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Mark Flower

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The University of Texas at Austin

University of California, Santa Barbara

Andrew M Colman

University of Leicester

József Böröcz

Rutgers, The State University of New Jersey

University of British Columbia

George Mason University

Lancaster University

Kansas State University

University of Cologne

Shaun Gallagher

University of Memphis

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Videos by Mark Flower

Community and Veteran Engagement

Talking about Peer Support and Addiction

1 views

Papers by Mark Flower

Health education through audio-teleconferencing

Hospital forum

Veteran Engagement in Survey Research to Prevent Suicide

by Mark Flower and Claire Hoffmire

Progress in Community Health Partnerships: Research, Education, and Action, Volume 17, Number 1, Spring 2023, pp. 129-134 (Article), 2023

with respect to methods of suicide. 5,6 Furthermore, veterans have described unique experiences a... more with respect to methods of suicide. 5,6 Furthermore, veterans have described unique experiences and preferences regarding suicide risk disclosure, assessment, and intervention. 7 To ensure that suicide risk and prevention research is responsive to veterans' unique needs, experiences, and preferences, veteran engagement is pivotal. Veteran engagement involves meaningfully incorporating veterans' perspectives into the research process. Doing so can help to ensure that research is relevant to the needs, experiences, and preferences of veterans. 8-10 Unfortunately, to our knowledge, veteran engagement in suicide risk and prevention research has historically been limited; veterans have not typically been

Impact of veteran‐led peer mentorship on posttraumatic stress disorder

by Mark Flower and Bob Curry

Journal of traumatic stress, Apr 18, 2024

Peer mentorship shows promise as a strategy to support veteran mental health. A community-academi... more Peer mentorship shows promise as a strategy to support veteran mental health. A community-academic partnership involving a veteran-led nonprofit organization and institutions of higher education evaluated a collaboratively developed peer mentor intervention. We assessed posttraumatic stress disorder (PTSD), postdeployment experiences, social functioning, and psychological strengths at

Industrial workshop in a drug detoxification unit: an approach to rehabilitation

Proceedings. National Conference on Methadone Treatment, 1973

Foreword to the Second Volume of the Special Issue on Veteran Community Engagement

Journal of Humanistic Psychology, Oct 8, 2023

Veteran community engagement is an evolving discipline informed by traditional community-based pa... more Veteran community engagement is an evolving discipline informed by traditional community-based participatory research, veteran studies, and veterans themselves. This Special Issue suggests that research collaborations including military veterans, soldiers, and their families as co-researchers is a critical next step toward a design thinking perspective in social and healthcare systems for this population. This Special Issue was conceptualized through a veteran community-academic partnership formed over a decade ago. This partnership hosted several Warrior Summit conferences from 2013 to present, with the last of this series calling for academic contributions. The resulting papers drawn from the conference and other authors form this issue, and include a wide range of topics: veteran microdosing and psychedelic self-medication; a historical view of the impact of education exchange between U.S. and South Korean military nurses; strategies for engaging veterans in research of a theaterbased intervention for PTSD; interprofessional approaches to addressing veteran identity considerations through collaborations between chaplain service and psychologists in the VA Healthcare System; an international perspective

Impact of veteran-led peer mentorship on posttraumatic stress disorder

Progress in Community Health Partnerships, Mar 1, 2024

Peer mentorship shows promise as a strategy to support veteran mental health. A community-academi... more Peer mentorship shows promise as a strategy to support veteran mental health. A community-academic partnership involving a veteran-led nonprofit organization and institutions of higher education evaluated a collaboratively developed peer mentor intervention. We assessed posttraumatic stress disorder (PTSD), postdeployment experiences, social functioning, and psychological strengths at baseline, midpoint, and 12-week discharge using the PTSD Checklist for DSM-5 (PCL-5), Deployment Risk and Resilience Inventory-2, Social Adaptation Selfevaluation Scale, and Values in Action Survey. Brief weekly check-in surveys reinforced mentor contact and assessed retention. The sample included 307 veterans who were served by 17 veteran peer mentors. Mixed-effects linear models found a modest effect for PTSD symptom change, with a mean PCL-5 score reduction of 4.04 points, 95% CI [−6.44, −1.64], d = 0.44. More symptomatic veterans showed a larger effect, with average reductions of 9.03 points, 95% CI [-12.11,-5.95], d = 0.77. There were no significant findings for other outcome variables. Compared to younger veterans, those aged 32-57 years were less likely to drop out by 6 weeks, aORs = 0.32-0.26. Week-by-week hazard of drop-out was lower with mentors ≥ 35 years old, aHR = 0.62, 95% CI [0.37, 1.05]. Unadjusted survival differed by mentor military branch, p = .028, but the small mentor sample reduced interpretability. Like many community research efforts, this study lacked a

