Developing an Integrated Model of Care for Veterans with Alcohol Problems

Abstract

Introduction: Veterans often do not present with alcohol problems in isolation, they may have a wide range of social, physical, and psychological needs. The aim of this study was to facilitate the development of a co-designed integrated model of care for veterans with alcohol problems.Methods: Following the development model by the Agency for Clinical Innovation, a planning symposium was held in North East of England to engage health and social care planners, public health leads, clinical commissioning groups and providers. Service users were empowered in discussions to provide insights and look for solutions (N = 43).Results: Using diagramming techniques, three examples of health and social care provision were created demonstrating the current commissioning landscape, one veteran's experience of accessing services and a proposal for a new integrated model of care for veterans with alcohol problems. Discussion: By engaging stakeholders and service users, the model proposed a potential solution to reducing the number of veterans 'falling through the gaps' or disengaging from services. The collaborative approach highlighted the difficulties in navigating the current complex health and social care systems. The co-designed hub and spoke model aims to enable alcohol misuse services to adapt and evolve so that they better fit the needs of veterans.

Meaning(s) of transition(s) from military to civilian life at the intersection with mental health: implications for clinical settings

“…Our study contributes to the evidence base informing the development of effective pathways into Mental Health Services for UK Veterans (Osborne et al, 2021 ). There is also a need to consider how organizations can move toward supporting veteran's transition, through organizational design.…”

Commissioning and co‐production in health and care services in the United Kingdom and Ireland: An exploratory literature review

“…The review identified 47 publications (journal articles n = 23; grey literature reports n = 23; PhD thesis n = 1) from 42 studies. Publications originated from England n = 32, 55–86 United Kingdom n = 10, 87–96 Scotland n = 2, 97,98 Ireland n = 2 99,100 and Wales n = 1 101 . Publications were largely qualitative ( n = 40) or mixed methods ( n = 4).…”

“…Further complexity resulted from rigid commissioning structures. Lack of integration between health and care budgets, not enough focus on prevention, early intervention or whole system approaches meant limited funding was directed towards services co‐produced with communities 69,72,79,84,86,90,94,96 . The emphasis on short‐term goals and funding of pilot projects, which were popular with commissioners, hindered co‐production approaches 64,72,79,93 …”

“…Examples of service users and community leaders independently pursuing their own ideas suggest a transfer of power can occur 68,77,79 . Some commissioners and providers felt service user presence made people in powerful positions more willing to listen to ideas, 57 and their voices added legitimacy to a shift in how services are designed 61,86 . Yet navigating the shift in power dynamics was not straightforward.…”

“…68,77,79 Some commissioners and providers felt service user presence made people in powerful positions more willing to listen to ideas, 57 and their voices added legitimacy to a shift in how services are designed. 61,86 Yet navigating the shift in power dynamics was not straightforward. Disempowerment of service users manifested in multiple ways: their apparent low status in meetings, 59,60 how meetings were conducted, 58 limited opportunity to contribute their voices, 71 lack of budget for their involvement activity, 61 and a devaluing of their lived experience.…”