1 00:00:01,025 --> 00:00:01,525 - And Dr. 2 00:00:02,185 --> 00:00:05,205 Zi a pleasure finding to have you, uh, to hear 3 00:00:05,315 --> 00:00:07,645 what I believe is an important topic on this evening. 4 00:00:08,285 --> 00:00:10,765 I am honored to share, uh, what I believe 5 00:00:10,765 --> 00:00:14,685 to be has been a very, very important, uh, research study, 6 00:00:15,305 --> 00:00:17,245 uh, supported by Charter University. 7 00:00:17,625 --> 00:00:19,605 And I'm delighted to share with you some 8 00:00:19,605 --> 00:00:22,365 of the findings on our topic, uh, today, 9 00:00:24,945 --> 00:00:27,725 the influences of intersectionality, theory 10 00:00:27,825 --> 00:00:28,805 and veteran healthcare 11 00:00:28,825 --> 00:00:30,765 post-transition barriers and challenges. 12 00:00:31,425 --> 00:00:33,405 It examines post-transition barriers 13 00:00:33,425 --> 00:00:35,565 and challenges experienced by military service 14 00:00:36,285 --> 00:00:38,325 veterans related to healthcare enrollment. 15 00:00:38,975 --> 00:00:43,085 Other study studies have examined similar issues as related 16 00:00:43,085 --> 00:00:44,165 to healthcare treatment. 17 00:00:45,145 --> 00:00:49,085 In this study, I compare self-reported data collected 18 00:00:49,085 --> 00:00:50,165 for health disparities 19 00:00:50,265 --> 00:00:53,005 and other concerns to examine the influence 20 00:00:53,005 --> 00:00:56,405 of intersectionality antecedent to the issues 21 00:00:57,805 --> 00:01:01,125 reported in prior research 22 00:01:01,125 --> 00:01:03,765 concerning VA healthcare system treatment. 23 00:01:04,635 --> 00:01:07,765 This, uh, this study adds to that body of knowledge 24 00:01:09,225 --> 00:01:11,885 on examination of the role of intersectionality 25 00:01:11,945 --> 00:01:14,645 as identified by age, gender, and race, 26 00:01:15,265 --> 00:01:16,885 and may have in the range of barriers 27 00:01:16,945 --> 00:01:21,205 and challenges noted by veterans at the point of entry 28 00:01:21,205 --> 00:01:23,245 before receiving VA healthcare treatment. 29 00:01:27,165 --> 00:01:31,205 A problem is to examine health equity disparity described in 30 00:01:31,205 --> 00:01:34,205 the national veteran, have equity research 31 00:01:35,145 --> 00:01:37,925 and is explained by intersectionality influences in 32 00:01:37,925 --> 00:01:38,965 post-transition, barriers 33 00:01:39,025 --> 00:01:41,725 and challenges antecedent to VA healthcare treatment 34 00:01:42,305 --> 00:01:45,325 for the purpose of examining the influence 35 00:01:45,325 --> 00:01:48,085 of intersectionality within the larger veteran community, 36 00:01:48,295 --> 00:01:50,685 antecedent to treatment in the VA healthcare system 37 00:01:51,265 --> 00:01:54,125 by testing for differences in veteran post-transition 38 00:01:54,365 --> 00:01:56,845 barriers and challenges by race and gender. 39 00:01:57,465 --> 00:01:59,965 And if the veteran is an African-American woman, 40 00:02:02,635 --> 00:02:05,165 This research examines post-transition barriers 41 00:02:05,305 --> 00:02:06,725 and challenges experienced 42 00:02:06,745 --> 00:02:09,005 by military service veterans related 43 00:02:09,005 --> 00:02:10,725 to healthcare enrollment. 44 00:02:11,375 --> 00:02:14,085 Other studies have examined these issues as related 45 00:02:14,085 --> 00:02:15,165 to healthcare treatment. 46 00:02:16,055 --> 00:02:18,185 This study adds to that body of knowledge 47 00:02:18,205 --> 00:02:22,185 and examination of the role intersectionality as defined 48 00:02:22,245 --> 00:02:25,265 by age, gender, and race, which may have in the range 49 00:02:25,265 --> 00:02:27,745 of barriers and challenges noted by veterans at the point 50 00:02:27,745 --> 00:02:31,705 of interview before re receiving VA healthcare treatment. 51 00:02:32,225 --> 00:02:34,785 A theoretical framework, uh, funnels the nature 52 00:02:34,785 --> 00:02:36,785 of hypothesis testing first 53 00:02:36,885 --> 00:02:38,945 for differences in post-transition, barriers 54 00:02:39,005 --> 00:02:41,265 and challenges by race, then by gender, 55 00:02:41,405 --> 00:02:44,225 and finally by if the veteran is an African American woman, 56 00:02:44,685 --> 00:02:47,545 and is designed to test for compounding differences 57 00:02:47,965 --> 00:02:50,745 as a marginalized population definition narrows 58 00:02:53,765 --> 00:02:56,185 our research question that hypothesis funnels 59 00:02:56,185 --> 00:03:00,165 to our intersectionality theory to examine, uh, 60 00:03:00,165 --> 00:03:02,605 that there is a significant difference 61 00:03:05,055 --> 00:03:07,795 in veteran post-transition barriers and challenges by race. 62 00:03:08,625 --> 00:03:10,915 That there is a significant difference in veteran 63 00:03:10,915 --> 00:03:13,555 post-transition barriers and challenges by gender. 64 00:03:14,215 --> 00:03:15,755 And due to intersectionality, 65 00:03:16,125 --> 00:03:20,275 there is a significant difference in veteran post transition 66 00:03:20,275 --> 00:03:21,315 varies and challenges 67 00:03:21,545 --> 00:03:24,955 between African American women veterans as compared 68 00:03:24,955 --> 00:03:26,355 to all other categories. 69 00:03:26,455 --> 00:03:30,995 As we follow into our intersection, um, theory, uh, we, uh, 70 00:03:31,195 --> 00:03:32,635 hypothesize on these, uh, components. 71 00:03:38,705 --> 00:03:40,365 Uh, patient diagnosis is d. 72 00:03:40,465 --> 00:03:43,485 We define our, our key terms as patient diagnosis, 73 00:03:43,775 --> 00:03:45,525 which are challenges used as our inde, 74 00:03:45,585 --> 00:03:46,765 our dependent variables. 75 00:03:47,215 --> 00:03:50,365 These are mental health diagnosis, substance use, 76 00:03:50,385 --> 00:03:52,565 dis dependency, and mental health diagnosis with 77 00:03:53,205 --> 00:03:54,285 substance use dependency. 78 00:03:54,635 --> 00:03:57,885 Each of these variables I dichotomous, uh, with a no 79 00:03:57,885 --> 00:03:58,885 or yes response. 80 00:03:59,585 --> 00:04:00,805 Our patient concerns 81 00:04:00,805 --> 00:04:03,685 or barriers used also as dependent variables. 82 00:04:03,905 --> 00:04:06,645 And these are homelessness, uh, programs, uh, 83 00:04:06,645 --> 00:04:08,925 the suicide ideation, suicide prevention 84 00:04:09,345 --> 00:04:12,405 and oral hotline, uh, the special emphasis, uh, 85 00:04:12,405 --> 00:04:17,085 and diversity, legal issues, legal concerns, rights 86 00:04:17,085 --> 00:04:19,005 and response, but rights 87 00:04:19,005 --> 00:04:22,205 and responsibility, discrimination service, animals, 88 00:04:22,295 --> 00:04:24,965 harassment and sexual harassment concerns. 89 00:04:25,035 --> 00:04:27,285 Each of these variables are also dichos 90 00:04:27,465 --> 00:04:29,365 and we respond to will a yes and no response. 