The Milwaukee Continuum: Older Veterans and Nonveterans Use Housing First to Exit Homelessness

Journal of Humanistic Psychology, Aug 8, 2019

Background: Homelessness is about survival and more than an issue of bricks and mortar. It is not... more Background: Homelessness is about survival and more than an issue of bricks and mortar. It is not a static dimension and alludes to a troubled age and brokenness of society. Despite dramatic declines in numbers of people presently homeless, the issue continues to be a public health issue. The number of veterans currently homeless continues to be of national concern despite application of resources. More needs to be done to better understand the concerns of veterans, once homeless and now housed. Method: Qualitative research in the form of interviews provided insights from the veterans on their experience around achieving housing. Qualitative methods are often used in evaluations as they speak of the experience of the program being evaluated by capturing and then communicating the narratives of the participants. This study was grounded in community-based participatory research where a member of community was a part of all phases of the research process. Results: Seven interviews with formerly homeless veterans were conducted. Themes included the following: Burnt

Delayed ITU discharge: causes and impact

Critical Care, Feb 1, 2011

Suicide Prevention Advertising Exposure and Perceptions of Firearm Safe Storage in a Sample of Wisconsin Veterans

Objective: This study summarizes results of a survey of veteran and non-veteran Wisconsin residen... more Objective: This study summarizes results of a survey of veteran and non-veteran Wisconsin residents on their reported exposure to suicide prevention public messages and attitudes about safe storage of firearms. Methods: A 41-item survey was completed by 400 state of Wisconsin residents (Dec. 2021 to Jan. 2022) which asked about: 1) exposure to suicide prevention messaging, 2) perceptions around safe storage of firearms for suicide prevention, 3) current mental health status and current stressors, 4) exposure to suicidal behavior, 5) firearm ownership and firearm storage and 6) demographic information. Comparisons were made between veteran and non-veterans. Results: Overall the results were consistent to previous studies regarding veterans owning more firearms and storing their firearm less securely than non-veterans. Additionally, veterans reported visiting websites, and seeing and hearing more public messages about suicide prevention and firearm safety than non-veterans. Veterans reported that they were less likely to safely storage firearm in the event of a crisis as compared to non-veterans. However, veterans reported that other people should store their firearms more safely than they felt they should. Conclusions: It is interesting that even though veteran might hear and see more messages about suicide prevention and firearm safe storage, that veterans are less likely to safely store their firearms. Even though veteran agree that "others" should safely store firearms, the veteran ("me or I") does not apply this recommendation to themselves. Recommendations on how public messaging should address the issue that veterans overall agree that firearms should be stored safely in the event of a crisis but they do not see this applying to themselves.

Beyond the Manuscript: Podcast Interview Transcript

Progress in Community Health Partnerships, 2016

The patients engaged in education and research (PEER) health care-associated infection prevention project: A Veteran perspective

by Mark Flower and Nasia Safdar

American Journal of Infection Control, Feb 1, 2022

Detecting & visualizing crisis events in human systems: An mHealth approach with high risk veterans

by Mark Flower and Jim Tasse

International Conference on Information Systems for Crisis Response and Management, 2018

Designing mHealth applications for mental health interventions has largely focused on education a... more Designing mHealth applications for mental health interventions has largely focused on education and patient self-management. Next generation applications must take on more complex tasks, including sensor-based detection of crisis events, search for individualized early warning signs, and support for crisis intervention. This project examines approaches to integrating multiple worn sensors to detect mental health crisis events in US military veterans. Our work has highlighted several practical and theoretical problems with applying technology to evaluation crises in human system, which are often subtle and difficult to detect, as compared to technological or natural crisis events. Humans often do not recognize when they are in crisis and under-report crises to prevent reputational damage. The current project explores preliminary use of the E4 Empatica wristband to characterize acute aggression using a combination of veteran self-report data on anger, professional actors simulating aggressive events, and preliminary efforts to discriminate between crisis data and early warning sign data.

