- And Dr.
Zi a pleasure finding to have you, uh, to hear
what I believe is an important topic on this evening.
I am honored to share, uh, what I believe
to be has been a very, very important, uh, research study,
uh, supported by Charter University.
And I'm delighted to share with you some
of the findings on our topic, uh, today,
the influences of intersectionality, theory
and veteran healthcare
post-transition barriers and challenges.
It examines post-transition barriers
and challenges experienced by military service
veterans related to healthcare enrollment.
Other study studies have examined similar issues as related
to healthcare treatment.
In this study, I compare self-reported data collected
for health disparities
and other concerns to examine the influence
of intersectionality antecedent to the issues
reported in prior research
concerning VA healthcare system treatment.
This, uh, this study adds to that body of knowledge
on examination of the role of intersectionality
as identified by age, gender, and race,
and may have in the range of barriers
and challenges noted by veterans at the point of entry
before receiving VA healthcare treatment.
A problem is to examine health equity disparity described in
the national veteran, have equity research
and is explained by intersectionality influences in
post-transition, barriers
and challenges antecedent to VA healthcare treatment
for the purpose of examining the influence
of intersectionality within the larger veteran community,
antecedent to treatment in the VA healthcare system
by testing for differences in veteran post-transition
barriers and challenges by race and gender.
And if the veteran is an African-American woman,
This research examines post-transition barriers
and challenges experienced
by military service veterans related
to healthcare enrollment.
Other studies have examined these issues as related
to healthcare treatment.
This study adds to that body of knowledge
and examination of the role intersectionality as defined
by age, gender, and race, which may have in the range
of barriers and challenges noted by veterans at the point
of interview before re receiving VA healthcare treatment.
A theoretical framework, uh, funnels the nature
of hypothesis testing first
for differences in post-transition, barriers
and challenges by race, then by gender,
and finally by if the veteran is an African American woman,
and is designed to test for compounding differences
as a marginalized population definition narrows
our research question that hypothesis funnels
to our intersectionality theory to examine, uh,
that there is a significant difference
in veteran post-transition barriers and challenges by race.
That there is a significant difference in veteran
post-transition barriers and challenges by gender.
And due to intersectionality,
there is a significant difference in veteran post transition
varies and challenges
between African American women veterans as compared
to all other categories.
As we follow into our intersection, um, theory, uh, we, uh,
hypothesize on these, uh, components.
Uh, patient diagnosis is d.
We define our, our key terms as patient diagnosis,
which are challenges used as our inde,
our dependent variables.
These are mental health diagnosis, substance use,
dis dependency, and mental health diagnosis with
substance use dependency.
Each of these variables I dichotomous, uh, with a no
or yes response.
Our patient concerns
or barriers used also as dependent variables.
And these are homelessness, uh, programs, uh,
the suicide ideation, suicide prevention
and oral hotline, uh, the special emphasis, uh,
and diversity, legal issues, legal concerns, rights
and response, but rights
and responsibility, discrimination service, animals,
harassment and sexual harassment concerns.
Each of these variables are also dichos
and we respond to will a yes and no response.
This is our, uh, literature that we found foundational
for establishing our study.
Uh, haw, uh, meet with our foundational study by Washington,
uh, which was a, uh, veteran specific, uh, uh,
study on that demographic.
Uh, international theory examines how overlapping social
identity, such as race
and gender interact to create unique experiences
of discrimination and privilege.
This leads to the conclusion
that African American women may experience unique health
disparities transcending those experienced
by race agenda independently.
The National Veteran Health Equity Report of 2021
reported the results of patient experience
and healthcare quality within the VA healthcare system,
Washington, who actually conducted these.
The study of 2023 expanded on that research
to extend the understanding
of health equity concerns within the VA healthcare system.
Regarding intersectionality,
the foundational study determined that black American women,
veterans of urban communities are treated according
to their measures worse than their female counterparts.
Our method, uh, a methodology is a quantitative
cross-sectional, uh, design using secondary data,
our design choices, the comparison
of the means using thena art tests for body match pairs,
data that was used to test each hospo hypothesis.
