1. NATIVE AMERICAN VETERANS’ USE OF VA SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES Bruce Kafer, RN, MSN, BSN, AAS Case Western Reserve University Department of Veterans Affairs

2. Purpose Statement To predict direct and indirect factors contributing to the use of VA substance abuse and mental health services among Native American Veterans. High military service rate, lower health literacy, 4x more likely to report unmet healthcare needs, historic access issues, tenuous relationship with the U.S. government.

3. PROBLEM Ongoing health disparities as evidenced by higher rates of substance abuse and mental illness. (Indian Health Service, 2000) “Cumulative emotional wounding over the lifespan and across generations resulting in a HISTORICAL TRAUMA RESPONSE (Brave Heart, 2000).”

4. All Veterans All Races / Ethnicities Grand Total American Indian and Alaska Native with and without Ethnicity 23,031,892167,679 100%0.73%

5. Design / Method Cross Sectional Correlation Design Secondary Data Analysis using U.S. Department of Veterans Affairs National Health Data of Native American veterans currently using VA SA/MH services.

6. Sample NA veterans currently using VA Healthcare services.

10. Independent Variables PREDISPOSING CHARACTERISTICS Age Marital status Religion Zip code Height Weight One race One or more races War Time Era Combat Need / Illness Level (Evaluated) ETOH Abuse PTSD Depression Schizophrenia Schizoaffective Bipolar Generalized Anxiety Disorder Axis II Disorders Borderline Personality Disorder Antisocial Personality Disorder Paranoid Personality Disorder GAF Traumatic Brain Injury Malignant Neoplasm Heart Disease * Liver Disease Unintentional Injuries Diabetes Hypertension Cerebrovascular Disease Kidney Disease Respiratory Disease * ENABLING CHARACTERISTICS Enrolled in VA Geographic Location

11. RESEARCH QUESTIONS Question 1 – Do predisposing characteristics, enabling characteristics, and need / illness level, directly or indirectly predict the use of VA SA/MH services among NA veterans? Question 2 – Do predisposing characteristics or enabling characteristics directly or indirectly predict need / illness level of Native American veterans? Question 3 – Do predisposing characteristics predict enabling characteristics of Native American veterans? Question 4 – Does the use of VA SA / MH services among Native American veterans explain predisposing characteristics, enabling characteristics, or need / illness level?

12. Dependent Variable = USE OF VA SA/MH SERVICES {Number of visits (encounters) within time period} Native American veterans USE of Substance Abuse Services and Mental Health Services

13. Analysis Multiple Regression Analysis Structural Equation Model

14. Gaining insight into factors associated with use of SA MH services may provide direction for strategic engagement, treatment, and retention among American Indian veterans. Increased fulfillment of the VA mission to be the principal health advocate for veterans and their families. Implications Increased awareness of Native American veterans’ use of substance abuse and mental health services will further VA’s ability to strategically plan and fulfill the mission.

15. “MITAKUYEPI AKICITA WOPILA HECA”