91 00:04:32,355 --> 00:04:35,245 This is our, uh, literature that we found foundational 92 00:04:35,465 --> 00:04:37,085 for establishing our study. 93 00:04:38,445 --> 00:04:41,665 Uh, haw, uh, meet with our foundational study by Washington, 94 00:04:42,125 --> 00:04:45,145 uh, which was a, uh, veteran specific, uh, uh, 95 00:04:45,145 --> 00:04:46,385 study on that demographic. 96 00:04:49,315 --> 00:04:52,375 Uh, international theory examines how overlapping social 97 00:04:52,895 --> 00:04:54,015 identity, such as race 98 00:04:54,115 --> 00:04:57,415 and gender interact to create unique experiences 99 00:04:57,435 --> 00:04:59,135 of discrimination and privilege. 100 00:04:59,725 --> 00:05:01,095 This leads to the conclusion 101 00:05:01,095 --> 00:05:03,815 that African American women may experience unique health 102 00:05:03,815 --> 00:05:06,775 disparities transcending those experienced 103 00:05:06,835 --> 00:05:09,015 by race agenda independently. 104 00:05:09,875 --> 00:05:13,175 The National Veteran Health Equity Report of 2021 105 00:05:13,895 --> 00:05:16,215 reported the results of patient experience 106 00:05:16,215 --> 00:05:19,215 and healthcare quality within the VA healthcare system, 107 00:05:19,865 --> 00:05:22,695 Washington, who actually conducted these. 108 00:05:22,995 --> 00:05:27,015 The study of 2023 expanded on that research 109 00:05:27,075 --> 00:05:28,175 to extend the understanding 110 00:05:28,175 --> 00:05:30,935 of health equity concerns within the VA healthcare system. 111 00:05:31,445 --> 00:05:32,815 Regarding intersectionality, 112 00:05:33,435 --> 00:05:36,135 the foundational study determined that black American women, 113 00:05:36,415 --> 00:05:38,575 veterans of urban communities are treated according 114 00:05:38,595 --> 00:05:41,455 to their measures worse than their female counterparts. 115 00:05:44,065 --> 00:05:46,605 Our method, uh, a methodology is a quantitative 116 00:05:46,605 --> 00:05:50,085 cross-sectional, uh, design using secondary data, 117 00:05:50,665 --> 00:05:52,445 our design choices, the comparison 118 00:05:52,445 --> 00:05:56,165 of the means using thena art tests for body match pairs, 119 00:05:56,275 --> 00:05:59,925 data that was used to test each hospo hypothesis. 120 00:06:00,465 --> 00:06:03,165 In addition, a linear regression was used to test 121 00:06:03,165 --> 00:06:05,485 for control variables in interaction 122 00:06:05,635 --> 00:06:07,325 with each dependent variable 123 00:06:07,325 --> 00:06:10,245 of which we will specifically see those further into 124 00:06:10,265 --> 00:06:11,445 the presentation. 125 00:06:13,525 --> 00:06:16,505 Our overall population of interest is veterans 126 00:06:16,605 --> 00:06:19,265 who utilize the veteran administration healthcare system 127 00:06:19,845 --> 00:06:22,625 Within that population, the participants responded 128 00:06:22,625 --> 00:06:24,225 to a recent survey administered 129 00:06:24,225 --> 00:06:26,425 by the VA Healthcare Administration in the 130 00:06:26,425 --> 00:06:27,585 Western Pennsylvania region. 131 00:06:28,885 --> 00:06:32,895 Data was secondary de-identify, de-identified data collected 132 00:06:32,895 --> 00:06:34,615 by the United States Department of Veterans Affairs 133 00:06:35,125 --> 00:06:38,695 extracted from the patient advocacy, uh, tracking system. 134 00:06:39,555 --> 00:06:41,535 And I could add also that's vision four 135 00:06:41,595 --> 00:06:45,055 of the 22 visits in the country, more 136 00:06:45,055 --> 00:06:46,655 of the North northeastern region. 137 00:06:48,835 --> 00:06:52,575 Our data analysis and results, uh, would determine that, uh, 138 00:06:52,595 --> 00:06:57,455 of the 200 we had 86, uh, from the missing data, uh, that, 139 00:06:57,515 --> 00:07:01,895 uh, patient diagnosis, uh, are the most, uh, trans, uh, 140 00:07:02,955 --> 00:07:04,775 excuse me, patient diagnosis 141 00:07:05,805 --> 00:07:07,305 are the post-transition challenges 142 00:07:08,055 --> 00:07:10,225 used at dependent variables. 143 00:07:11,635 --> 00:07:15,425 These were mental health diagnosis, substance use, 144 00:07:15,475 --> 00:07:17,545 dependency, and mental health diagnosis 145 00:07:17,545 --> 00:07:19,025 with substance use dependency. 146 00:07:19,865 --> 00:07:24,025 Although there were some statistical different significance, 147 00:07:26,745 --> 00:07:27,965 Let me read that please again. 148 00:07:29,985 --> 00:07:32,985 Although there were some statistically significant 149 00:07:32,985 --> 00:07:34,665 differences by race and gender 150 00:07:34,845 --> 00:07:36,825 and African American women status, 151 00:07:39,675 --> 00:07:44,345 these effects were so small as to the of little meaning. 152 00:07:45,405 --> 00:07:47,145 Please forgive me, you don't have my phone. Sorry. 153 00:07:47,725 --> 00:07:52,185 Um, meaningful value and the, 154 00:07:52,645 --> 00:07:54,145 and are excluded from the summary. 155 00:07:55,445 --> 00:07:58,465 The patient concerns were barriers, uh, used 156 00:07:58,565 --> 00:08:00,685 as dependent variables. 157 00:08:00,815 --> 00:08:03,685 These are homelessness programs, suicidal ideation, 158 00:08:03,875 --> 00:08:07,085 suicide provision hotline, uh, special 159 00:08:08,085 --> 00:08:09,765 emphasis on diversity concerns, 160 00:08:09,765 --> 00:08:12,885 special emphasis on diver diversity, rights 161 00:08:13,465 --> 00:08:16,845 and responsibilities, discrimination, uh, service, 162 00:08:16,985 --> 00:08:19,365 animal harassment and sexual harassment. 163 00:08:21,455 --> 00:08:24,845 These concerns dealing with suicidal ideation, 164 00:08:25,205 --> 00:08:27,765 suicidal prevention hotline, special emphasis, 165 00:08:27,765 --> 00:08:30,165 diversity concerns, uh, service animals 166 00:08:30,165 --> 00:08:32,605 and sexual harassment concerns were reported 167 00:08:32,705 --> 00:08:36,405 by a very small percentage of participation, less than 5%. 168 00:08:36,425 --> 00:08:38,125 At a sample of 186. 169 00:08:38,585 --> 00:08:41,885 Uh, these results were excluded, uh, from evaluation 170 00:08:41,885 --> 00:08:45,445 because the sample was too small to, uh, for meaningful, uh, 171 00:08:45,565 --> 00:08:45,925 comparison 172 00:08:53,785 --> 00:08:55,365 And evaluation of our fund. 173 00:08:55,385 --> 00:08:58,845 Uh, findings on our first hypothesis, uh, determined 174 00:08:58,845 --> 00:09:01,845 that there were significant, uh, differences by race 175 00:09:02,105 --> 00:09:06,405 for legal concerns, rights and responsibilities, concerns 176 00:09:06,505 --> 00:09:07,845 and discrimination concerns. 