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Civilian Healthcare Providers Need Training to Appropriately Treat Veterans

by U.S. Medicine

March 7, 2016

By Brenda L. Mooney

Lisa Butler, PhD, associate professor in the UB School of Social Work, says her research is especially significant in light of the push for veterans already being treated at the VA to have more options for care from civilian providers. Photo from the University of Buffalo

Lisa Butler, PhD, associate professor in the UB School of Social Work, says her research is especially significant in light of the push for veterans already being treated at the VA to have more options for care from civilian providers. Photo from the University of Buffalo

BUFFALO, NY – Civilian healthcare providers need to acquire more “military/veteran cultural competence” to provide adequate care to veterans, servicemembers and their families.

That’s according to a new study, published recently in the journal Military Behavioral Health, which calls for training so that healthcare systems and providers better understand military culture in order to work effectively with those patients.

University of Buffalo-led researchers says their study is one of the first documenting the many difficulties facing military families in the community, especially when it comes to medical care.

“Military service — and combat experience in particular — is a profound life experience that many civilians do not understand — and veterans are well aware of this,” explained first author Lisa Butler, PhD, associate professor in the UB School of Social Work.

The research is especially significant in light of the push for even veterans already being treated at the VA to have more options for care from civilian providers.

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More than 600 Fort Irwin soldiers and family members turned out for an open house at a Fort Irwin, CA, medical center last year. Teddy bears were used as “surrogate patients” to help children become comfortable with medical care. Army photo by Michael Beaton.

For the study, researchers used four different focus groups — two male veteran groups, one female veteran group and one comprised of veterans’ family members. Participants were asked about the collective healthcare experience and what participants perceived to be the gaps and needs in healthcare and mental healthcare provision.

Interestingly, the sample was recruited from veterans in the community and not from patients treated within the VHA.

“The VA research is important, but we don’t know if those findings can be generalized across the entire veteran population,” noted Butler, who is also the principal investigator of Joining Forces-UB, a combined nursing-social work team which seeks to better address the needs of veterans and military families through research and by developing training programs for students in both schools.

“Many people do not realize that only about one in three veterans turn to the VA for their health and mental healthcare and that most research on veterans is conducted with those in the VA system,” she pointed out. “This is why the research mission of our Joining Forces-UB project is so unique — we are seeking to better understand the needs of all veterans and military families by conducting community-based research.”

Butler emphasized, “Just as you want to be culturally competent working with any population, with veterans it is particularly important because they may shut you out if they suspect a lack of understanding. They’ll walk away.”

Veterans often feel as if civilian healthcare providers fail to understand their experience and context, according to the study.

“Providers who bring military/veteran cultural competence to their interactions with veterans have the potential to enhance outcomes and increase quality of care. This is in addition to preventing veterans from walking away from care that may be beneficial,” added co-author Braden Linn, a doctoral candidate in the UB School of Social Work.

Lack of cultural competence, however, means that healthcare providers are unaware of what questions to ask and what information to gather.

Except in a VA hospital, questions about a patient’s military service is rarely part of a patient’s intake, Butler said in a University of Buffalo press release, adding, “Providers outside of the VA often don’t think about a client having military experience or how that service might affect the veteran’s presenting condition; how to treat them; or how they’ll respond to treatment.

“The critical issue is to ask about past military service, and then follow up with questions about hazardous exposures that are known to be specific to their era of service — these are listed on the VA’s website. It is also important to have a basic knowledge of military culture and what that could mean for how veterans approach their health care.”

The study is entitled, “We Don’t Complain About Little Things”: Views of Veterans and Military Family Members on Health Care Gaps and Needs” – a comment that came up during research.

“That’s a quote from a veteran,” Butler recounted. “She was speaking to the lack of understanding often present in healthcare. She was saying that it takes a lot for a veteran to seek help and so a medical complaint should never be viewed as trivial.”

  1. Butler, LD, Linn BK, Meeker MA, McClain-Meeder K, Nochajski TH. “We Don’t Complain About Little Things”: Views of Veterans and Military Family Members on Health Care Gaps and Needs. Military Behavioral Health, 2015; 3 (2): 116 DOI: 1080/21635781.2015.1009209

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