Veterans’ Treatment Engagement and Dropout from Couple and Family Therapy in a Veterans Affairs Health Care System

Abstract

The present study utilizes data from a Couple and Family Therapy Program in the Veterans Affairs Health Care System (VAHCS) seeks to understand veterans’ and their family members’ treatment engagement and dropout from initial referral for therapy to the active phase of treatment. Veterans (N = 177) referred to couple or family therapy were included in the study, and data about session attendance was collected through chart reviews. About 60% of couples and families dropped out at some point between referral to entering the active phase of treatment. Results showed that the majority of dropout occurred between the phone screen and the first session, with significant attrition also occurring between the first session and the assessment phase of treatment. In examining individual, relational, and logistical factors, a chronic pain diagnosis and serving during the Post-9/11 era were related to completion of various phases of therapy. Findings have implications for enhancing efforts to engage and retain veterans and their family members in treatment. Specific strategies for clinicians are discussed, with a focus on the shift to telehealth in the VAHCS and other health care settings in response to the COVID-19 pandemic.

Keywords:

• Family (mental health therapy)
• pain
• Veterans Administration (VA)
• military spouses
• military families and children
• OEF
• OIF

Notes

1 The variable distance from clinic was obtained through using Google Maps and estimating the distance between the VA Health Care System and the city in which the veterans lived. Exact addresses were not used in calculating distance to protect veterans’ privacy.

2 To examine whether the same pattern of findings exist with only couples therapy cases (i.e., with family therapy cases removed), we conducted analyses with only the veterans enrolled in couples treatment (n = 164). We found that the original findings remained consistent in this smaller sample of couples, although the active phase chi-square is now at a p-value of .004 (slightly above the Bonferroni cutoff level of .003).

Analysis

Full sample (n = 177)

Couples Only (n = 164)

Active Phase: Era

χ2(1) = 9.43, p = .002

χ2(1) = 6.482, p = .004

Assessment Phase: Chronic Pain

χ2(1) = 9.07, p = .003

χ2(1) = 10.045, p = .002

No other analyses were significant at the p-value cutoff of .003 established a-priori for post-hoc tests.

3 This number includes one couple composed of a veteran transgender man and civilian cisgender women, as the veteran identifies as a man.

4 This number includes one couple composed of a veteran transgender woman and civilian cisgender man, as the veteran identifies as a woman.

5 This percentage includes veterans who are unemployed and retired, but may receive service-connected disability benefits.

6 Diagnoses were separated according to these 7 broad categories and dummy coded (1 = present, 0 = absent); thus, percentages will not add up to 100%

Additional information

Funding

Jerika C. Norona’s effort was supported by the Sierra-Pacific Mental Illness Education and Clinical Center (MIRECC). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Veterans Affairs or the United States Government.