Veterans Focus Groups_Moderator Guide_COVER Commission

OMB Control Number: 2900-____

Estimated Burden: 120 minutes

Expiration Date: 06/30/2022

COVER COMMISSION

Veterans Focus Group

Moderator's Guide

1. WELCOME/BACKGROUND INFORMATION (5-10 minutes)

Welcome. Thank you for taking the time to participate in our focus group discussion for Veterans. My name is _________. I am here with my colleague _________and we work for an independent health consulting organization based in the Washington D.C. area. We are under contract to the VA to support the Creating Options for Veterans Expedited Recovery (COVER) Commission.

Before we get started, I must notify you that this information is being collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. The OMB control number is 2900-____.  We may not conduct or sponsor, and you are not required to respond to, a collection of information unless it has a valid OMB number. We anticipate that the time to complete the Focus Group will average two (2) hours. Your participation in the Focus Group is voluntary, and your decision to respond or not respond will not have any impact on your entitlement to benefits.

Information gathered will be kept private to the extent provided by law. The data we collect will be aggregated, and disclosure of information will involve the release of statistical data and other non-identifying data for improving the quality of service delivery. No information will be attributable to you as an individual.

The COVER Commission is mandated by the Comprehensive Addiction and Recovery Act of 2016 (known as CARA), Section 931 (Public Law 114-198) and charged to assess the services offered by VA facilities for treating mental health conditions of Veterans and the potential benefits of incorporating complementary and integrative health treatments available in VA and non-VA facilities.

The main purpose of this focus group discussion today is to hear your thoughts about the kinds of outpatient, inpatient, residential, complementary and integrative health (CIH) treatments of mental health concerns—like PTSD, depression, substance use disorder including opioid use, or any other mental health issues—you are receiving or have received in the past at [this VA facility] or any non-VA facility. We would also like to hear about your preferences in mental health treatment options, challenges related to seeking mental health care, and any suggestions for improvement of services.

Have any of you ever been in a focus group before? WAIT FOR RESPONSE/SHOW OF HANDS The purpose of focus groups is to get the honest opinions of small groups of people about a specific topic. These topics may range from what people think about a particular soft drink, soap product, or in our case, a far more important issue, mental health services offered to Veterans. Before we get started there are a few things I should mention.

• We will be using first names only today. Your participation is completely voluntary, refusal to participate will involve no penalty or loss of benefits to which you are otherwise entitled, and you may discontinue participation at any time. If you choose to participate, you don’t have to answer any of our questions that make you feel uncomfortable.

• Everything you say is confidential. We ask that each of you respect the privacy of the group participants and not discuss the opinions of others outside of this session.

• The only time we would need to break confidentiality is if we heard that someone was planning to harm him/herself or someone else. A primary benefit of your participation is that we learn valuable information to assist in improving Veteran mental health care; the main risk to you in participating is that you may feel uncomfortable sharing your experiences in front of others.

• We have contact information for the Veterans Crisis Line that we will share with you now should you ever need it. PROVIDE THE CONTACT INFORMATION TO THE PARTICIPANTS.

• There are no right or wrong answers. We are here to listen to your experiences and preferences so please feel free to tell us your thoughts, whether they are positive or negative.

• It is ok to disagree with one another. We want to hear everyone’s point of view. However, if you disagree, please do so respectfully.

• Only one person should talk at a time. If two people talk at once, it is difficult to hear and understand what everyone is saying. I may remind you of this during the discussion.

• We have a lot that we want to talk about today. So, do not be surprised if at some point I interrupt the discussion and change topics. But, if there is something important you want to say, let me know and you can quickly add your thoughts before we change subjects.

• Do not worry about offending us. We really want to learn from you and find out what you think about the issues we talk about today. Please tell us your honest opinions.

• After we conduct several of these group discussions, we will write a report describing what people have said. Your name will not appear anywhere in the report or in any other written documents.

This discussion will last about two hours. You will not get out any later than _______. We will be taking a formal break half-way through, but if you need to leave for a restroom break, the bathrooms are_____________. We will also ask you to complete a very short (5-minutes) anonymous survey at the end of the session.

