Jornal de Depressão e Ansiedade
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Collaborative Care for Returning Veterans

Christopher J. Miller, Sally Holmes, Carol VanDeusen Lukas and Mark S. Bauer

Background: Treatment of Returning Veterans (RVs) involves heterogeneous challenges including post traumatic stress disorder, traumatic brain injuries, and substance dependence. Individual RVs fall along a diagnostic and functional spectrum ranging from remarkably resilient to extremely impaired. Successful treatment requires systems capable of managing such complex, varied presentations and may require adaptations to meet the needs of this population. The Collaborative Chronic Care Model (CCM) may be useful in this regard.

Methods: We interviewed 20 staff members at a large urban VA medical center who care for RVs to determine strengths and areas for improvement. We used qualitative methods to assess whether the CCM could be applied to organize care to serve RV needs and prevent chronicity.

Results: Analysis of interview data and fit of emergent themes to CCM elements led to consensus that the CCM was likely to be an effective framework for organizing care of RVs provided certain adaptations are made. Need for adaptation was based on analysis of themes that did not match to CCM elements. Of these, “Unique Characteristics of RVs” and “Patient Engagement” were judged to be most essential to informing adaptations to the CCM.

Conclusion: Results show the CCM as likely to be an effective method of organizing care for this non-chronic population if expanded emphasis is placed on understanding unique population characteristics as a means of fostering patient engagement. Follow-up studies using RVs and other non-chronic populations as primary sources and testing of hypotheses at multiple sites would further clarify meaning and generalizability of these findings.