177 00:09:08,065 --> 00:09:10,365 African-American participation, excuse me, 178 00:09:10,385 --> 00:09:12,965 African-American participants experiencing greater barriers 179 00:09:13,435 --> 00:09:14,485 than white participants. 180 00:09:14,715 --> 00:09:17,245 However, white participants reported a much higher 181 00:09:17,245 --> 00:09:19,005 experience of harassment concerns. 182 00:09:19,545 --> 00:09:21,965 Uh, our data, uh, I will highlight some of those numbers 183 00:09:22,025 --> 00:09:23,925 to the right, uh, there if you review that. 184 00:09:24,385 --> 00:09:29,015 Uh, some other time. For our second hypothesis, 185 00:09:29,015 --> 00:09:32,255 it was determined that men were much more likely 186 00:09:32,515 --> 00:09:35,455 to experience concerns about homelessness and legal issues. 187 00:09:36,025 --> 00:09:38,215 Women were more likely to experience concerns 188 00:09:38,215 --> 00:09:39,535 regarding rights and responsibilities, 189 00:09:39,535 --> 00:09:41,655 discrimination and harassment. 190 00:09:44,795 --> 00:09:48,655 And our third hypothesis due to intersectionality, 191 00:09:48,945 --> 00:09:51,015 there is a significant, uh, 192 00:09:51,135 --> 00:09:53,215 significant difference in veteran post-transition barriers 193 00:09:53,215 --> 00:09:55,455 and challenges between African-American women veterans 194 00:09:55,835 --> 00:09:57,975 as compared to all other categories. 195 00:09:58,475 --> 00:10:01,095 Uh, African-American women, veterans were much more likely 196 00:10:01,195 --> 00:10:04,055 to experience concerns, uh, regarding rights 197 00:10:04,055 --> 00:10:05,655 and responsibilities and discrimination, 198 00:10:05,655 --> 00:10:08,695 and much less likely to experience concerns with legal 199 00:10:09,355 --> 00:10:12,735 issues or harassment, as compared to participants 200 00:10:12,755 --> 00:10:15,535 who were not African American women veterans. 201 00:10:17,915 --> 00:10:20,335 The depth of the data set limited the ability 202 00:10:20,475 --> 00:10:22,535 to fully explore all areas of interest 203 00:10:22,955 --> 00:10:26,495 or to definitively accomplish a objective 204 00:10:26,495 --> 00:10:28,055 of determining if the findings 205 00:10:28,875 --> 00:10:31,775 of the National Veteran Health Equity Report of 2021 206 00:10:31,775 --> 00:10:36,055 and the Washington, um, VA report research is explained 207 00:10:36,055 --> 00:10:37,695 by intersectionality influences 208 00:10:38,075 --> 00:10:40,815 and post-transition barriers, intelligence antecedent 209 00:10:40,815 --> 00:10:41,815 to VA healthcare treatment. 210 00:10:42,225 --> 00:10:44,375 There were simply not enough responses 211 00:10:44,375 --> 00:10:48,255 to make meaningful findings in many relevant areas. 212 00:10:49,955 --> 00:10:52,615 The implications for our theory, uh, 213 00:10:52,615 --> 00:10:57,015 these findings are consistent with both critical 214 00:10:58,125 --> 00:11:00,175 race theory and intersectionality. 215 00:11:00,885 --> 00:11:03,655 Also, we did include to other theories, uh, 216 00:11:03,655 --> 00:11:06,215 which was the theory of change, uh, 217 00:11:06,215 --> 00:11:09,375 which was based on a study by the Annie Casey Foundation, 218 00:11:10,155 --> 00:11:13,615 and also the, um, there was the 219 00:11:15,005 --> 00:11:17,465 social change, uh, social social change theory 220 00:11:17,465 --> 00:11:20,225 that had been, uh, uh, discussed as a potential, uh, 221 00:11:20,305 --> 00:11:24,505 a theory to look at for, um, how intervention could, 222 00:11:24,595 --> 00:11:27,225 could become part of a future study. 223 00:11:28,495 --> 00:11:31,585 However, there were areas that seemed to, 224 00:11:34,535 --> 00:11:35,985 However, there are areas 225 00:11:36,055 --> 00:11:37,385 that seem on the surface is 226 00:11:37,385 --> 00:11:38,625 consistent with critical race theory. 227 00:11:39,075 --> 00:11:41,865 White participants reported a much higher experience 228 00:11:41,865 --> 00:11:45,425 of harassment concerns compounding toward white women. 229 00:11:45,745 --> 00:11:46,825 Veterans men were more likely 230 00:11:46,845 --> 00:11:48,865 to experience concerns about homelessness 231 00:11:49,585 --> 00:11:51,265 compounded toward white men. 232 00:11:52,005 --> 00:11:55,405 The sample was small, so these may be an anomalies. 233 00:11:55,785 --> 00:11:58,005 It could also be a reflection on traditional role 234 00:11:58,075 --> 00:12:01,765 stereotypes, as men are more apt to view themselves 235 00:12:01,945 --> 00:12:04,085 as responsible for sheltering families, 236 00:12:04,085 --> 00:12:06,085 and most of the participants being 237 00:12:06,105 --> 00:12:09,405 of middle age may have been more likely to hold these views. 238 00:12:09,745 --> 00:12:11,205 It is important to keep in mind 239 00:12:11,325 --> 00:12:14,165 that participants were limited to a single concern. 240 00:12:14,225 --> 00:12:16,525 So it may reflect what is foremost in their mind, 241 00:12:16,905 --> 00:12:18,845 not necessarily the full experience. 242 00:12:19,585 --> 00:12:20,885 In those areas of concern 243 00:12:20,885 --> 00:12:23,805 where white participants marginally see more affected than 244 00:12:23,865 --> 00:12:25,245 African-American participants, 245 00:12:25,505 --> 00:12:28,325 it may reflect areas in which they perceive increased 246 00:12:28,645 --> 00:12:31,205 pressures of feelings of anxiety as compared 247 00:12:31,225 --> 00:12:34,325 to the other areas of concern in which African Americans 248 00:12:34,525 --> 00:12:37,685 perceive greater increased pressures of feelings of anxiety. 249 00:12:40,625 --> 00:12:44,085 Uh, any places for practice will give our, uh, 250 00:12:45,425 --> 00:12:47,445 the professional community a better understanding 251 00:12:47,465 --> 00:12:49,365 of the influence of intersectionality, 252 00:12:50,055 --> 00:12:52,285 which enables healthcare workers to grasp 253 00:12:55,625 --> 00:12:57,565 the nuances of each patient's identity 254 00:12:57,585 --> 00:12:59,565 and how these intersecting identities 255 00:12:59,565 --> 00:13:01,405 influence their health outcomes. 256 00:13:01,545 --> 00:13:04,285 For example, an African American woman veteran may have 257 00:13:04,725 --> 00:13:06,605 obstacles that are distinct from those 258 00:13:06,625 --> 00:13:08,085 of other parent patients. 259 00:13:10,665 --> 00:13:13,845 Uh, implications for, for future research, uh, 260 00:13:13,845 --> 00:13:15,485 were based on the findings of the study 261 00:13:15,595 --> 00:13:18,445 that introduced a unique character characterization 262 00:13:18,505 --> 00:13:20,805 for understanding the intricate details 263 00:13:20,835 --> 00:13:22,845 that are established from the specific demographic 264 00:13:22,845 --> 00:13:25,765 and subgroups as ability to intersectionality. 