San Francisco VA researchers reach out to Iraq and Afghanistan vets

By Steve Tokar

A study getting under way at the San Francisco VA Medical Center (SFVAMC) aims to identify the best ways to encourage veterans of Iraq and Afghanistan to seek treatment for their combat-related problems. It also seeks to identify the most efficient ways for veterans to get the services they need.

As the first step in the study, “we will be speaking on the telephone with nearly one thousand Northern California veterans” who have returned from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), says principal investigator Karen Seal, MD, MPH, a staff physician at SFVAMC.

“The initiative is part of a national effort by the VA to help returning veterans readjust to life after war,” Seal notes.

Seal and her fellow researchers will screen the veterans on the telephone for combat-related difficulties such as symptoms of post-traumatic stress disorder (PTSD), depression, alcohol and substance abuse, and traumatic brain injury (TBI).

“We’ll also be asking the vets about challenges they might encounter when they try to access health care services,” says Seal, who is also an assistant professor of medicine at the University of California, San Francisco (UCSF). 

Veterans who screen positive for symptoms of combat-related difficulties will be offered enrollment in a study that compares the benefits of two telephone interviewing methods. Individuals will be randomly assigned to a group that receives one of the two techniques.

One group will receive motivational interviewing, a new technique that encourages veterans to “think about their own readiness to seek care, and about the potential barriers they might encounter in trying to get care,” explains Seal. “Interviewers will work with veterans to figure out ways in which they can more easily access care, and how they might be able to cut through some of the red tape that they perceive to be there, or that may actually be there, to get the services that they need.” 

The other group will be offered standard information and education about combat-related difficulties.

Both groups will receive referrals to appropriate treatment.

“Every veteran in the study will find out one way or another about their options for care,” says Seal. “Our goal is to see if motivational interviewing enhances the rate at which veterans engage with VA health care or other types of health care services in northern California.”

Project director Jennifer Cohen, MPA, says that if motivational interviewing proves effective, it can be adopted by VA health care facilities around the United States. “Basic training in these techniques takes only a few days,” Cohen explains.

Seal says that her study is part of a larger initiative at SFVAMC to improve care for OIF and OEF veterans. “We now have an integrated OIF/OEF clinic that combines primary care with combat stress services and social services in one visit,” she says. “It’s a one-stop clinic for veterans who need help with any combat-related difficulties.”

Seal notes that, nationally, VA health care is free of charge for all OIF and OEF veterans for two years following separation for any health problem possibly related to wartime service. In addition, all veterans newly enrolled in the VA health care system are routinely screened for combat related difficulties including PTSD and TBI. “Our study will complement this outreach effort by informing and educating veterans who perhaps haven’t sought out or received the care they are entitled to,” she says.

The VA website for returning veterans of Iraq and Afghanistan is

Seal says the ultimate goal of her study is to “provide care givers new ways to intervene early so that veterans of Iraq and Afghanistan don’t develop the chronic difficulties and disabilities we’ve seen with Vietnam-era veterans.”

The study is now recruiting veterans of OIF and OEF living in Northern California to participate in the study. “It’s a chance for veterans to help their comrades get help,” says Cohen.

Any veteran interested in participating in the study should call 415-221-4810, ext. 4627.

The study is supported by funds from the United States Department of Defense that are administered by the Northern California Institute for Research and Education (NCIRE), and the VA Clinical Services and Research Development Service.

Co-investigators on the study are Charles Marmar, MD, of SFVAMC and UCSF; David Mohr, PhD, of Northwestern University and Hines VA Hospital, Chicago; and Shannon McCaslin, PhD, of SFVAMC and UCSF.

NCIRE - the Veterans Health Research Institute - is the largest research institute associated with a VA medical center. Its mission is to improve the health and well-being of veterans and the general public by supporting a world-class biomedical research program conducted by the UCSF faculty at SFVAMC.

SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.

UCSF is a leading university that advances health worldwide by conducting advanced biomedical research, educating graduate students in the life sciences and health professions, and providing complex patient care.