by housing and income status. RESULTS:: HUD-VASH Veterans had more inpatient, outpatient, and ED use than currently homeless Veterans. Adjusting for demographics and need, HUD-VASH Veterans and the low-income housed Veterans had similar likelihoods of medical/surgical inpatient and outpatient utilization, compared with the housed, not low-income group. Adjusting first for demographics and need (model 1), then also for primary care use (model 2), HUD-VASH Veterans had the greatest decrease in incident rates of specialty medical/surgical, mental health, and ED care from models 1 to 2, becoming similar to the currently homeless, compared with the housed, not low-income group. CONCLUSIONS:: Our findings suggest that currently homeless Veterans underuse health care relative to housed Veterans. HUD-VASH may address this disparity by providing housing and linkages to primary care. © 2014 by Lippincott Williams & Wilkins.


Day F.C.,University of California at Los Angeles | Srinivasan M.,University of California at Davis | Der-Martirosian C.,Veterans Emergency Management Evaluation Center | Griffin E.,University of California at Davis | And 2 more authors.
Academic Medicine | Year: 2015

Purpose Few studies have compared the effect of Web-based eLearning versus small-group learning on medical student outcomes. Palliative and end-of-life (PEOL) education is ideal for this comparison, given uneven access to PEOL experts and content nationally. Method In 2010, the authors enrolled all third-year medical students at the University of California, Davis School of Medicine into a quasi-randomized controlled trial of Web-based interactive education (eDoctoring) compared with small-group education (Doctoring) on PEOL clinical content over two months. Students participated in three 3-hour PEOL sessions with similar content. Outcomes included a 24-item PEOL-specific self-efficacy scale with three domains (diagnosis/treatment [Cronbach alpha = 0.92; CI: 0.91-0.93], communication/prognosis [alpha = 0.95; CI: 0.93-0.96], and social impact/ self-care [alpha = 0.91; CI: 0.88-0.92]); 8 knowledge items; 10 curricular advantage/disadvantages; and curricular satisfaction (both students and faculty). Results Students were randomly assigned to Web-based eDoctoring (n = 48) or small-group Doctoring (n = 71) curricula. Self-efficacy and knowledge improved equivalently between groups (e.g., prognosis self-efficacy, 19%; knowledge, 10%-42%). Student and faculty ratings of the Web-based eDoctoring curriculum and the small-group Doctoring curriculum were equivalent for most goals, and overall satisfaction was equivalent for each, with a trend toward decreased eDoctoring student satisfaction. Conclusions Findings showed equivalent gains in self-efficacy and knowledge between students participating in a Web-based PEOL curriculum in comparison with students learning similar content in a small-group format. Web-based curricula can standardize content presentation when local teaching expertise is limited, but it may lead to decreased user satisfaction.


PubMed | University of California at Los Angeles, Veterans Emergency Management Evaluation Center, Baystate Medical Center and Agency for Healthcare Research and Quality
Type: Journal Article | Journal: BMC emergency medicine | Year: 2016

Adequate hospital staffing during and after a disaster is critical to meet increased health care demands and to ensure continuity of care and patient safety. However, when a disaster occurs, staff may become both victim and responder, decreasing their ability and willingness to report for work. This qualitative study assessed the personal and professional challenges that affected staff decisions to report to work following a natural disaster and examined the role of management in addressing staff needs and concerns.Semi-structured interviews were conducted with individuals who filled key management roles in the United States Department of Veterans Affairs New York Harbor Healthcare Systems response to Superstorm Sandy and during the facilitys initial recovery phase. All interviews were audio recorded and transcribed. Three major themes were identified: 1) Barriers to reporting (Barriers), 2) Facilitators to reporting (Facilitators), and 3) Responses to staff needs and concerns (Responses). Atlas.ti 7.1.6 software program was used for the management and analysis of the transcripts.Results indicated that staff encountered several barriers that impeded their ability to report to work at mobile vans at the temporarily nonoperational Manhattan campus or at two other VA facilities in Brooklyn and the Bronx in the initial post-Sandy period including transportation problems, personal property damage, and communication issues. In addition, we found evidence of facilitators to reporting as expressed through descriptions of professional duty. Our findings also revealed that management was aware of the challenges that staff was facing and made efforts to reduce barriers and accommodate staff affected by the storm.During and after a disaster event, hospital staff is often confronted with challenges that affect decisions to report for work and perform effectively under potentially harsh conditions. This study examined barriers and facilitators that hospital staff encountered following a major natural disaster from the management perspective. Insights gained from this study can be used to inform future disaster planning and preparedness efforts, and help ensure that there is adequate staffing to mount an effective response when a disaster occurs, and to recover from its aftermath.