In addition, a linear regression was used to test
for control variables in interaction
with each dependent variable
of which we will specifically see those further into
the presentation.
Our overall population of interest is veterans
who utilize the veteran administration healthcare system
Within that population, the participants responded
to a recent survey administered
by the VA Healthcare Administration in the
Western Pennsylvania region.
Data was secondary de-identify, de-identified data collected
by the United States Department of Veterans Affairs
extracted from the patient advocacy, uh, tracking system.
And I could add also that's vision four
of the 22 visits in the country, more
of the North northeastern region.
Our data analysis and results, uh, would determine that, uh,
of the 200 we had 86, uh, from the missing data, uh, that,
uh, patient diagnosis, uh, are the most, uh, trans, uh,
excuse me, patient diagnosis
are the post-transition challenges
used at dependent variables.
These were mental health diagnosis, substance use,
dependency, and mental health diagnosis
with substance use dependency.
Although there were some statistical different significance,
Let me read that please again.
Although there were some statistically significant
differences by race and gender
and African American women status,
these effects were so small as to the of little meaning.
Please forgive me, you don't have my phone. Sorry.
Um, meaningful value and the,
and are excluded from the summary.
The patient concerns were barriers, uh, used
as dependent variables.
These are homelessness programs, suicidal ideation,
suicide provision hotline, uh, special
emphasis on diversity concerns,
special emphasis on diver diversity, rights
and responsibilities, discrimination, uh, service,
animal harassment and sexual harassment.
These concerns dealing with suicidal ideation,
suicidal prevention hotline, special emphasis,
diversity concerns, uh, service animals
and sexual harassment concerns were reported
by a very small percentage of participation, less than 5%.
At a sample of 186.
Uh, these results were excluded, uh, from evaluation
because the sample was too small to, uh, for meaningful, uh,
comparison
And evaluation of our fund.
Uh, findings on our first hypothesis, uh, determined
that there were significant, uh, differences by race
for legal concerns, rights and responsibilities, concerns
and discrimination concerns.
African-American participation, excuse me,
African-American participants experiencing greater barriers
than white participants.
However, white participants reported a much higher
experience of harassment concerns.
Uh, our data, uh, I will highlight some of those numbers
to the right, uh, there if you review that.
Uh, some other time. For our second hypothesis,
it was determined that men were much more likely
to experience concerns about homelessness and legal issues.
Women were more likely to experience concerns
regarding rights and responsibilities,
discrimination and harassment.
And our third hypothesis due to intersectionality,
there is a significant, uh,
significant difference in veteran post-transition barriers
and challenges between African-American women veterans
as compared to all other categories.
Uh, African-American women, veterans were much more likely
to experience concerns, uh, regarding rights
and responsibilities and discrimination,
and much less likely to experience concerns with legal
issues or harassment, as compared to participants
who were not African American women veterans.
The depth of the data set limited the ability
to fully explore all areas of interest
or to definitively accomplish a objective
of determining if the findings
of the National Veteran Health Equity Report of 2021
and the Washington, um, VA report research is explained
by intersectionality influences
and post-transition barriers, intelligence antecedent
to VA healthcare treatment.
There were simply not enough responses
to make meaningful findings in many relevant areas.
The implications for our theory, uh,
these findings are consistent with both critical
race theory and intersectionality.
Also, we did include to other theories, uh,
which was the theory of change, uh,
which was based on a study by the Annie Casey Foundation,
and also the, um, there was the
social change, uh, social social change theory
that had been, uh, uh, discussed as a potential, uh,
a theory to look at for, um, how intervention could,
could become part of a future study.
However, there were areas that seemed to,
However, there are areas
that seem on the surface is
consistent with critical race theory.
White participants reported a much higher experience
of harassment concerns compounding toward white women.
Veterans men were more likely
to experience concerns about homelessness
compounded toward white men.
The sample was small, so these may be an anomalies.
It could also be a reflection on traditional role
stereotypes, as men are more apt to view themselves
as responsible for sheltering families,
and most of the participants being
of middle age may have been more likely to hold these views.
It is important to keep in mind
that participants were limited to a single concern.
So it may reflect what is foremost in their mind,
not necessarily the full experience.