265 00:13:26,345 --> 00:13:27,685 It addressed knowledge gaps 266 00:13:27,905 --> 00:13:30,565 for understanding the problem omitted in present research. 267 00:13:31,065 --> 00:13:34,085 The data collected in this study compares other studies 268 00:13:34,135 --> 00:13:36,805 being the most recent with a potential model 269 00:13:36,805 --> 00:13:39,165 for geographical spec spec specificity. 270 00:13:41,435 --> 00:13:43,125 Some of the limitations, um, 271 00:13:43,475 --> 00:13:46,285 that we are have listed here are the key character 272 00:13:46,505 --> 00:13:50,245 characteristics of the sample may not be generalizable 273 00:13:50,265 --> 00:13:51,365 to the larger population. 274 00:13:51,425 --> 00:13:55,805 If there is a potential for selection bias, a longitudinal, 275 00:13:56,185 --> 00:13:59,925 uh, design may offer deeper insight into the evolving 276 00:13:59,925 --> 00:14:02,565 experiences of veterans post transition. 277 00:14:03,335 --> 00:14:05,525 Since data is collected from the Western Pennsylvania 278 00:14:05,525 --> 00:14:07,285 region, only experience 279 00:14:07,285 --> 00:14:10,565 of the target population may differ from those of regions 280 00:14:10,565 --> 00:14:12,845 and other vectors in other regions. 281 00:14:12,845 --> 00:14:15,245 And availability of data in the economist format 282 00:14:15,785 --> 00:14:18,165 is less robust than might be possible in a 283 00:14:18,775 --> 00:14:20,205 multi valve scale. 284 00:14:20,345 --> 00:14:23,645 And I would also like to note that, uh, I discovered from, 285 00:14:24,025 --> 00:14:25,245 uh, the data set was 286 00:14:25,245 --> 00:14:29,125 that it was a recently established data set, uh, since 2023. 287 00:14:29,425 --> 00:14:33,685 So there may be, uh, a future, uh, data to be, uh, 288 00:14:34,155 --> 00:14:37,085 extracted as time as they continue to collect data, uh, 289 00:14:37,085 --> 00:14:41,725 from this, uh, particular tracking system system. 290 00:14:41,725 --> 00:14:43,365 The future research recommendations, 291 00:14:44,625 --> 00:14:47,645 the research into the unexpected findings, legal concerns 292 00:14:47,645 --> 00:14:50,165 of African American male participates 293 00:14:50,385 --> 00:14:53,005 and respite concerns for white female participants. 294 00:14:54,615 --> 00:14:55,985 Primary data collection 295 00:14:55,985 --> 00:14:58,265 of which the participants could rank the importance 296 00:14:58,365 --> 00:15:01,185 and degree of concern, rather than being limited 297 00:15:01,325 --> 00:15:02,385 to a single concern, 298 00:15:02,715 --> 00:15:05,825 would yield improved results in estimating the 299 00:15:06,425 --> 00:15:08,145 relative importance by race and gender. 300 00:15:08,245 --> 00:15:11,665 And in terms of adding depth to the degree of the concern, 301 00:15:11,725 --> 00:15:14,505 rather than just the presence of the concern, 302 00:15:15,035 --> 00:15:18,425 mixed methods research could also add greater context 303 00:15:18,605 --> 00:15:19,785 to the findings as well. 304 00:15:24,675 --> 00:15:27,725 That concludes the narrative 305 00:15:27,865 --> 00:15:30,365 and the findings of our analysis, 306 00:15:30,625 --> 00:15:32,005 and I would like to open up 307 00:15:32,025 --> 00:15:33,565 to any questions from the committee. 308 00:15:34,185 --> 00:15:36,125 And thank you for your attention and listening. 309 00:15:36,205 --> 00:15:38,765 I hope there was some added, uh, interest, uh, 310 00:15:38,765 --> 00:15:40,725 that were given by some of the things that we've able 311 00:15:40,725 --> 00:15:41,805 to discover in this study. 312 00:15:43,995 --> 00:15:45,725 - Okay. - Great job, Kathy. 313 00:15:46,225 --> 00:15:48,725 And, um, I'll be taking notes so you don't have to take them 314 00:15:48,725 --> 00:15:50,165 as we go through the Q&a period. 315 00:15:50,665 --> 00:15:52,485 And Dr. Carter, would you like to begin? 316 00:15:56,305 --> 00:15:58,085 - Yep, absolutely. Great presentation. 317 00:15:58,135 --> 00:16:00,765 Kathy, I, I wish we could have recorded this one 318 00:16:00,765 --> 00:16:02,165 because you did a, a fantastic job. 319 00:16:02,165 --> 00:16:03,325 That was perfect. 320 00:16:04,145 --> 00:16:07,685 Um, I have a question on this slide here. 321 00:16:07,945 --> 00:16:09,565 You say the key characteristics 322 00:16:09,705 --> 00:16:11,885 of the sample may not be generalizable 323 00:16:11,885 --> 00:16:12,885 to a larger population. 324 00:16:12,905 --> 00:16:14,005 Can you tell me a little bit about that? 325 00:16:14,385 --> 00:16:17,485 - Yes, because the, the, uh, data is collected, uh, 326 00:16:17,485 --> 00:16:20,845 regionally, uh, there are 22, uh, visits in the country. 327 00:16:21,465 --> 00:16:23,845 Uh, these particular demographics consist 328 00:16:23,925 --> 00:16:28,285 of six facilities within a, a particular, uh, um, network. 329 00:16:28,785 --> 00:16:31,245 Uh, the veteran, the Veterans Integrated Service Network, 330 00:16:31,695 --> 00:16:34,085 which is based out of Pittsburgh, the Western region. 331 00:16:34,185 --> 00:16:36,245 So they were collecting data through this, uh, 332 00:16:36,825 --> 00:16:38,525 the single data collection system, 333 00:16:38,695 --> 00:16:40,725 which they were joined from six facilities 334 00:16:40,725 --> 00:16:41,925 throughout the state of Pennsylvania. 335 00:16:42,585 --> 00:16:45,885 So it wasn't significant enough of the data, 336 00:16:46,505 --> 00:16:51,165 did not have a broad enough reach, uh, to characterize it 337 00:16:51,165 --> 00:16:52,165 to a larger population, 338 00:16:52,165 --> 00:16:55,245 because each demographic across the country in the business, 339 00:16:55,305 --> 00:16:58,605 uh, would, would, would, would be assumed to have different, 340 00:16:58,865 --> 00:17:01,485 uh, demographics, and they would be responding 341 00:17:01,485 --> 00:17:02,645 differently based on that. 342 00:17:02,825 --> 00:17:06,325 Uh, I believe that would be sufficient to, uh, respond in 343 00:17:06,325 --> 00:17:10,085 that way because what I do understand about the 22 million, 344 00:17:10,505 --> 00:17:14,045 uh, veterans that are enrolled within the VA system, uh, 345 00:17:14,045 --> 00:17:16,005 many of these, uh, various visits, 346 00:17:16,185 --> 00:17:17,765 the Veterans Integrated Service Network, 347 00:17:17,995 --> 00:17:19,925 they are not collecting data, 348 00:17:20,335 --> 00:17:24,125 which made this particular study, uh, being recently, uh, 349 00:17:24,225 --> 00:17:26,285 one that is start to track this particular data 350 00:17:26,285 --> 00:17:28,885 through this, uh, patient advocacy TRA system. 351 00:17:29,585 --> 00:17:32,325 It would, uh, it would become somewhat of a model. 