The influence of a motivational interviewing based computerized screening assessment on veteran request for mental health services and treatment entrance rates

Abstract

Military veterans experience high prevalence rates of mental illness, substance use disorders (SUDs), and traumatic brain injury (TBI). However, veterans enter into treatment for these problems at very low rates. Mental health stigma, and particularly self-stigma, are posited as reasons for these low treatment entrance rates. One potential way to combat this self-stigma is through the use of computer-assisted screening, allowing veterans to reveal symptoms to a computer. The purpose of this study was to examine the effectiveness of a computer-assisted motivational interviewing (MI) intervention supported by the tenets of Self-Determination Theory in encouraging veterans to request a referral for treatment and to follow-through on attending at least one appointment for services within a 30-day follow-up period. The computer screening created for this purpose contained demographic questions, the Global Appraisal of Individual Needs: Short Screener (GAIN: SS) and the Neurobehavioral Symptom Inventory (NSI). These instruments were followed by a brief MI intervention provided by an on-screen avatar. The final question of the instrument asked participants if they would like a referral to a provider for any symptoms they might have. Those veterans requesting a referral were provided with one to an appropriate local provider and received a brief follow-up in 30 days to determine whether they had attended at least one appointment. Results of referral request rates and follow-through on entering into treatment were compared to Lindley, Cacciapaglia, Noronha, Carlson, and Schatzberg (2010), a study completed with veterans with mental health symptoms given the opportunity to accept a referral from primary care providers or mental health providers. The present study was effective at encouraging veterans to request a referral, though did not perform as well as the comparison study in the area of follow-through. Additional analysis uncovered other patterns indicating that some groups of veterans were more likely to request a referral than others. Future research is needed to improve computer-assisted interventions and to uncover those groups for whom they can be best recommended.