In those areas of concern
where white participants marginally see more affected than
African-American participants,
it may reflect areas in which they perceive increased
pressures of feelings of anxiety as compared
to the other areas of concern in which African Americans
perceive greater increased pressures of feelings of anxiety.
Uh, any places for practice will give our, uh,
the professional community a better understanding
of the influence of intersectionality,
which enables healthcare workers to grasp
the nuances of each patient's identity
and how these intersecting identities
influence their health outcomes.
For example, an African American woman veteran may have
obstacles that are distinct from those
of other parent patients.
Uh, implications for, for future research, uh,
were based on the findings of the study
that introduced a unique character characterization
for understanding the intricate details
that are established from the specific demographic
and subgroups as ability to intersectionality.
It addressed knowledge gaps
for understanding the problem omitted in present research.
The data collected in this study compares other studies
being the most recent with a potential model
for geographical spec spec specificity.
Some of the limitations, um,
that we are have listed here are the key character
characteristics of the sample may not be generalizable
to the larger population.
If there is a potential for selection bias, a longitudinal,
uh, design may offer deeper insight into the evolving
experiences of veterans post transition.
Since data is collected from the Western Pennsylvania
region, only experience
of the target population may differ from those of regions
and other vectors in other regions.
And availability of data in the economist format
is less robust than might be possible in a
multi valve scale.
And I would also like to note that, uh, I discovered from,
uh, the data set was
that it was a recently established data set, uh, since 2023.
So there may be, uh, a future, uh, data to be, uh,
extracted as time as they continue to collect data, uh,
from this, uh, particular tracking system system.
The future research recommendations,
the research into the unexpected findings, legal concerns
of African American male participates
and respite concerns for white female participants.
Primary data collection
of which the participants could rank the importance
and degree of concern, rather than being limited
to a single concern,
would yield improved results in estimating the
relative importance by race and gender.
And in terms of adding depth to the degree of the concern,
rather than just the presence of the concern,
mixed methods research could also add greater context
to the findings as well.
That concludes the narrative
and the findings of our analysis,
and I would like to open up
to any questions from the committee.
And thank you for your attention and listening.
I hope there was some added, uh, interest, uh,
that were given by some of the things that we've able
to discover in this study.
- Okay. - Great job, Kathy.
And, um, I'll be taking notes so you don't have to take them
as we go through the Q&a period.
And Dr. Carter, would you like to begin?
- Yep, absolutely. Great presentation.
Kathy, I, I wish we could have recorded this one
because you did a, a fantastic job.
That was perfect.
Um, I have a question on this slide here.
You say the key characteristics
of the sample may not be generalizable
to a larger population.
Can you tell me a little bit about that?
- Yes, because the, the, uh, data is collected, uh,
regionally, uh, there are 22, uh, visits in the country.
Uh, these particular demographics consist
of six facilities within a, a particular, uh, um, network.
Uh, the veteran, the Veterans Integrated Service Network,
which is based out of Pittsburgh, the Western region.
So they were collecting data through this, uh,
the single data collection system,
which they were joined from six facilities
throughout the state of Pennsylvania.
So it wasn't significant enough of the data,
did not have a broad enough reach, uh, to characterize it
to a larger population,
because each demographic across the country in the business,
uh, would, would, would, would be assumed to have different,
uh, demographics, and they would be responding
differently based on that.
Uh, I believe that would be sufficient to, uh, respond in
that way because what I do understand about the 22 million,
uh, veterans that are enrolled within the VA system, uh,
many of these, uh, various visits,
the Veterans Integrated Service Network,
they are not collecting data,
which made this particular study, uh, being recently, uh,
one that is start to track this particular data
through this, uh, patient advocacy TRA system.
It would, uh, it would become somewhat of a model.
I think they're going to start to adopt.
This has been significant for getting some of that, uh,
more detailed and start
to highlight some of these other concerns.
- Okay. Fantastic. That's a great answer.
I I think that you could also put
that paragraph in your limitations in there, there,
because I Yes, I can extrapolate, but that's, and,
and when you explain it, it's like, oh,
yeah, that definitely makes sense.