352 00:17:32,525 --> 00:17:33,845 I think they're going to start to adopt. 353 00:17:33,845 --> 00:17:36,485 This has been significant for getting some of that, uh, 354 00:17:36,515 --> 00:17:37,765 more detailed and start 355 00:17:37,765 --> 00:17:39,485 to highlight some of these other concerns. 356 00:17:41,795 --> 00:17:43,285 - Okay. Fantastic. That's a great answer. 357 00:17:43,525 --> 00:17:45,685 I I think that you could also put 358 00:17:46,035 --> 00:17:49,165 that paragraph in your limitations in there, there, 359 00:17:49,165 --> 00:17:53,165 because I Yes, I can extrapolate, but that's, and, 360 00:17:53,185 --> 00:17:54,925 and when you explain it, it's like, oh, 361 00:17:54,955 --> 00:17:56,125 yeah, that definitely makes sense. 362 00:17:56,365 --> 00:17:59,245 I, I might even just add a, a bit of what you said there, 363 00:17:59,245 --> 00:18:01,765 because that makes perfect sense, 364 00:18:01,825 --> 00:18:04,325 and it almost took to add that, um, 365 00:18:05,835 --> 00:18:08,805 that exclamation point onto chapter five, 366 00:18:08,855 --> 00:18:10,325 which we really want to, and, 367 00:18:10,385 --> 00:18:12,965 and a lot of times once we get to, you know, we get 368 00:18:12,965 --> 00:18:15,885 through our data analysis in chapter four, we, 369 00:18:16,555 --> 00:18:19,925 that momentum in chapter, I think that would really help 370 00:18:19,995 --> 00:18:23,445 that exclamation point in your, in your chapter five. 371 00:18:24,345 --> 00:18:29,085 Um, so for, I, I've got your future research, 372 00:18:29,915 --> 00:18:34,245 what do you think can be done in, um, in practice? 373 00:18:36,305 --> 00:18:40,365 - We do understand that as the population grows with the, 374 00:18:40,745 --> 00:18:44,965 uh, accessible accessibility, uh, for the veterans, I think, 375 00:18:45,345 --> 00:18:48,045 uh, what has been discussed and what's, 376 00:18:48,145 --> 00:18:52,925 and much of the, uh, sources that we were able to, 377 00:18:53,665 --> 00:18:57,925 uh, learn from about the various, uh, facilities 378 00:18:58,275 --> 00:19:03,245 that the training, uh, on particular areas 379 00:19:03,315 --> 00:19:05,765 with regard particularly to, uh, military sexual trauma, 380 00:19:05,815 --> 00:19:09,205 which was one of the, uh, issues we found 381 00:19:09,205 --> 00:19:11,605 that was fundamental to each facility, that 382 00:19:11,605 --> 00:19:14,085 that was an underlying, uh, issue with many 383 00:19:14,085 --> 00:19:15,205 of those reported male 384 00:19:15,265 --> 00:19:17,685 and female who had experienced military sexual trauma. 385 00:19:18,105 --> 00:19:20,365 So I think, uh, what would be 386 00:19:21,545 --> 00:19:25,965 of importance would be training at the providers have 387 00:19:27,025 --> 00:19:28,765 not only combat specific training, 388 00:19:29,545 --> 00:19:33,165 but with regards to some of the post transition barriers 389 00:19:33,185 --> 00:19:36,725 and challenges, there has to be some interconnectivity 390 00:19:36,785 --> 00:19:40,045 to the community and the other stakeholders that could, uh, 391 00:19:40,445 --> 00:19:42,125 actually bridge some of these, uh, service gaps. 392 00:19:43,025 --> 00:19:45,445 So I think there needs to be a lot more conversation about 393 00:19:45,445 --> 00:19:48,325 what that need is, uh, so that they can understand how 394 00:19:48,345 --> 00:19:51,205 to address a particular population, which is 395 00:19:52,145 --> 00:19:54,685 un uncharacterized in the general population. 396 00:19:54,785 --> 00:19:57,205 Uh, the veterans are becoming more pronounced in communities 397 00:19:57,225 --> 00:19:59,685 now that they can demonstrate 398 00:19:59,785 --> 00:20:02,365 and articulate some of their more distinct, uh, needs. 399 00:20:02,825 --> 00:20:04,965 And I think that needs to, uh, be assessed on a, 400 00:20:05,045 --> 00:20:08,285 a larger scale, uh, so that there could be training, uh, 401 00:20:08,285 --> 00:20:11,125 intervention, uh, particular strategies 402 00:20:11,125 --> 00:20:13,165 that could address this particular demographic, uh, 403 00:20:13,165 --> 00:20:15,845 based on, uh, some of the things that they are reported. 404 00:20:15,845 --> 00:20:17,605 This is a self-reporting, uh, system 405 00:20:17,645 --> 00:20:18,725 where we've learned this data. 406 00:20:19,145 --> 00:20:21,685 So I think that the, now that the, uh, 407 00:20:21,685 --> 00:20:23,325 voice is coming from the veteran themselves, 408 00:20:23,325 --> 00:20:25,525 that could be a, a, a stronger interaction 409 00:20:25,775 --> 00:20:28,485 where the veteran is actually speaking from work, their own 410 00:20:28,585 --> 00:20:30,045 and needs may could be assessed. 411 00:20:30,605 --> 00:20:31,605 I think that would be important. 412 00:20:34,925 --> 00:20:37,765 - I think that could really help 413 00:20:37,785 --> 00:20:39,405 to add some to your, your paper . 414 00:20:39,805 --> 00:20:40,765 I know you have a section on 415 00:20:40,765 --> 00:20:42,245 recommendations for future research. 416 00:20:42,325 --> 00:20:43,725 I think you could have a recommendations 417 00:20:43,725 --> 00:20:44,805 for future practice too, 418 00:20:44,805 --> 00:20:47,525 because like, like you said, this isn't a problem. 419 00:20:47,635 --> 00:20:51,445 This is an issue. So I think you're on the road to solving 420 00:20:51,445 --> 00:20:54,365 that, and I, I think that would make a really good, um, 421 00:20:55,105 --> 00:20:57,845 or at least in the conclusion, if, if nothing else, I think 422 00:20:57,845 --> 00:20:59,925 that would be great to add that that in there. 423 00:21:00,505 --> 00:21:04,045 Um, what do you think was the hardest part of your study? 424 00:21:05,275 --> 00:21:07,965 - Once we were able to retrieve the data, uh, 425 00:21:08,095 --> 00:21:12,045 which came kind of somewhat, uh, at, towards the end of the, 426 00:21:12,465 --> 00:21:15,955 uh, uh, um, the academic, uh, um, 427 00:21:17,485 --> 00:21:20,995 study, the need to have the data to 428 00:21:22,185 --> 00:21:27,155 make it relevant today, I had that conversation, 429 00:21:27,455 --> 00:21:29,035 uh, with several people before. 430 00:21:29,355 --> 00:21:33,395 I believe it was really, actually understood the relevance 431 00:21:34,055 --> 00:21:38,715 for, Uh, well, the pri the, the most previous data, 432 00:21:38,915 --> 00:21:41,635 I will say was from 2024, 433 00:21:42,455 --> 00:21:45,115 but it did not extend to the level 434 00:21:45,115 --> 00:21:47,395 where it was the veteran themselves reporting. 435 00:21:47,815 --> 00:21:50,115 It was somewhat of a, uh, more professional 436 00:21:50,295 --> 00:21:52,995 or, um, facility assessment. 437 00:21:53,815 --> 00:21:57,475 So I think getting the data helped us to see more clearly, 438 00:21:58,175 --> 00:21:59,875 uh, for highlighting some of the specifics. 