Considering child care and parenting needs in Veterans Affairs mental health services
Introduction
Parenting and child care options for adults with mental illness are both relatively new areas that have begun to receive widespread attention (Belle, 1990, Mayberry and Reupert, 2009, Nicholson et al., 2009). While there has been more focus on child care for adults with severe mental illness (Blanch et al., 1994, Oyserman et al., 2000), adults with mental illness, in general, often need regular outpatient mental health treatment and their children can hinder their access and ability to take care of their own health needs (Alvidrez and Azocar, 1999, Gelberg et al., 1997). Child care options or the lack thereof among adults with mental illness and its potential to be a barrier to mental health services is a rather unexplored area.
In addition to their needs for child care, adults with mental illness often experience psychosocial and functioning impairments, which can lead to difficulties with parenting (Mullick et al., 2001, Stallard et al., 2004). Numerous psychological and genetic studies have also pointed to the higher risk for behavioral problems among children of parents with mental illness (Downey and Coyne, 1990, Goodman and Gotlib, 1999, Jaffee and Price, 2007), which in turn, can increase parenting difficulties. While this can be a sensitive topic (Aldridge and Becker, 2003, Hinshaw, 2004), certainly some adults with mental illness can benefit from parenting support and education.
One of the largest, integrated healthcare networks in the U.S. operated by the Department of Veterans Affairs (VA) is beginning to explore the possibility of supporting patients who are parents by offering child care on-site at VA facilities. The recent passage of the “Caregivers and Veterans Omnibus Health Services Act of 2010” (“Caregivers and Veterans Omnibus Health Services Act of 2010,” 2010) has allowed the VA to pilot child care for the first time and is intended to help veterans seek mental health treatment at VA facilities. In 2011, the VA initiated a 2-year pilot program to offer free drop-in child care services at three VA medical centers (U.S. Department of Veterans Affairs, 2011). It is unknown whether this will lead to expansion of child care services at other VAs nationwide and legislative changes would need to be made before that can happen.
Offering child care services on-site at health care facilities may represent a dramatic system change and may be especially important for the VA as female veterans have become a high priority population and one of the fastest growing groups using VA health care (Meehan, 2006, Yano et al., 2010). Women constitute 8% of all veterans (Yano et al., 2010) and 11% of veterans who have served in Iraq and Afghanistan (Women Veterans Health Strategic Health Care Group, 2008), but utilize VA health services at lower rates than their male counterparts, constituting less than 6% of service utilizers at VA facilities (Goldzweig, Balekian, Rolon, Yano, & Shekelle, 2006). The low utilization of VA mental health services among female veterans may be due to a number of factors, one of which may be that the VA serves a predominantly male patient population and so is not always an inviting or comfortable setting for female veterans. For example, a 2009 report by the Government Accountability Office found that none of the 19 VA facilities they visited were fully compliant with VA policy requirements related to privacy for women veterans (Williamson, 2009). Nonetheless, there is high medical and mental health comorbidity among female veterans and those who do use VA health services use outpatient services more heavily than male veterans, suggesting their need for services (Frayne et al., 2007).
The majority of female veterans currently accessing VA care are of child-bearing age (Women Veterans Health Strategic Health Care Group, 2008) and female veterans often serve as the primary caregivers for their children (Mattocks et al., 2011, Street et al., 2009). Aside from child care issues, female veterans may also experience unique parenting challenges post-deployment as many often return home to children exhibiting behavioral problems due to their absence (Kelley et al., 2001, Pierce et al., 1998), which can be particularly stressful for veteran mothers struggling with their own mental health issues.
A survey of over 2000 female veterans found that lack of information about the VA, perceptions of VA quality, and inconvenience of VA care, were deterrents to use of VA facilities (Washington, Yano, Simon, & Sun, 2006). Although lack of child care was not specifically examined, it may also have been a barrier to care and one that needs to be more thoroughly examined. The VA Advisory Committee on Women Veterans reported that “women veterans currently accessing VA healthcare services frequently cite the lack of child care as a major barrier to keeping their scheduled appointments” (Advisory Committee on Women Veterans, 2010, p. 8) and the Committee has recommended that the VA aim to diminish barriers to accessing VA services by providing child care options.
To better understand child care and parenting needs among veterans with mental illness, we conducted a brief survey using a convenience sample of veterans seeking mental health treatment at one VA hospital. While the sample may not be representative of the veteran population, it may shed light on the child care and parenting needs of female and male veterans currently seeking VA mental health services and highlight the role child care could play in improving services for veterans with mental illness as well as provide suggestions for future research and development.
Section snippets
Methods
Veterans seeking outpatient mental health care at the mental hygiene clinic (including the substance abuse firm) or the psychiatric rehabilitation center at the VA Connecticut Healthcare System were invited to complete a two-page survey of their child care and parenting needs. The VA Connecticut Healthcare System is located in the urban, medium-sized city of West Haven and is not one of the pilot sites for the 2-year VA child care program (although it originally expressed interest but lacked
Results
Of the total sample of 147 veterans, 52 (35.4%) veterans seeking VA mental health care reported they had children under the age of 18, although only 36 responded to all survey items for analysis. Of the 36 veterans that provided full data, 69.4% were male and 30.6% were female. The majority of respondents were White (52.8%) or African American (30.6%), with a mean age of 42.9 (sd = 14.2), and had one (40.0%) or two (37.1%) children with a mean age of 9.2 (sd = 5.7).
Table 1 shows the ratings of both
Discussion
This paper explores the perspectives of a convenience sample of veterans seeking mental health care at one VA medical care facility regarding their child care and parenting needs. Although the sample is small and may not be representative of all VA mental health clients, our findings may provide some insight about the potential of child care at the VA and stimulates needed discussion about the needs of mental health service users as parents. Moreover, to the best of our knowledge, there has
Lessons learned
Although the results of our brief survey suggest the potential of on-site child care at VA hospitals, we found in conducting this study that it was difficult to obtain a treatment-seeking sample of veterans who had children under the age of 18 and so more research is needed on a representative community sample of veterans. Given the large aging veteran population, there may be only a minority of veterans who may benefit from VA child care services, although undoubtedly, many will be those who
Conflict of interests
None of the authors report any conflicts of interest.
Disclaimer
This work was supported by the United States Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development. But the views presented here are those of the authors, alone, and do not represent the position of the United States Government.
Jack Tsai, Ph.D., is a Core Investigator for the Veterans Affairs New England Mental Illness Research, Education, and Clinical Center (MIRECC) and the Pain Research, Informatics, Medical comorbidities, and Education (PRIME) Center; and an Assistant Professor of Psychiatry at the Yale School of Medicine. He focuses on vulnerable populations and works to improve access and quality of health services for these populations.
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Jack Tsai, Ph.D., is a Core Investigator for the Veterans Affairs New England Mental Illness Research, Education, and Clinical Center (MIRECC) and the Pain Research, Informatics, Medical comorbidities, and Education (PRIME) Center; and an Assistant Professor of Psychiatry at the Yale School of Medicine. He focuses on vulnerable populations and works to improve access and quality of health services for these populations.
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