I, I might even just add a, a bit of what you said there,
because that makes perfect sense,
and it almost took to add that, um,
that exclamation point onto chapter five,
which we really want to, and,
and a lot of times once we get to, you know, we get
through our data analysis in chapter four, we,
that momentum in chapter, I think that would really help
that exclamation point in your, in your chapter five.
Um, so for, I, I've got your future research,
what do you think can be done in, um, in practice?
- We do understand that as the population grows with the,
uh, accessible accessibility, uh, for the veterans, I think,
uh, what has been discussed and what's,
and much of the, uh, sources that we were able to,
uh, learn from about the various, uh, facilities
that the training, uh, on particular areas
with regard particularly to, uh, military sexual trauma,
which was one of the, uh, issues we found
that was fundamental to each facility, that
that was an underlying, uh, issue with many
of those reported male
and female who had experienced military sexual trauma.
So I think, uh, what would be
of importance would be training at the providers have
not only combat specific training,
but with regards to some of the post transition barriers
and challenges, there has to be some interconnectivity
to the community and the other stakeholders that could, uh,
actually bridge some of these, uh, service gaps.
So I think there needs to be a lot more conversation about
what that need is, uh, so that they can understand how
to address a particular population, which is
un uncharacterized in the general population.
Uh, the veterans are becoming more pronounced in communities
now that they can demonstrate
and articulate some of their more distinct, uh, needs.
And I think that needs to, uh, be assessed on a,
a larger scale, uh, so that there could be training, uh,
intervention, uh, particular strategies
that could address this particular demographic, uh,
based on, uh, some of the things that they are reported.
This is a self-reporting, uh, system
where we've learned this data.
So I think that the, now that the, uh,
voice is coming from the veteran themselves,
that could be a, a, a stronger interaction
where the veteran is actually speaking from work, their own
and needs may could be assessed.
I think that would be important.
- I think that could really help
to add some to your, your paper .
I know you have a section on
recommendations for future research.
I think you could have a recommendations
for future practice too,
because like, like you said, this isn't a problem.
This is an issue. So I think you're on the road to solving
that, and I, I think that would make a really good, um,
or at least in the conclusion, if, if nothing else, I think
that would be great to add that that in there.
Um, what do you think was the hardest part of your study?
- Once we were able to retrieve the data, uh,
which came kind of somewhat, uh, at, towards the end of the,
uh, uh, um, the academic, uh, um,
study, the need to have the data to
make it relevant today, I had that conversation,
uh, with several people before.
I believe it was really, actually understood the relevance
for, Uh, well, the pri the, the most previous data,
I will say was from 2024,
but it did not extend to the level
where it was the veteran themselves reporting.
It was somewhat of a, uh, more professional
or, um, facility assessment.
So I think getting the data helped us to see more clearly,
uh, for highlighting some of the specifics.
So once we were able to, uh, retrieve that data, uh, and,
and create that relationship with the va, uh, that I think
that we had crossed a really major hurdle there.
So I think that, uh, once, once we recognized
that the data itself, uh, actually, uh, was, it fills
so many gaps just to see what it was we were talking about.
It was no longer speculation,
but we actually had real data, um, with that,
that particular challenge was minimized with that.
So, uh, we actually concluded, uh, with getting the data
as being, uh, very satisfactory for, uh, overcoming that,
that, that what was, what that prior been a major hurdle.
So it was getting the data.
- So what future, what advice would you give
to future students who, uh,
might be doing either a study like yours or similar?
- Um, I, I researched quite a bit across the, uh, VA
and the government systems to understand, uh,
many of the uses of data.
I participated in many of the various webinars I signed on
to the FDA anywhere the veterans, uh, was getting, uh,
any type of, uh, uh, use for
any type of, uh, uh, their own participation,
whether it was human subject participation
or any other type of enrollment.
I did learn that Medicare collected data.
I did learn that, um, other sources
besides the VA was collecting data.
However, it was very restricted, uh, to access.
I believe that for other students, uh,
to study the environment, to study the population, uh, study
what they're connected to.
I am a veteran, so I was navigating some
of my own experience through this.
So I was, um, very, uh, intrigued to learn about some
of the things that I, myself, it was,
was actually a part of.