439 00:21:59,875 --> 00:22:04,195 So once we were able to, uh, retrieve that data, uh, and, 440 00:22:04,215 --> 00:22:07,635 and create that relationship with the va, uh, that I think 441 00:22:07,635 --> 00:22:09,555 that we had crossed a really major hurdle there. 442 00:22:09,615 --> 00:22:12,995 So I think that, uh, once, once we recognized 443 00:22:12,995 --> 00:22:17,815 that the data itself, uh, actually, uh, was, it fills 444 00:22:17,815 --> 00:22:21,295 so many gaps just to see what it was we were talking about. 445 00:22:21,395 --> 00:22:22,615 It was no longer speculation, 446 00:22:22,615 --> 00:22:25,655 but we actually had real data, um, with that, 447 00:22:25,655 --> 00:22:27,775 that particular challenge was minimized with that. 448 00:22:27,915 --> 00:22:31,495 So, uh, we actually concluded, uh, with getting the data 449 00:22:31,635 --> 00:22:35,255 as being, uh, very satisfactory for, uh, overcoming that, 450 00:22:35,255 --> 00:22:38,655 that, that what was, what that prior been a major hurdle. 451 00:22:39,355 --> 00:22:40,535 So it was getting the data. 452 00:22:43,355 --> 00:22:45,175 - So what future, what advice would you give 453 00:22:45,175 --> 00:22:47,215 to future students who, uh, 454 00:22:47,385 --> 00:22:51,255 might be doing either a study like yours or similar? 455 00:22:52,435 --> 00:22:55,935 - Um, I, I researched quite a bit across the, uh, VA 456 00:22:55,955 --> 00:22:58,975 and the government systems to understand, uh, 457 00:23:00,695 --> 00:23:02,785 many of the uses of data. 458 00:23:03,585 --> 00:23:07,825 I participated in many of the various webinars I signed on 459 00:23:07,825 --> 00:23:11,665 to the FDA anywhere the veterans, uh, was getting, uh, 460 00:23:11,765 --> 00:23:15,665 any type of, uh, uh, use for 461 00:23:16,565 --> 00:23:19,425 any type of, uh, uh, their own participation, 462 00:23:19,425 --> 00:23:21,305 whether it was human subject participation 463 00:23:21,405 --> 00:23:23,385 or any other type of enrollment. 464 00:23:23,985 --> 00:23:26,425 I did learn that Medicare collected data. 465 00:23:26,745 --> 00:23:29,705 I did learn that, um, other sources 466 00:23:29,705 --> 00:23:31,705 besides the VA was collecting data. 467 00:23:32,175 --> 00:23:35,625 However, it was very restricted, uh, to access. 468 00:23:36,425 --> 00:23:39,265 I believe that for other students, uh, 469 00:23:39,365 --> 00:23:42,745 to study the environment, to study the population, uh, study 470 00:23:42,745 --> 00:23:43,785 what they're connected to. 471 00:23:44,105 --> 00:23:46,325 I am a veteran, so I was navigating some 472 00:23:46,325 --> 00:23:47,765 of my own experience through this. 473 00:23:48,465 --> 00:23:53,125 So I was, um, very, uh, intrigued to learn about some 474 00:23:53,125 --> 00:23:54,885 of the things that I, myself, it was, 475 00:23:54,945 --> 00:23:56,325 was actually a part of. 476 00:23:56,745 --> 00:23:58,565 And I think that became some 477 00:23:58,565 --> 00:24:01,925 of the introduction when I began to navigate through the, 478 00:24:01,985 --> 00:24:06,405 uh, VA hierarchy to help them understand, I am a veteran 479 00:24:06,505 --> 00:24:10,205 and I was a student, and I really wanted to help 480 00:24:11,215 --> 00:24:13,605 solve problems because I was having problems. 481 00:24:13,745 --> 00:24:15,645 And I could identify with much of 482 00:24:15,645 --> 00:24:19,285 what we've shared here today, uh, on any of the topic. 483 00:24:19,765 --> 00:24:21,925 I think that a student has to really embrace it. 484 00:24:22,205 --> 00:24:24,005 This is a very, very passionate topic of mind. 485 00:24:24,005 --> 00:24:26,805 You probably can hear that. So I think that when a, 486 00:24:26,805 --> 00:24:31,205 when a student actually, uh, is, becomes intrigued 487 00:24:31,385 --> 00:24:32,405 by the research itself, 488 00:24:32,405 --> 00:24:35,565 which I have become just extremely intrigued by the research 489 00:24:35,585 --> 00:24:39,205 and the processes here, how passionate they can be about 490 00:24:39,205 --> 00:24:41,125 what it is they want to learn, or what to discover 491 00:24:41,545 --> 00:24:42,725 or what they taught to solve. 492 00:24:43,225 --> 00:24:47,135 And, uh, because I, um, felt 493 00:24:47,135 --> 00:24:49,495 that there was a need there that I could actually, 494 00:24:49,495 --> 00:24:53,135 through this process begin to address, I believe 495 00:24:53,135 --> 00:24:56,895 that another student will also agree that you, you, you, 496 00:24:57,035 --> 00:24:58,575 you have to have some passion about 497 00:24:58,575 --> 00:24:59,775 what it is that you're doing. 498 00:25:00,355 --> 00:25:04,255 You have to know that, uh, the end result is 499 00:25:04,275 --> 00:25:05,695 to help other people. 500 00:25:06,075 --> 00:25:08,775 And, uh, that was one of the driving forces with myself. 501 00:25:09,295 --> 00:25:11,215 I knew that if I could complete this 502 00:25:11,315 --> 00:25:14,535 and get into the right hands, it would be, uh, an attraction 503 00:25:14,635 --> 00:25:18,375 and an appeal, uh, that could possibly open the eyes 504 00:25:18,515 --> 00:25:20,415 to people who are unfamiliar, first of all, 505 00:25:20,415 --> 00:25:22,175 with the population and some 506 00:25:22,175 --> 00:25:24,135 of the solid sufferers in the communities 507 00:25:24,135 --> 00:25:27,015 where they don't really get the opportunity to have a voice. 508 00:25:27,195 --> 00:25:30,335 So the research was used on, uh, in my opinion, 509 00:25:31,035 --> 00:25:32,735 to give voice and also 510 00:25:32,735 --> 00:25:34,375 to bring in the professional community. 511 00:25:34,375 --> 00:25:39,295 It was a multi-pronged, uh, role for me, uh, to, uh, 512 00:25:39,295 --> 00:25:40,495 have the conversation as a veteran 513 00:25:40,835 --> 00:25:42,095 and to bring in this data. 514 00:25:42,755 --> 00:25:47,655 So, um, my final, um, I think the, the end 515 00:25:47,755 --> 00:25:51,315 of my, uh, my research would be, 516 00:25:52,295 --> 00:25:55,675 and I would think that any other, uh, researcher, 517 00:25:55,955 --> 00:25:58,435 a student researcher would be as passionate 518 00:25:58,985 --> 00:26:01,635 that they would want to know as much about this and, 519 00:26:01,855 --> 00:26:03,515 and know the people that they would be 520 00:26:03,515 --> 00:26:04,915 helping, uh, at the conclusion. 521 00:26:07,535 --> 00:26:09,355 - That's great. That's great. Kathy, thank you for that. 522 00:26:09,455 --> 00:26:12,595 Uh, that's all the questions that I had. Okay. Dr, 523 00:26:22,295 --> 00:26:23,355 are you able to, um, 524 00:26:35,235 --> 00:26:36,235 - I don't see him present. 