With your permission, we would like to record this discussion. This recording will be used to help us recall exactly what was said when we summarize the themes of our discussion today. The recording will be destroyed after the Commission issues its final report.

ASK AGAIN IF THERE ARE ANY QUESTIONS. ANSWER ALL QUESTIONS.

I’d like to start the audio recording now. TURN ON RECORDER. For the purpose of the recoding I am going to ask each of you to state out loud if you are willing to participate in this discussion and if I have your permission to audio record this discussion. GO AROUND AND ALLOW EACH PARTICIPANT TO STATE THEIR AGREEMENT TO PARTICIPATE AND BE AUDIO-RECORDED.

II. INTRODUCTIONS (5 minutes)

Let’s get started.

START WITH THE PARTICIPANT TO YOUR RIGHT. HAVE THEM RESPOND IN ROUND ROBIN FASHION

1. Please tell me your first name, the years you served in the military, and the branch of service you were in.

III. MAIN FOCUS GROUP QUESTIONS

1. Finding Out About Veterans Mental Health Services (15 minutes)

Sometimes military service members and Veterans need support related to dealing with emotional or psychological stress and issues. I want to start by asking about your experiences finding out about mental health services offered to Veterans and their families. We are interested in hearing about your experience in both VA and non-VA facilities.

1. Overall, how easy do you think it is to find out about mental health services for Veterans?

2. Where do Veterans go to find out about available mental health services? How effective is this communication?

3. What could be done to make it easier to find out about mental health services for Veterans?

4. If VA wanted to inform more Veterans about mental health services what would be some good ways to do that?

2. Initial Experience in Using Services (15 minutes)

Now I want to turn to your experience with pursuing mental health services offered to Veterans. I want you to think back to when you first sought out these services.

1. (ROUND-ROBIN) Provide a brief description of your first experience in seeking out mental health services such as individual therapy, medication management, group therapy? NOTE: IF THEY RECEIVED SERVICES PRIOR TO LIVING IN THE AREA THEY SHOULD TALK ABOUT THEIR FIRST EXPERIENCES WHEN THEY ARRIVED HERE.

PROBE:

• How did you learn about these services?

• Was this at a VA facility? DoD facility? If not, why did you choose a non-VA facility?

2. What was your first step in pursuing these services? Were you already receiving VA care for something else when you first sought MH services?

PROBE:

• Internet, email, phone call, office visit?

3. What happened when you talked to someone about what you needed?

PROBE:

• What information were you provided?

• What kind of questions did they ask you?

• Were you asked to fill out a survey or questionnaire about what you were looking for?

• Did you feel like you were listened to and heard?

4. Was it hard to get mental health services? If so,

1. what was the thing that made it most difficult to get services?

5. Who or what helped you get services?

1. Who or what was the most helpful?

6. Can you tell us about the programs at this facility or at non-VA facilities that help to treat your mental health concerns?

1. What are the good things about these programs? What do you like?

2. What are some of the things that you don’t like about these programs?

3. What could work better? Do you have any recommendations for improvement?

7. Were you connected with any services outside the VA facility/organization where you first went for help? (e.g., housing, help with employment etc.) Please describe that experience.

3. Ongoing Experience with Mental Health Services including CIH (15 minutes)

Now I want to ask about your current experiences with receiving mental health services.

1. (ROUND-ROBIN) What mental health services are you currently receiving? Where are you receiving these services? At a CBOC? At a Vet Center?

IF NOT RECEIVING SERVICES AT THE VA, ASK WHY NOT?

1. Why do you think some Veterans are not coming to [this VA facility] for mental health services?

2. Do your mental health providers understand and value your military service?

PROBE:

• Transportation?

• Stigma?

• Not aware of available services?

• Quality of services?

• Have heard negative things in the media

• Too long of a wait to receive services

2. What services or treatment options were offered to you? Did your provider discuss your choices before beginning treatment?

   1. Were you offered medication? Individual psychotherapy? Group psychotherapy?

   2. Were you offered evening or weekend appointments?

   3. Were you offered telemental health care (telephone or CVT)?

3. Were you offered any complementary and integrative health (CIH) approaches as part of your treatment options? [PASS AROUND THE CIH CHECKLIST AND GLOSSARY AND GIVE EXAMPLES OF CIH TREATMENT] CIH treatments include acupuncture, tai chi, yoga, chiropractic, meditation, equine therapy, service dog therapy etc.