And I think that became some
of the introduction when I began to navigate through the,
uh, VA hierarchy to help them understand, I am a veteran
and I was a student, and I really wanted to help
solve problems because I was having problems.
And I could identify with much of
what we've shared here today, uh, on any of the topic.
I think that a student has to really embrace it.
This is a very, very passionate topic of mind.
You probably can hear that. So I think that when a,
when a student actually, uh, is, becomes intrigued
by the research itself,
which I have become just extremely intrigued by the research
and the processes here, how passionate they can be about
what it is they want to learn, or what to discover
or what they taught to solve.
And, uh, because I, um, felt
that there was a need there that I could actually,
through this process begin to address, I believe
that another student will also agree that you, you, you,
you have to have some passion about
what it is that you're doing.
You have to know that, uh, the end result is
to help other people.
And, uh, that was one of the driving forces with myself.
I knew that if I could complete this
and get into the right hands, it would be, uh, an attraction
and an appeal, uh, that could possibly open the eyes
to people who are unfamiliar, first of all,
with the population and some
of the solid sufferers in the communities
where they don't really get the opportunity to have a voice.
So the research was used on, uh, in my opinion,
to give voice and also
to bring in the professional community.
It was a multi-pronged, uh, role for me, uh, to, uh,
have the conversation as a veteran
and to bring in this data.
So, um, my final, um, I think the, the end
of my, uh, my research would be,
and I would think that any other, uh, researcher,
a student researcher would be as passionate
that they would want to know as much about this and,
and know the people that they would be
helping, uh, at the conclusion.
- That's great. That's great. Kathy, thank you for that.
Uh, that's all the questions that I had. Okay. Dr,
are you able to, um,
- I don't see him present.
Dr. Cromer,
- He's in the, uh, he's logged in twice.
- Okay.
- Let's see if he can hear us here.
I wonder if he's not
- Okay.
- He can hear us.
No, we can't hear you. It looks like you
Yes, patient, Kathy.
Okay. This is NAS presentation. I enjoyed it.
How can your findings inform lost it.
How can your findings inform the training
and professional development of VA staff
to effectively address intersect theology related barriers?
- That's a very good question. Thank you. Ha, Dr. Hzi.
Uh, One of the things that I've been able
to do in this process, I have matured, uh, as a veteran,
and I have the respect now of the va, which was a very,
very important step in this process to have now the respect
of those providership that now see that, um, my commitment
to, uh, not most veterans have their own advocacy.
We represent ourselves.
And, you know, oftentimes, uh, the veterans, uh, are seeing,
uh, providers that are not military or military trained.
So understanding the culture, uh, some of the data
that we were able to collect will help inform, uh,
the medical providers as to, um, some of the more distinct,
uh, layers within the population where you're talking about,
uh, the geographical, uh, factors, the, uh,
environmental factors we talk about urban.
Uh, urban was a focus of what I was paying attention
to when, when we talked about some of the facilities, uh,
we knew that Philadelphia County
and many of the counties was, was kind of scarce.
Uh, uh, they were throughout the state of Pennsylvania, many
of them were rural, but, uh, the, uh, two
that were actually in a, um, urban community,
it brought different information.
Uh, I do believe that would be helpful for
an intersectionality training program,
or to be incorporate intersectionality
to understand the unique characteristics from those
who are in certain neighborhoods, uh, environmental factors.
I would, and, and, and I'm,
and I plan to, along with this research, um, I meet
with the, uh, Philadelphia VA director,
and she's excited about, um, allowing me
to present on this in March,
uh, during Women's History month.
And I'm going to be so excited to share with her.
And from that, I do believe that she's gonna take this very,
very seriously and that she will believe
that there will be some contribution, uh, to the VA system
for understanding how the overlapping factors
that may exist.
Now, we are more than just a veteran. We are mothers.
Uh, we have, uh, various different, uh, parts of our lives
that are not as visible.
This will help them to understand who
that person is when they present to the VA hospital.
And so I think, uh, in other words, um, uh, Dr.
Jazzie, I think that the training could definitely be
incorporated, um, uh, maybe through an orientation.
