title: Reducing barriers to mental health and social services for Iraq and Afghanistan veterans: outcomes of an integrated primary care clinic.
abstract: BACKGROUND
  Despite high rates of post-deployment psychosocial problems in Iraq and Afghanistan veterans, mental health and social services are under-utilized.
  
  
  OBJECTIVE
  To evaluate whether a Department of Veterans Affairs (VA) integrated care (IC) clinic (established in April 2007), offering an initial three-part primary care, mental health and social services visit, improved psychosocial services utilization in Iraq and Afghanistan veterans compared to usual care (UC), a standard primary care visit with referral for psychosocial services as needed.
  
  
  METHODS
  Retrospective cohort study using VA administrative data.
  
  
  METHODS
  Five hundred and twenty-six Iraq and Afghanistan veterans initiating primary care at a VA medical center between April 1, 2005 and April 31, 2009.
  
  
  METHODS
  Multivariable models compared the independent effects of primary care clinic type (IC versus UC) on mental health and social services utilization outcomes.
  
  
  RESULTS
  After 2007, compared to UC, veterans presenting to the IC primary care clinic were significantly more likely to have had a within-30-day mental health evaluation (92% versus 59%, p < 0.001) and social services evaluation [77% (IC) versus 56% (UC), p < 0.001]. This exceeded background system-wide increases in mental health services utilization that occurred in the UC Clinic after 2007 compared to before 2007. In particular, female veterans, younger veterans, and those with positive mental health screens were independently more likely to have had mental health and social service evaluations if seen in the IC versus UC clinic. Among veterans who screened positive for  ≥ 1 mental health disorder(s), there was a median of 1 follow-up specialty mental health visit within the first year in both clinics.
  
  
  CONCLUSIONS
  Among Iraq and Afghanistan veterans new to primary care, an integrated primary care visit further improved the likelihood of an initial mental health and social services evaluation over background increases, but did not improve retention in specialty mental health services.
authors.affiliation: San Francisco VA Medical Center, San Francisco, CA 94121, USA. Karen.Seal@va.gov
authors.forename: Karen H
authors.initials: KH
authors.lastname: Seal
authors.forename: Greg
authors.initials: G
authors.lastname: Cohen
authors.forename: Daniel
authors.initials: D
authors.lastname: Bertenthal
authors.forename: Beth E
authors.initials: BE
authors.lastname: Cohen
authors.forename: Shira
authors.initials: S
authors.lastname: Maguen
authors.forename: Aaron
authors.initials: A
authors.lastname: Daley
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D000554:Ambulatory Care Facilities / Q000639:trends; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated / Q000379:methods / Q000639:trends; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008605:Mental Health Services / Q000639:trends*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology; D011320:Primary Health Care / Q000379:methods / Q000639:trends*; D012189:Retrospective Studies; D012949:Social Work, Psychiatric / Q000379:methods / Q000639:trends*; D014728:Veterans / Q000523:psychology*; D055815:Young Adult