Digital Services Veterans Affairs (DSVA), VSA, Facility Locator
Leyda Hughes (leyda.hughes@adhocteam.us), 10/23/2020
As part of the larger discovery effort to understand the services offered by Vet Centers for the purpose of upgrading existing Vet Center facility detail pages, the goal of this study was to understand a Vet Center client’s experience, impression, and relationship with Vet Centers.
Prior to the study, we hypothesized that:
- Current clients have a favorable view of Vet Centers and the services that they offer and view them as distinct entities from other VA facilities.
- 45 minute generative questioning interview sessions conducted via Zoom
- Review of current Vet Center facility detail page
All participants:
- 15 Veterans (8 of which were confirmed to be Vet Center clients)
- Ages: 1-(25-34), 1-(35-44), 2-(45-54), 2-(55-64), 6-(65-74), 1-(75+), 2-(Undisclosed)
- 9-male, 6-female. Clients: 4-male, 4-female
- 5-Vietnam Veteran, 5-GWOT Veteran, 3-Undisclosed, 1-Army reservist (not deployed), 1-Marine (not deployed)
- 5-PTSD, 4-PTSD+MST, 4-Undisclosed, 1-MST.
Of the 8 Clients:
- Ages: 1-(25-34), 1-(35-44), 2-(45-54), 1-(55-64), 2-(65-74), 1-(Undisclosed)
- 5-GWOT, 1-Vietnam, 1-Army reservist (not deployed), 1-Marine (not deployed)
- 4-Caucasian, 2-Hispanic/Latino, 1-African American, 1-Native Hawaiian/Pac Islander
- All clients received group or individual counseling
- 7 major metro, 1 rural
- Wide range of disability ratings and cognitive disabilities
- 3-PTSD, 2-PTSD+MST, MST-1
- How do Veterans and service members first learn about Vet Centers?
- What is the client experience for different demographics?
- What services, resources or activities are most valuable to Veterans, service members and their families?
- How long do clients typically engage with Vet Centers and does their engagement or opinion of Vet Centers change over time?
- What information do Veterans and service members want or expect to see on a website?
- Clients have a favorable view of Vet Centers and the services that they offer: TRUE
- Clients view Vet Centers as distinct entities from other VA facilities: TRUE
- Vet Centers are not well known among Veterans.
- 8 of 8 Clients had a favorable view of Vet Centers.
- 7 of 8 Clients expressed being “separate from VA” as a key benefit of Vet Centers
- Clients feel deeply understood at Vet Centers
- Clients value the Veteran to Veteran approach to counseling, outreach and staffing of Vet Centers
- Veterans often need help with VA benefits and want to know what help is available at a Vet Center
- Military culture can be especially difficult for clients dealing with MST
- Clients would like to know the name and background of VC staff before calling or visiting
- 3 Clients were surprised to see employment referral as a Vet Center service
- 2 Clients called out flexibility in scheduling as a benefit that should be highlighted on a website
Non-clients confuse Vet Centers with any place you get medical care within the VA system. Most of the non-client participants were convinced that they had been going to Vet Centers. Of the 7 non-clients, only 1 was familiar Vet Centers.
How clients in this study learned about Vet Centers:
- 3-Referred by a VA medical professional (often another counselor)
- 2-Internet search
- 1-CBOC (2 negative experiences with CBOCS by MST participants)
- 1-Outreach event
- 1-Another Veteran
Clients value Vet Center’s unique ability to help Veterans with diverse needs, at different stages of their journey, navigate the transition to civilian life, especially when they had already hit brick walls with care or eligibility
How clients view Vet Centers:
"Just doing some internet research looking for resources that I could use to help me and my family with some issues we had been having. I went from 0 to 100 having stumbled upon it and having no expectations to advocating for it."
"I think with vet centers they do their best to help folks because it can be stressful when you have veteran friends that get benefits but you don't so you feel isolated or targeted because you don't get what they get. The vet center is able to show you that you can get help that is not contingent on va medical care."
"I can see how easily it is to walk out of the military with bad paperwork. I have seen really good guys get bad discharges that should have never gotten it. To watch them get hammered by the system for doing what everyone thinks it is right but the rules being the rules took it the other way. All veterans can benefits. [from Vet Centers]"
"[A Vet Center is] an institution that was established to respect the privacy of veterans that were distrustful of the VA hospitals. I held it in when it happened almost 30 years ago. [Of a Vet Center counselor:] I told her she saved my life because that’s how I feel."
This sentiment was expressed most often when asked “What is the most important thing for someone to know before visiting a Vet Center for the first time?” or when asked to compare a Vet Center with other VA facilities. What “separate from VA” means to a Veteran:
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Confidentiality - 5 of 8 Clients interviewed expressed the importance of privacy and confidentiality that Vet Centers provide. Veterans felt confident that counseling would remain “off the record” and could not be used against them. Privacy and confidentiality needs were expressed by 100% of the female participants in this study.
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Location and environment - The physical location being away from other VA facilities seemed to reinforce the sense of confidentiality for clients. Clients often mentioned the “small”, "warm", “intimate”, nondescript nature of a Vet Center that creates the “safe” environment that makes them comfortable. Many also mentioned that it wasn’t “big”, “intimidating” or “bureaucratic” like other VA facilities can be.