I'm going to speak about this in terms of
how each department who interacts as of, uh, directly
with the veterans, uh,
certainly particularly in the mental health department, uh,
some of the layers, uh,
that could be considered when they present dual diagnose,
uh, mental health disorder along with the,
uh, substance abuse disorder.
I think those, uh, environmental factors,
when you're talking to the mental health,
the behavioral health would be very, very important for them
to understand some of those distinctions there.
So, uh, I'm going to be working this, working this as much
as possible and hopefully unlayering some
of those possibilities for strategizing on what
that training could look like in the future.
- Okay. And he had a follow up question.
What practical recommendations would you provide
to VA healthcare providers based on your findings on race
and gender disparities?
- There is a sensitivity in the VA system, uh,
by the veterans who, whom I spoke, uh, with regards to,
uh, understanding the culture.
The military has this culture,
but oftentimes when we present as African American women,
we bring another culture.
Uh, oftentimes there are micro, uh, aggressions
or we may feel, um,
some type sensitivity towards the professionals.
I know that just from conversations.
But what I do believe is that we have to be compassionate.
And this is something I believe that comes out of all
of the different concerns when you're talking about
discrimination, uh, diversity, uh, legal issues, some
of the various, uh, uh, dependent variables that we use.
And we're able to find, uh, some, uh,
significant differences, particularly
for the male population and homelessness
and the legal concerns, which was a,
a surprise when we were able to find, uh,
how those numbers actually reflected on
these are human beings here.
So what is it exactly that they're experiencing
that when they actually, uh, responded to
that in the screening, uh, are the experiences.
So I would like to dive into that to a little bit more
to find out what some of those distinctions are.
How can we, uh, start to identify
what those characteristics are and what a root cause?
Why are they happening? Uh, one of the challenges
that I believe would be important, uh, Dr.
Hijazi, is to help people to understand who the people are.
Who are these veterans, uh,
besides service members, uh, who are they?
And, uh, once we can, uh, um,
become less systematic in how that treatment is strategized,
and how that treatment, uh, becomes less, uh, less personal,
it's more clinical, uh,
but becomes more personable in terms of knowing
who the people are, that could be a better relationship
and respect, uh, for that, uh, that veteran
who would present, uh, to the VA hospital.
- Okay. And, alright. Okay.
Um, so that concludes those questions.
Let me just, uh, ask Dr. Carter to kick it back to you.
Do you have any further questions?
No, no further questions. Okay.
And Kathy, do you have any questions for us?
- I would just like to thank you for your attentiveness
and listening, uh,
and the questions that really were very thought provoking
for me and the advice to move forward with the, uh, uh,
limitations on some of those
characteristics to further define them.
I believe that, uh, we can, uh, really learn a lot more.
And your feedback was awesome.
Uh, thank you for, uh, just listening to hear
that importance to share,
uh, some of that important feedback.
I believe it's going to be helpful. I'm just really just
pleased, uh, with TriNet University for embracing this topic
and all of my support systems.
I had some very difficult challenging times there.
Sometimes I did not always think that I could make it here.
Um, but I think Dr.
Kromer, who's just been such an amazing mentor, uh, teacher,
professor, and just, um, I'm just really grateful to have,
uh, reached this particular milestone.
And I'm just hoping that, uh, the work will certainly, um,
reflect the effort that went into that.
So I just wanna thank you all, my committee
for the guidance, Dr. Carter, your notes
and your, all of your, uh,
feedback has been extremely helpful.
And thank you for being so detailed about most much of
what I was guided through, uh, with regards
to my, uh, defense proposal.
And I just wanna just thank you all for all
of your contributions to what I, uh, believe to be, uh, um,
helpful to the field
and to what I believe is going
to help other people around the country.
- Okay, Kathy. And so thank you.
And what I'll ask you to do is leave the room
and then I'll call you back shortly right
after we finish filling out the paperwork
and filling out your rubric.
- Thank you. Thank, thank you, sir.
- Okay. Kathy, - I
- Have to figure out how to get outta here.
Dr. Coma. Lemme see. Close it. Well, you don't.
Hey girl, girl.
Oh, I could not see this little right girl.