IOM Invitation Letter

Evaluation of the Department of Veteran Affairs Mental Health Services-OEF/OIF/OND Veterans’ Access to Health Services Survey
OMB No. 2900-xxxx
Estimated Burden: 35 minutes
Expiration Date: xx/xx/xxxx

The Paperwork Reduction Act of 1995: This information is collected in accordance with section
3507 of the Paperwork Reduction Act of 1995. Accordingly, we may not conduct or sponsor and you
are not required to respond to, a collection of information unless it displays a valid OMB number. We
anticipate that the time expended by all individuals who complete this survey will average 35 minutes.
This includes the time it will take to follow instructions, gather the necessary facts and respond to
questions asked. The purpose of this web-based survey is to help VA to better understand why
Veterans choose to use or not use VA mental health services available to them. The survey results will
lead to improvements in the quality of service delivery by helping to improve Veterans’ access to VA
mental health services. Participation in this survey is voluntary and failure to respond will have no
impact on benefits to which you may be entitled.

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ATTACHMENT 10
Data Analyses
Information will be collected from OEF/OIF/OND veterans using a survey as well as DOD and
VA administrative data. The survey will include all OEF/OIF/OND era veterans which will include
both individuals who have used VA mental health services and those who have not. The sample of
veterans will be representative of the population of OEF/OIF/OND veterans, and it will be large
enough to ensure the results will have adequate statistical precision for subgroups of interest. The
survey will collect information from OEF/OIF/OND VA-eligible veterans to assess and compare
between groups the following:
 Potential mental health needs,
 Perceived mental health needs,
 Future expectations for using VA mental health services,
 Pathways to mental health care, and
 Barriers to accessing, receiving, and continuing mental health care.
The administrative data will include demographic and military service information on all
OEF/OIF/OND era veterans. In addition, for those that use the VA, the administrative data will
include information on their utilization of services. These data will support both sampling for the
veteran survey as well as provide detailed information on service use patterns of VA users overall
and those who use mental health services.
Overall, a variety of analyses will be conducted using different subgroups of veterans and will make
comparisons between these subgroups. Descriptive analyses will be univariate and include describing
the sample in terms of their background characteristics and summarizing the responses to the survey
questions. As Table 1 shows, we plan to use three categories of background characteristics to
describe the sample: socio-demographic variables, military service history, and mental health status.
In addition to examining basic statistics for each of these background characteristics, we will also
provide basic counts of the survey responses to key questions regarding use of services, access,
experiences with the VA, reasons for not using the VA, barriers/facilitators (including alternative
pathways), and use expectations.
Table 1. Descriptive analysis variables
Background
characteristics
Socio-demographics
Military service

Variables
Gender, race, ethnicity, education, marital status, age band, economic
status, health insurance status, location (rural/urban flag based on zip
code)
Service branch, component, rank, combat exposure, number of
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Mental health status

deployments, cumulative length of deployments, and service-connected
disability status
Current mental health conditions based on screeners, past diagnoses
(administrative data), time period of past diagnoses, months in treatment

We will also use cross-tabulations to explore the basic relationships among questionnaire responses
and between the question responses and veterans’ background characteristics. For all crosstabulations between groups, we will use t-tests or an appropriate variant (for continuous variables)
and chi-square tests (for categorical variables) that take the sample design and weighting into
account. Additionally, we will use factor analysis and regression modeling to explore how barriers
and facilitators correlate with each other, to determine the factors that underlie mental health needs
and use, and to forecast future mental health needs.
More specifically, analysis of the survey data will focus on answering the research questions as
shown in Table 2. Additional ad hoc analyses will be generated as part of a collaborative process
between IOM and Westat to assure that study reports meet required needs.
Table 2. Analyses and subgroups used for answering the research questions
Groups
Analyses and key variables
What is the general mental health profile of the veteran population?
 Descriptive analyses (counts, frequencies, etc.) of the sample by:
o Background characteristics:
 Socio-demographics, military service, and mental health status
 For users of VA mental health services, differences between
All groups
screener results and diagnoses on administrative records
o Questionnaire responses
 Use of services, access, experiences with the VA ,
barriers/facilitators, reasons for not using the VA, use expectations
What is the potential need for mental health services? What is the perceived need?
Groups 1a, 1b,  Descriptive analyses of those who screen positive for a current mental health
2a
need or perceived need by:
o Same breakouts as above
Groups 1, 2
o Compare profile of those with current need to those with no current need
(denominator)
 Cross-tabulations of percentage with a current need by:
o Socio-demographics, military service, current mental health condition
group, perceived need, VA user group, past diagnoses, and
barriers/facilitators
 Logit model of the probability of having a current mental health need
What are future expectations for using VA mental health services?
 Descriptive analyses: of those who expect to seek care at all and at the VA; and
current VA mental health users
 Cross tabulations of percentage who intend to use services by:
All groups
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o User group, use of other VA services, socio-demographics, military service,
current mental health status, access issues, and barriers
 Multinomial logit model of the probability of using VA mental health services
Group 2
 Descriptive analyses of VA mental health users by:
o Average number of encounters and inpatient days; proportion who
terminated treatment early and reasons why
 Cross-tabulations of the above use measures by:
o Current verses past user, use of other VA services (non-mental health),
socio-demographics, military service, current mental health status, access
issues and barriers
What are the barriers to care? Pathways to obtaining services? Access issues? Satisfaction
levels?
Groups 1a, 1b,  Descriptive analyses of:
2a, 2b
o Barriers/facilitators (including pathways), access issues, and satisfaction
 Cross tabulations of barriers/facilitators (including pathways, access issues
and satisfaction by:
o User group, use of other VA services (non-mental health), sociodemographics, military service, mental health status
o Factor analysis of barriers/facilitators
Groups 1a, 1b  Descriptive analyses of:
o Reasons for not using the VA
 Cross-tabulations of reasons for not using the VA by:
o User group, use of other VA services (non-mental health), sociodemographics, military service, mental health status

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