"Make sure they know they are separate from the VA and what you tell them is between you and them unless you want it in your VA records. A lot of people like the vet centers because they don't want it in the VA records."
"It is a smaller, tighter environment; I noticed that they schedule the appointment with very little people or no people at all in the waiting room so you don't need to worry about people hearing what your conversation is. With confidentiality it was a big thing for me and it is nice to have the privacy, at the Medical center it is a landmine, you have to go around a lot of veterans and the culture may be still ingrained into them. So that can mess up your day. With the Vet Center it is more private."
"I would say confidentiality, for myself when I started it was really important to me because of the military culture and my situation. I was worried that if I said anything I thought it would get back to the VA and would prevent me from benefits. I think most veterans are spooked and kind of in the mindset that what you said will be used against you. To let them know confidentiality is highly important."
Clients felt Vet Center staff and counselors do a good job of asking questions and understanding a Veteran’s context when assessing their needs and helping them find solutions.
"The VA has gotten better with bad paper discharges but there are still hard lines where anything less than an honorable discharge then they don't get services whereas Vet Centers are able to interpret what happened. Vet centers ask why they made them do it and they get the answers. The army, there is little room to recover or grieve. Like 45 minutes to grieve then get back out to the mission, we lost 19 guys and we had the highest casualty rate. You come in grieve then go back out to combat, you get water and eat, cry, and get back out there."
"I think the vet center can take in account what is occurring and with their training/understanding they can maybe take an errant comment like ‘I'm going to kick your ass’ [in stride] whereas if it is at a PCM appointment, it has to be taken at face value. A [Vet Center] counselor may have better understanding and get deeper without having to do a more formal reporting. Not that it isn't documented but they have better context if that makes sense"
"I think the folks at the vet center have worked in units or with veterans in general they are good at removing the fear and understanding where they are coming from and their thoughts. They are able to evaluate the fears for the veterans."
"I am not really a group person because I don't really like people... but I have found the women's group to be surprisingly wonderful and I can go and not feel judged or that it is too much. I am still a skeptic of group and not a big fan of it. Since my therapist forced me to go it is a pretty good thing, even though I won't tell her that."
5. Clients value the Veteran to Veteran approach to counseling, outreach and staffing of Vet Centers.
Shared military experiences helps to creates a sense of belonging and similitude among clients, especially those that engaged in group counseling. Sharing of their own personal experiences was the way most clients said that they would approach describing a Vet Center to friend who might benefit from contacting a Vet Center or to make them comfortable visiting.
"The vet center is where I felt like I belonged and not alone in what I was feeling. I am from a nonmilitary family so I came home feeling screwed up. Knowing that someone else has gone through it and has been there. I put myself out there so they know they aren't alone. The biggest thing is the stigma with mental health, you're not weak for asking for help. "
"I would tell them my experience, having a group of veterans from your era then the leader starts the topic and then talking about the issues like living with PTSD with family. It was instructional the first time I heard it because it was the same issues I was having. Meeting with people that you were in war with is the number one way to deal with it."
"That they are not alone and the Vet Center is the place to go to get help without judgement."
"The vet center for me was a great fit because we all are similar. Us taking care of us."
Many participants faced administrative challenges when dealing with VA benefits disability ratings, claims and eligibility that created barriers for them before they were able to begin managing their mental health. Clients valued the help that Vet Centers can offer in navigating the VA system for benefits but some were unaware of the help available to them. Participants wanted to see this spelled out more clearly.
"It doesn't seem like they can help with benefits at least not from what I am aware of."
"Most veterans need help with claims so if they help with va claims and appeals you need to say that and it be prominent. They are not VSO's like people that help with claims so if they are you need to spell that out."
"They did help me, I just had eligibility issues so they helped to provide records of my PTSD to further show that I deserve the care at the VA which is frustration that you need to prove and then do everything except give up your first born."
"they can access a liaison at the VA if needed. If you call and ask to talk to a counselor it's like jumping through 1000 hoops and the vet center can break those barriers and if you need to go to the VA the Vet center can work as a liaison for you."
In this study 4 of the 5 participants dealing with MST were also dealing with PTSD. In this study all MST participants were women and while the majority of these Veterans were satisfied with their care, they shared similar accounts of having to endure "military culture" which makes their situation extra challenging. Making this demographic feel comfortable is important to understand.
"I went to the VA, first and they always asked me if I'm here with my dad, or husband but I am like I spent this time in Iraq and you can't even respect me as a veteran so that's what changed now. [with Vet Center]"
"When me and my friend started working to get more women to use the VA, they changed the layout of the lobby so that when a female goes in there, you don't have to sit and listen to guys talking about who they screwed over the weekend. I don't have to sit in an environment like that. They starting putting signs up to watch your languages."
"After experiencing and going to the vet center it changed my thought. When I first heard of them it seemed like a place to hangout but due to my experiences, I didn't want to go hangout with a lot of bros and that were hanging out but not getting paid. I was surprised to learn it was more personalized and not so many people."