525 00:26:36,375 --> 00:26:37,375 Dr. Cromer, 526 00:26:40,665 --> 00:26:43,725 - He's in the, uh, he's logged in twice. 527 00:26:48,755 --> 00:26:49,045 - Okay. 528 00:26:59,855 --> 00:27:01,205 - Let's see if he can hear us here. 529 00:27:04,445 --> 00:27:05,445 I wonder if he's not 530 00:27:07,195 --> 00:27:08,195 - Okay. 531 00:27:09,385 --> 00:27:10,085 - He can hear us. 532 00:27:18,425 --> 00:27:20,805 No, we can't hear you. It looks like you 533 00:27:45,265 --> 00:27:46,325 Yes, patient, Kathy. 534 00:27:46,635 --> 00:27:49,845 Okay. This is NAS presentation. I enjoyed it. 535 00:27:49,945 --> 00:27:53,245 How can your findings inform lost it. 536 00:27:53,465 --> 00:27:55,965 How can your findings inform the training 537 00:27:56,065 --> 00:27:58,365 and professional development of VA staff 538 00:27:58,905 --> 00:28:01,925 to effectively address intersect theology related barriers? 539 00:28:03,865 --> 00:28:06,885 - That's a very good question. Thank you. Ha, Dr. Hzi. 540 00:28:06,945 --> 00:28:10,565 Uh, One of the things that I've been able 541 00:28:10,565 --> 00:28:15,405 to do in this process, I have matured, uh, as a veteran, 542 00:28:15,705 --> 00:28:20,205 and I have the respect now of the va, which was a very, 543 00:28:20,235 --> 00:28:24,805 very important step in this process to have now the respect 544 00:28:24,825 --> 00:28:29,725 of those providership that now see that, um, my commitment 545 00:28:29,745 --> 00:28:33,285 to, uh, not most veterans have their own advocacy. 546 00:28:33,745 --> 00:28:35,045 We represent ourselves. 547 00:28:35,305 --> 00:28:39,085 And, you know, oftentimes, uh, the veterans, uh, are seeing, 548 00:28:39,185 --> 00:28:43,205 uh, providers that are not military or military trained. 549 00:28:43,705 --> 00:28:46,885 So understanding the culture, uh, some of the data 550 00:28:46,885 --> 00:28:49,845 that we were able to collect will help inform, uh, 551 00:28:49,845 --> 00:28:54,685 the medical providers as to, um, some of the more distinct, 552 00:28:55,425 --> 00:28:58,685 uh, layers within the population where you're talking about, 553 00:28:59,105 --> 00:29:02,645 uh, the geographical, uh, factors, the, uh, 554 00:29:02,645 --> 00:29:04,445 environmental factors we talk about urban. 555 00:29:04,585 --> 00:29:07,325 Uh, urban was a focus of what I was paying attention 556 00:29:07,325 --> 00:29:09,645 to when, when we talked about some of the facilities, uh, 557 00:29:09,645 --> 00:29:11,085 we knew that Philadelphia County 558 00:29:11,665 --> 00:29:14,005 and many of the counties was, was kind of scarce. 559 00:29:14,385 --> 00:29:17,405 Uh, uh, they were throughout the state of Pennsylvania, many 560 00:29:17,425 --> 00:29:20,325 of them were rural, but, uh, the, uh, two 561 00:29:20,435 --> 00:29:24,125 that were actually in a, um, urban community, 562 00:29:24,825 --> 00:29:26,125 it brought different information. 563 00:29:26,585 --> 00:29:29,085 Uh, I do believe that would be helpful for 564 00:29:30,305 --> 00:29:32,965 an intersectionality training program, 565 00:29:33,425 --> 00:29:35,605 or to be incorporate intersectionality 566 00:29:35,945 --> 00:29:39,605 to understand the unique characteristics from those 567 00:29:39,785 --> 00:29:43,605 who are in certain neighborhoods, uh, environmental factors. 568 00:29:44,845 --> 00:29:46,125 I would, and, and, and I'm, 569 00:29:46,125 --> 00:29:48,925 and I plan to, along with this research, um, I meet 570 00:29:48,925 --> 00:29:51,205 with the, uh, Philadelphia VA director, 571 00:29:51,265 --> 00:29:53,605 and she's excited about, um, allowing me 572 00:29:53,605 --> 00:29:54,765 to present on this in March, 573 00:29:55,105 --> 00:29:56,285 uh, during Women's History month. 574 00:29:56,285 --> 00:29:59,045 And I'm going to be so excited to share with her. 575 00:29:59,185 --> 00:30:01,445 And from that, I do believe that she's gonna take this very, 576 00:30:01,445 --> 00:30:03,725 very seriously and that she will believe 577 00:30:03,725 --> 00:30:07,165 that there will be some contribution, uh, to the VA system 578 00:30:07,345 --> 00:30:10,885 for understanding how the overlapping factors 579 00:30:11,035 --> 00:30:12,365 that may exist. 580 00:30:12,505 --> 00:30:14,485 Now, we are more than just a veteran. We are mothers. 581 00:30:14,825 --> 00:30:19,205 Uh, we have, uh, various different, uh, parts of our lives 582 00:30:19,235 --> 00:30:20,365 that are not as visible. 583 00:30:21,275 --> 00:30:22,965 This will help them to understand who 584 00:30:22,965 --> 00:30:25,365 that person is when they present to the VA hospital. 585 00:30:26,105 --> 00:30:29,765 And so I think, uh, in other words, um, uh, Dr. 586 00:30:29,945 --> 00:30:33,125 Jazzie, I think that the training could definitely be 587 00:30:33,125 --> 00:30:37,325 incorporated, um, uh, maybe through an orientation. 588 00:30:37,705 --> 00:30:40,005 I'm going to speak about this in terms of 589 00:30:40,065 --> 00:30:43,605 how each department who interacts as of, uh, directly 590 00:30:43,605 --> 00:30:45,165 with the veterans, uh, 591 00:30:45,165 --> 00:30:47,885 certainly particularly in the mental health department, uh, 592 00:30:47,885 --> 00:30:49,165 some of the layers, uh, 593 00:30:49,165 --> 00:30:52,245 that could be considered when they present dual diagnose, 594 00:30:52,265 --> 00:30:54,925 uh, mental health disorder along with the, 595 00:30:54,925 --> 00:30:56,525 uh, substance abuse disorder. 596 00:30:56,925 --> 00:30:59,085 I think those, uh, environmental factors, 597 00:30:59,155 --> 00:31:00,605 when you're talking to the mental health, 598 00:31:00,625 --> 00:31:03,165 the behavioral health would be very, very important for them 599 00:31:03,165 --> 00:31:04,885 to understand some of those distinctions there. 600 00:31:05,505 --> 00:31:08,565 So, uh, I'm going to be working this, working this as much 601 00:31:08,565 --> 00:31:10,325 as possible and hopefully unlayering some 602 00:31:10,325 --> 00:31:13,005 of those possibilities for strategizing on what 603 00:31:13,005 --> 00:31:14,565 that training could look like in the future. 604 00:31:18,135 --> 00:31:19,785 - Okay. And he had a follow up question. 605 00:31:19,935 --> 00:31:22,385 What practical recommendations would you provide 606 00:31:22,385 --> 00:31:26,665 to VA healthcare providers based on your findings on race 607 00:31:26,665 --> 00:31:27,745 and gender disparities? 608 00:31:30,835 --> 00:31:35,465 - There is a sensitivity in the VA system, uh, 609 00:31:35,565 --> 00:31:39,585 by the veterans who, whom I spoke, uh, with regards to, 610 00:31:40,805 --> 00:31:42,105 uh, understanding the culture. 