Guerrero E.G.,University of Southern California | Heslin K.C.,Veterans Emergency Management Evaluation Center | Chang E.,Center for the Study of Healthcare Innovation | Fenwick K.,University of Southern California | Yano E.,Center for the Study of Healthcare Innovation
Administration and Policy in Mental Health and Mental Health Services Research | Year: 2015

This study explored the role of organizational factors in the ability of Veterans Health Administration (VHA) clinics to implement colocated mental health care in primary care settings (PC-MH). The study used data from the VHA Clinical Practice Organizational Survey collected in 2007 from 225 clinic administrators across the United States. Clinic degree of implementation of PC-MH was the dependent variable, whereas independent variables included policies and procedures, organizational context, and leaders’ perceptions of barriers to change. Pearson bivariate correlations and multivariable linear regression were used to test hypotheses. Results show that depression care training for primary care providers and clinics’ flexibility and participation were both positively correlated with implementation of PC-MH. However, after accounting for other factors, regressions show that only training primary care providers in depression care was marginally associated with degree of implementation of PC-MH (p = 0.051). Given the importance of this topic for implementing integrated care as part of health care reform, these null findings underscore the need to improve theory and testing of more proximal measures of colocation in future work. © 2014, Springer Science+Business Media New York.


Claver M.L.,Veterans Emergency Management Evaluation Center | Wyte-Lake T.,Veterans Emergency Management Evaluation Center | Dobalian A.,Veterans Emergency Management Evaluation Center
Prehospital and Disaster Medicine | Year: 2015

Introduction Veterans served by Veterans Health Administration (VHA) home-based primary care (HBPC) are an especially vulnerable population due to high rates of physical, functional, and psychological limitations. Home-bound patients tend to be an older population dealing with normal changes that accompany old age, but may not adequately be prepared for the increased risk that often occurs during disasters. Home health programs are in an advantageous position to address patient preparedness as they may be one of the few outside resources that reach community-dwelling adults. Problem This study further explores issues previously identified from an exploratory study of a single VHA HBPC program regarding disaster preparedness for HBPC patients, including ways in which policy and procedures support the routine assessment of disaster preparedness for patients, including patient education activities. Methods This project involved semi-structured interviews with 31 practitioners and leadership at five VHA HBPC programs; three urban and two rural. Transcripts of the interviews were analyzed using content analysis techniques. Results Practitioners reported a need for further training regarding how to assess properly patient disaster preparedness and patient willingness to prepare. Four themes emerged, validating themes identified in a prior exploratory project and identifying additional issues regarding patient disaster preparedness: (1) individual HBPC programs generally are tasked with developing their disaster preparedness policies; (2) practitioners receive limited training about HBPC program preparedness; (3) practitioners receive limited training about how to prepare their patients for a disaster; and (4) the role of HBPC programs is focused on fostering patient self-sufficiency rather than presenting practitioners as first responders. There was significant variability across the five sites in terms of which staff have responsibility for preparedness policies and training. Conclusion Variability across and within sites regarding how patient needs are addressed by preparedness policies, and in terms of preparedness training for HBPC providers, could place patients at heightened risk of morbidity or mortality following a disaster. Despite the diversity and uniqueness of HBPC programs and the communities they serve, there are basic aspects of preparedness that should be addressed by these programs. The incorporation of resources in assessment and preparedness activities, accompanied by increased communication among directors of HBPC programs across the country, may improve HBPC programs' abilities to assist their patients and their caregivers in preparing for a disaster. Claver ML, Wyte-Lake T, Dobalian A. © World Association for Disaster and Emergency Medicine 2015.


Wyte-Lake T.,Veterans Emergency Management Evaluation Center
Gerontology | Year: 2016

Background: Chronic conditions paired with normal aging put home-bound individuals at risk of harm during a disaster. Because of their high rate of comorbidities, veterans receiving care from the Veterans Health Administration (VHA)'s home-based primary care (HBPC) program are especially vulnerable, which may prevent them from being prepared for disaster. With intimate knowledge of their patients' home environments, medical needs, resources, and limitations, HBPC practitioners are uniquely positioned to assess and improve disaster preparedness of patients. Objective: This study explored issues regarding disaster preparedness for HBPC patients, including ways in which policy and procedures support routine assessment of disaster preparedness for patients as well as patient education activities. Methods: This project involved 32 semi-structured interviews with practitioners and leadership at 5 VHA HBPC programs - 3 urban and 2 rural. Transcripts of the interviews were analyzed using content analysis techniques. Results: Three themes emerged regarding the assessment of a patient's disaster preparedness: (1) assessment tools are rudimentary and, in some cases, individually developed by practitioners; (2) comprehension of criteria for assigning risk categories varies among practitioners, and (3) patients' cognitive impairment, limited resources, and out-of-date or inaccessible materials are the primary challenges to their preparedness. A fourth additional theme emerged as well: (4) the interdisciplinary nature of the HBPC team allows for unique innovative practices, such as a central focus on caregiver support and personal safety, as it relates to assessment and preparedness of the patient. Conclusion: Health and functional limitations may prevent home-bound patients from being adequately prepared for disasters. Standardized strategies and tools concerning disaster preparedness assessment for HBPC patients, which allow flexibility in consideration of factors such as local hazards, could assist in creating more comprehensive planning approaches and, in turn, more prepared persons. This is a work of the US Government and is not subject to copyright protection in the USA. Foreign copyrights may apply. Published by S. Karger AG, Basel Copyright © 2016, S. Karger AG. All rights reserved.