"For MST, they are going to be particular about the gender of the person, keyed in on how confidential it is. I can envision some that would be comfortable doing it in group but others that would be terrified of group sessions. Maybe spelling it out what resources for MST is available for the vet center and how it is different from the medical center would be useful."
8. Clients would like to know the name and background of VC staff before calling or visiting. 4 Clients offered this suggestion as a website improvement.
"I think that would lessen some of the unknowns, for me when I first went in I had very few expectations and was open to it but I didn't know what I was getting into so if I had the opportunity to learn a bit about the staff that were there I would have taken advantage and read it before my first visit. "
"Maybe one more thing, they could put the counselor's name and/or pictures of who are the people that operate that Vet Center, like introducing themselves and telling a little about themselves, so maybe the person will know who they are going to see, what to expect more or less. I look at this but I don't know who I'm going to meet, their experience or what they look like."
[After reviewing the list of services on Vet Center website] "That tracks with my understanding but I didn't know they did employment referral and that's what I actually do I work with job seeking veterans."
10. 2 Clients called out flexibility in scheduling as a benefit that should be highlighted on a website
"I also know that they have some flexible scheduling and make some appointments available to come in early or later in the day and weekend times but it is on a case by case basis."
"Another thing I don't like is the hours of operation, their hours are more broad and they have someone that stays late, if you are working 9-5 then you think this may not work for me because they end at 4:30. It doesn't give you the idea that someone is [available] there until 8pm. Stuff like that, you feel more comfortable calling in if I need a late appointment but this website doesn't indicate that."
1. Transitioning into civilian life can be lifelong. One Veteran mentioned waiting 50 years and another 30 years before finally seeking professional help to deal with their military trauma.
"I have been dealing with the PTSD since Vietnam and have just started talk to them last December so I have been hanging on and just letting it go for 50 years before I said something. "
"could alienate 90% of the veteran population because they may think that's were just combat guys go. The truth of the tell is that only 10% have had direct combat so the other 90% is just supporting them. "
" I have no idea. I wouldn’t even be eligible would I? The Vietnam era veterans that had used it prior to January 2013, I doubt that they kept my paper from that short time I went. "
"It is a tough thing because it depends where and when you service, character discharged, gender identity because some people have gotten bad discharges due to don't ask don't tell or being transgender."
"One of the biggest groups that were hit by it was the LQB community because of don't ask don't tell. "
"Also Homeless veterans because an issues people have at VA medical centers you have to go through red tape and if you are homeless the resources at the medical center you may not be eligible for if you didn't go to combat or were in the reserves so vet centers are better for the community resources and are not contingent on service obligations."
"Also focusing on MST, I think if there were a subpage for that because it has a whole lot of stigma and the servicemember/veterans suffering from MST. It is one of those things that it is a mind field as where they are and how they are coping with it. I think if there were maybe something that those that are suffering from it they could click on it and get a little more specific information about how a vet center may be able to offer them resources and service along the way."
"All veterans can benefits [from Vet Centers] but the MST portion of it, I don't know much about it but it is talked about heavily because the MST service is needed and you can come if that happens to you, it is away from the VA and the commands."
"Yes that is what my vet center offered except for MST because they didn't have a counselor for that. [wife was in need of this]"
"In all the time I have gotten care at the VA for mental health in the past 16 years I do not recall anyone saying anything about the Vet center. I don't think that is right. The psychiatrists are more into medication and the counselors do not mention it either and I think that is a failure on the VA's part because the groups aren't like the VA groups. They are better in some ways. That's all I have to say about that."
6. 4 clients believed Vet Centers could help all Veterans regardless of eligibility status. The other 4 had a more nuanced understanding of the combat or MST experience requirement.
7. Clients who'd tried group therapy at the VA preferred Vet Centers' affinity grouping approach over VA's mixing of Veterans of different eras.
9. Hearing loss made one Vietnam Veteran choose individual counseling over group and avid user of text over phone.
- Explore keyword search analytics, SEO, and search improvement opportunities to connect VC services to Vet needs, eg PTSD, MST [Language analysis to inform this]
- Improve findability of Vet Center locations from Google
- Stress 100% confidential
- Leverage by Veterans for Veterans mission statement on website
- Mirror Vet language in content writing [Language analysis to inform this]
- Give concrete examples of the types of benefit & employment help Veterans can expect
- Communicate Vet Centers’ intimate, casual, non-intimidating environment on website
- Highlight client testimonial on website
- List accurate examples of affinity groups available at each Vet Center
- Give MST a dedicated section or page with tailored information and imagery
- Highlight flexibility in scheduling
- List key personnel with a brief background on website
- Simplify and clarify eligibility with an emphasis on "just call, we'll help"
- Highlight Vet Center's inclusivity and broad ability to help Vets in need
- Share findings with stakeholders and discuss highest priority needs for MVP.
- Second pass language synthesis to inform any needed updates to health services taxonomy and copywriting for Vet Center website MVP
- Work with team to explore keyword, SEO, and search improvement opportunities to connect Veteran needs to Vet Center services
- Prototype Vet Center website MVP