611 00:31:42,365 --> 00:31:43,865 The military has this culture, 612 00:31:44,085 --> 00:31:47,665 but oftentimes when we present as African American women, 613 00:31:48,005 --> 00:31:49,025 we bring another culture. 614 00:31:50,085 --> 00:31:53,105 Uh, oftentimes there are micro, uh, aggressions 615 00:31:53,285 --> 00:31:54,905 or we may feel, um, 616 00:31:55,935 --> 00:31:58,505 some type sensitivity towards the professionals. 617 00:31:58,705 --> 00:32:00,305 I know that just from conversations. 618 00:32:00,565 --> 00:32:04,905 But what I do believe is that we have to be compassionate. 619 00:32:04,925 --> 00:32:06,865 And this is something I believe that comes out of all 620 00:32:06,865 --> 00:32:09,025 of the different concerns when you're talking about 621 00:32:09,385 --> 00:32:12,985 discrimination, uh, diversity, uh, legal issues, some 622 00:32:12,985 --> 00:32:16,105 of the various, uh, uh, dependent variables that we use. 623 00:32:16,125 --> 00:32:18,665 And we're able to find, uh, some, uh, 624 00:32:18,855 --> 00:32:20,665 significant differences, particularly 625 00:32:20,665 --> 00:32:22,385 for the male population and homelessness 626 00:32:22,605 --> 00:32:24,945 and the legal concerns, which was a, 627 00:32:25,105 --> 00:32:27,465 a surprise when we were able to find, uh, 628 00:32:28,525 --> 00:32:30,465 how those numbers actually reflected on 629 00:32:30,465 --> 00:32:31,705 these are human beings here. 630 00:32:32,005 --> 00:32:35,185 So what is it exactly that they're experiencing 631 00:32:35,695 --> 00:32:37,905 that when they actually, uh, responded to 632 00:32:37,905 --> 00:32:41,245 that in the screening, uh, are the experiences. 633 00:32:41,265 --> 00:32:43,005 So I would like to dive into that to a little bit more 634 00:32:43,005 --> 00:32:45,005 to find out what some of those distinctions are. 635 00:32:45,625 --> 00:32:47,365 How can we, uh, start to identify 636 00:32:47,365 --> 00:32:49,645 what those characteristics are and what a root cause? 637 00:32:49,785 --> 00:32:52,285 Why are they happening? Uh, one of the challenges 638 00:32:52,285 --> 00:32:54,685 that I believe would be important, uh, Dr. 639 00:32:55,025 --> 00:32:57,965 Hijazi, is to help people to understand who the people are. 640 00:32:58,305 --> 00:32:59,765 Who are these veterans, uh, 641 00:32:59,795 --> 00:33:02,405 besides service members, uh, who are they? 642 00:33:03,025 --> 00:33:05,725 And, uh, once we can, uh, um, 643 00:33:06,305 --> 00:33:10,045 become less systematic in how that treatment is strategized, 644 00:33:10,065 --> 00:33:14,045 and how that treatment, uh, becomes less, uh, less personal, 645 00:33:14,115 --> 00:33:15,765 it's more clinical, uh, 646 00:33:15,765 --> 00:33:18,085 but becomes more personable in terms of knowing 647 00:33:18,105 --> 00:33:20,685 who the people are, that could be a better relationship 648 00:33:20,825 --> 00:33:23,525 and respect, uh, for that, uh, that veteran 649 00:33:23,585 --> 00:33:25,325 who would present, uh, to the VA hospital. 650 00:33:36,065 --> 00:33:39,475 - Okay. And, alright. Okay. 651 00:33:39,615 --> 00:33:42,755 Um, so that concludes those questions. 652 00:33:42,895 --> 00:33:46,195 Let me just, uh, ask Dr. Carter to kick it back to you. 653 00:33:46,195 --> 00:33:47,395 Do you have any further questions? 654 00:33:51,095 --> 00:33:52,995 No, no further questions. Okay. 655 00:33:53,895 --> 00:33:55,995 And Kathy, do you have any questions for us? 656 00:33:56,835 --> 00:33:58,675 - I would just like to thank you for your attentiveness 657 00:33:58,695 --> 00:33:59,795 and listening, uh, 658 00:34:00,335 --> 00:34:02,555 and the questions that really were very thought provoking 659 00:34:02,555 --> 00:34:06,675 for me and the advice to move forward with the, uh, uh, 660 00:34:06,675 --> 00:34:07,835 limitations on some of those 661 00:34:07,835 --> 00:34:09,355 characteristics to further define them. 662 00:34:10,115 --> 00:34:13,595 I believe that, uh, we can, uh, really learn a lot more. 663 00:34:13,975 --> 00:34:15,315 And your feedback was awesome. 664 00:34:15,575 --> 00:34:18,275 Uh, thank you for, uh, just listening to hear 665 00:34:18,465 --> 00:34:20,035 that importance to share, 666 00:34:20,295 --> 00:34:21,515 uh, some of that important feedback. 667 00:34:21,595 --> 00:34:24,275 I believe it's going to be helpful. I'm just really just 668 00:34:24,275 --> 00:34:27,075 pleased, uh, with TriNet University for embracing this topic 669 00:34:27,175 --> 00:34:28,915 and all of my support systems. 670 00:34:29,115 --> 00:34:31,635 I had some very difficult challenging times there. 671 00:34:31,635 --> 00:34:34,035 Sometimes I did not always think that I could make it here. 672 00:34:34,695 --> 00:34:36,555 Um, but I think Dr. 673 00:34:36,575 --> 00:34:40,275 Kromer, who's just been such an amazing mentor, uh, teacher, 674 00:34:40,345 --> 00:34:44,275 professor, and just, um, I'm just really grateful to have, 675 00:34:44,335 --> 00:34:46,355 uh, reached this particular milestone. 676 00:34:46,355 --> 00:34:49,875 And I'm just hoping that, uh, the work will certainly, um, 677 00:34:50,505 --> 00:34:52,675 reflect the effort that went into that. 678 00:34:52,775 --> 00:34:54,475 So I just wanna thank you all, my committee 679 00:34:54,935 --> 00:34:56,715 for the guidance, Dr. Carter, your notes 680 00:34:56,735 --> 00:34:58,235 and your, all of your, uh, 681 00:34:58,515 --> 00:35:00,195 feedback has been extremely helpful. 682 00:35:00,375 --> 00:35:02,635 And thank you for being so detailed about most much of 683 00:35:02,635 --> 00:35:05,115 what I was guided through, uh, with regards 684 00:35:05,115 --> 00:35:06,595 to my, uh, defense proposal. 685 00:35:07,295 --> 00:35:09,075 And I just wanna just thank you all for all 686 00:35:09,075 --> 00:35:12,235 of your contributions to what I, uh, believe to be, uh, um, 687 00:35:12,235 --> 00:35:14,635 helpful to the field 688 00:35:15,335 --> 00:35:16,875 and to what I believe is going 689 00:35:16,875 --> 00:35:18,915 to help other people around the country. 690 00:35:21,705 --> 00:35:23,555 - Okay, Kathy. And so thank you. 691 00:35:23,615 --> 00:35:25,715 And what I'll ask you to do is leave the room 692 00:35:25,935 --> 00:35:27,795 and then I'll call you back shortly right 693 00:35:27,795 --> 00:35:29,795 after we finish filling out the paperwork 694 00:35:29,795 --> 00:35:30,955 and filling out your rubric. 695 00:35:31,005 --> 00:35:32,275 - Thank you. Thank, thank you, sir. 696 00:35:33,785 --> 00:35:36,995 - Okay. Kathy, - I 697 00:35:37,085 --> 00:35:38,285 - Have to figure out how to get outta here. 698 00:35:38,385 --> 00:35:42,285 Dr. Coma. Lemme see. Close it. Well, you don't. 699 00:35:53,425 --> 00:35:56,245 Hey girl, girl. 700 00:36:01,985 --> 00:36:04,005 Oh, I could not see this little right girl.