IF NO SKIP TO QUESTION 6

4. Did you choose any CIH approaches as a treatment option? Why or Why not? Please explain.

PROBE: Did you use it…

• Instead of some or all medications?

• For depression or anxiety?

• For stress reduction/relaxation?

• It was recommended by another Veteran

• For some other reason? Please explain.

5. Looking at the CIH checklist provided to you [SHOW/HOLD UP THE CHECKLIST], which CIH approaches have you used at [this facility]? If you have used any of these CIH therapies, please describe how they have helped you.

PROBE:

• Have you experienced any barriers to accessing any of these CIH therapies?

• Have you experienced any barriers in using any of these CIH therapies?

6. Have you used any of these CIH approaches at a non-VA facility? IF YES, why?

7. Have you used any CIH approaches not on this list? If so, please explain your experience and whether you believe it is a treatment that VA should offer to Veterans?

8. Would you be interested in trying or learning more about any of these CIH treatments? IF NOT, why not?

9. Would you like to see any of these approaches/treatments offered at [this VA facility] that is not currently offered?

10. For those of you who are receiving mental health care from more than one provider, do the VA providers share information about your care? Do your VA and non-VA providers talk to each other or share records or communicate in a timely way? What works well? What could work better?

BREAK (15 minutes)

We will take a 15-minute break, please be back by [GIVE AN EXACT TIME]

4. Quality of Mental Health Services (20 minutes)

Now I’d like to learn about your satisfaction with the mental health services you’ve received.

1. Overall how satisfied are you with the quality of the mental health services you’ve received at [this VA facility]?

Very satisfied____

Satisfied____

Neither Satisfied nor Dissatisfied_____

Dissatisfied____

Very Dissatisfied____

ASK PARTICIPANTS TO EXPLAIN THEIR RESPONSE

2. Do you think you are getting better as a result of the services you are receiving? Why or why not?

PROBE:

• Decrease in or less bothersome symptoms?

• Something you can do now that you were not able to do before you started receiving treatment? Better relationships?

3. FOR THOSE RECEIVING CIH TREATMENTS – how satisfied are you with the quality of the CIH treatments you’ve received at [this VA facility]?

Very satisfied____

Satisfied____

Neither Satisfied nor Dissatisfied_____

Dissatisfied____

Very Dissatisfied____

ASK PARTICIPANT TO EXPLAIN THEIR RESPONSE

4. Do you think you are getting better as a result of the CIH services you are receiving? Why or why not?

PROBE:

• Decrease in or less bothersome mental health symptoms?

• Something you can do now that you were not able to do before you started receiving treatment? Better relationships?

1. What works well about the CIH treatments you are receiving? What could work better?

2. What services, including CIH treatments, would you like that are not currently available to you here? Please explain.

5. What could [this VA facility] do to engage Veterans who may be in need of mental health services, but who are not contacting the VA for mental health services?

   1. What could your community do to assist Veterans in seeking help?

6. What are some goals and commitments that drive you to seek mental health care?

   1. What matters to you? Why do you want to be healthy?

4. CLOSING (10 minutes)

In thinking back over our discussion today, what is the most important message that you have for [this VA facility] and the Commission about how they can better serve you? Is there anything I haven’t asked about that you would like to tell me related to the topics we have discussed?

CHECK FOR QUESTIONS OR FOLLOW-UP FROM NOTE TAKER – COLLECT THE CIH CHECKLIST AND GLOSSARY DOCUMENTS AND PASS AROUND THE SHORT DEMOGRAPHIC SURVEY.

5. SURVEY (5 minutes)

We’ve come to the end of our questions, but before we stop I want to ask you to please

take a few minutes to complete this short survey. Be sure NOT to include your name on

that form.

The Commissioners are very grateful for your time and participation today. Your opinions will be used to improve the effectiveness of mental healthcare for you and your fellow Veterans.

Suggestions to decrease the burden for this Focus Group and other questions or comments can be sent to [email protected].

COVER Commission Veteran Focus Group Moderator Guide Page 12