"Voice of concern" for rural veterans with PTSD: Care managers' role engaging rural veterans in evidence-based therapies via telemedicine.

Abstract

Objective: In a Department of Veterans Affairs collaborative care implementation trial, care managers (CMs) focused on engaging rural Veterans diagnosed with posttraumatic stress disorder in trauma-focused psychotherapies, specifically cognitive processing therapy and prolonged exposure therapy, delivered over telehealth. As part of a summative evaluation, we interviewed Veterans about their experience, especially their interactions with their CM. Because relatively few Veterans initiated a trauma-focused psychotherapy, we specifically asked them about their conversations with CMs to better understand what worked and what did not work with regard to treatment engagement.

Method: We conducted phone interviews with a purposive sample of 43 unique Veterans between 2017 and 2019. We purposively sampled Veterans who reported changes in satisfaction with Veterans Affairs posttraumatic stress disorder services and had experiences with different care modalities and patients who declined to initiate a trauma-focused psychotherapy. Data were analyzed using deductive-inductive content analysis.

Results: Overall, Veterans perceived CMs as helpful in three ways: (a) for care coordination-especially with therapists; (b) as a "voice of concern"-for Veterans' health and daily life; and (c) as a "side counselor"-helping prepare Veterans for appointments and following up after their trauma-focused psychotherapy sessions.

Conclusions: Veterans appreciated many qualities about their CM unrelated to trauma-focused psychotherapy. For those engaging in trauma-focused psychotherapy, CMs played the role of "side counselor" helping them stay engaged in care. Understanding patient perspectives about CMs' roles can help other types of providers understand how to best engage patients in trauma-focused psychotherapies. (PsycInfo Database Record (c) 2025 APA, all rights reserved).