Wyte-Lake T.,Veterans Emergency Management Evaluation Center | Claver M.,Veterans Emergency Management Evaluation Center | Griffin A.,Veterans Emergency Management Evaluation Center | Dobalian A.,Veterans Emergency Management Evaluation Center
Gerontology | Year: 2014

Background: Veterans receiving home-based primary care (HBPC) are an especially vulnerable population served by the Veterans Health Administration (VHA) due to high rates of physical, functional, and psychological limitations. These vulnerabilities may prevent these persons from being adequately prepared for disasters. HBPC providers connect the community-dwelling population with their regional health care system and thus are appropriate partners for assessing preparedness. The limited literature on this topic suggests that there are issues with the development and implementation of emergency management plans, dissemination to staff, and inconsistencies with preparedness strategies across agencies. Objective: To further explore identified issues regarding emergency management planning for patients receiving medical care in their home, including ways in which policy and procedures support the routine assessment of disaster preparedness for patients. Methods: This exploratory pilot project, carried out in a single VHA HBPC program located in an urban area, involved seven 15- to 25-min semistructured interviews with practitioners and leadership. Transcripts of the interviews were analyzed using content analysis techniques to develop themes to describe information obtained through the interviews. Results: Six themes emerged from the data: (1) a national policy regarding the inclusion of disaster preparedness assessment in routine HBPC assessment exists in only a skeletal manner and individual HBPC programs are tasked with developing their own policies; (2) the tools used at the initial assessment were rudimentary and, in some cases, individually developed by providers; (3) the comprehension of criteria for assigning risk categories (i.e. acuity levels) varied among providers; (4) the primary challenges identified by respondents to patient engagement in emergency preparedness activities included cognitive impairments, patients' willingness to invest in preparedness activities, and limited resources; (5) providers received limited formal training on how to prepare their patients for a disaster, and (6) provider recommendations included training to focus on better strategies to get patients to participate, more consistent time spent on patient education, formalization of the initial assessment, and having emergency preparedness be formally addressed on a more consistent basis. Conclusion: Formal standardized strategies regarding disaster preparedness assessment for HBPC patients, which leave room for flexibility in consideration of local factors, could assist in creating more comprehensive emergency management planning agendas and community collaboration. © 2014 S. Karger AG, Basel.


Heslin K.C.,Veterans Emergency Management Evaluation Center
Prehospital and disaster medicine | Year: 2013

The health of people with chronic medical conditions is particularly vulnerable to the disruptions caused by public health disasters, especially when there is massive damage to the medical infrastructure. Government agencies and national organizations recommend that people with chronic illness prepare for disasters by stockpiling extra supplies of medications. A wide range of chronic illnesses has long been documented among veterans of the US armed forces. Veterans with chronic illness could be at great risk of complications due to disaster-related medication disruptions; however, the prevalence of personal medication preparedness among chronically ill veterans is not currently known. Data was used from the 2009 California Health Interview Survey on 28,167 respondents who reported taking daily medications. After adjusting for differences in age, health status, and other characteristics, calculations were made of the percentage of respondents who had a two-week supply of emergency medications and, among respondents without a supply, the percentage who said they could obtain one. Veteran men, veteran women, nonveteran men, and nonveteran women were compared. Medication supplies among veteran men (81.9%) were higher than among nonveteran women (74.8%; P < .0001) and veteran women (81.1%; P = 0.014). Among respondents without medication supplies, 67.2% of nonveteran men said that they could obtain a two-week supply, compared with 60.1% of nonveteran women (P = .012). Discussion Among adults in California with chronic illness, veteran men are more likely to have personal emergency medication supplies than are veteran and nonveteran women. Veteran men may be more likely to be prepared because of their training to work in combat zones and other emergency situations, which perhaps engenders in them a culture of preparedness or self-reliance. It is also possible that people who choose to enlist in the military are different from the general population in ways that make them more likely to be better prepared for emergencies. Veterans in California have a relatively high level of emergency medication preparedness. Given the health complications that can result from disaster-related medication disruptions, this is a promising finding. Disasters are a national concern, however, and the personal preparedness of veterans in all parts of the nation should be assessed; these findings could serve as a useful reference point for such work in the future.


Heslin K.C.,Veterans Emergency Management Evaluation Center | Guerrero E.G.,University of Southern California | Mitchell M.N.,Veterans Emergency Management Evaluation Center | Afable M.K.,Veterans Emergency Management Evaluation Center | Dobalian A.,Veterans Emergency Management Evaluation Center
Substance Use and Misuse | Year: 2013

Hepatitis C virus (HCV) infection is common among people with substance abuse histories and a burden for U.S. veterans in particular. This study compares self-reported HCV between 1,652 veterans and 48,013 nonveterans who received public-sector substance abuse treatment in Los Angeles between 2006 and 2010. A higher percentage of veterans than nonveterans reported HCV (6.5% vs. 3.8%, p < .0001). Homelessness and mental illness explained, respectively, 8.6% and 7.1% of the difference in HCV between the two groups, adjusting for other variables. Reducing homelessness and mental illness among veterans may also help reduce the excess burden of HCV in this population. © 2013 Informa Healthcare USA, Inc.

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