Engaging veterans in identifying key elements of environmental cleaning and disinfection for preventing healthcare-associated infections: A qualitative study

American Journal of Infection Control, 2022

BACKGROUND Environmental cleaning and disinfection are important for preventing healthcare-associ... more BACKGROUND Environmental cleaning and disinfection are important for preventing healthcare-associated infections (HAIs) via contaminated surfaces. Hospital cleanliness plays a large role in patient perception and satisfaction regarding their healthcare. However, patient perceptions of environmental cleaning procedures remain unclear. The objective of the study was to engage patients in achieving patient-centered care and examine patient perspectives on environmental cleaning work systems in healthcare. METHODS A qualitative descriptive study was conducted using semi-structured interviews with hospitalized patients at a Midwestern Veterans Administration Hospital. Interviews were audio recorded, transcribed, then coded to identify recurring themes. RESULTS Fifteen patient interview were conducted. Patients reported expecting a clean hospital room. Some patients expressed feeling "in the way" during cleaning, possibly rushing cleaning procedures. Patients expressed confidence in Environmental Management Service (EMS) staff's skilled work and noted "soft skills" as desirable attributes, including camaraderie which can develop between Veteran patients and Veteran staff during room cleaning. CONCLUSIONS Patients identified environmental cleaning as a priority for HAI patient-centered infection prevention practices. Cleaning occupied rooms may be an important entry point for intervention to address actual or perceived disruption to patients or build upon Veteran peer relationships. Cleaning procedures may become more patient-centric if cleaning procedures were explained and based on patient preferences.

Engaging veterans in identifying key elements of environmental cleaning and disinfection for preventing healthcare-associated infections: A qualitative study

by Mark Flower and Linda McKinley

Background: Environmental cleaning and disinfection are important for preventing healthcare-assoc... more Background: Environmental cleaning and disinfection are important for preventing healthcare-associated infections (HAIs) via contaminated surfaces. Hospital cleanliness plays a large role in patient perception and satisfaction regarding their healthcare. However, patient perceptions of environmental cleaning procedures remain unclear. The objective of the study was to engage patients in achieving patient-centered care and examine patient perspectives on environmental cleaning work systems in healthcare. Methods: A qualitative descriptive study was conducted using semi-structured interviews with hospitalized patients at a Midwestern Veterans Administration Hospital. Interviews were audio recorded, transcribed, then coded to identify recurring themes. Results: Fifteen patient interview were conducted. Patients reported expecting a clean hospital room. Some patients expressed feeling "in the way" during cleaning, possibly rushing cleaning procedures. Patients expressed confidence in Environmental Management Service (EMS) staff's skilled work and noted "soft skills" as desirable attributes, including camaraderie which can develop between Veteran patients and Veteran staff during room cleaning. Conclusions: Patients identified environmental cleaning as a priority for HAI patient-centered infection prevention practices. Cleaning occupied rooms may be an important entry point for intervention to address actual or perceived disruption to patients or build upon Veteran peer relationships. Cleaning procedures may become more patient-centric if cleaning procedures were explained and based on patient preferences.

Veteran Engagement in Survey Research to Prevent Suicide

Progress in Community Health Partnerships: Research, Education, and Action

with respect to methods of suicide. 5,6 Furthermore, veterans have described unique experiences a... more with respect to methods of suicide. 5,6 Furthermore, veterans have described unique experiences and preferences regarding suicide risk disclosure, assessment, and intervention. 7 To ensure that suicide risk and prevention research is responsive to veterans' unique needs, experiences, and preferences, veteran engagement is pivotal. Veteran engagement involves meaningfully incorporating veterans' perspectives into the research process. Doing so can help to ensure that research is relevant to the needs, experiences, and preferences of veterans. 8-10 Unfortunately, to our knowledge, veteran engagement in suicide risk and prevention research has historically been limited; veterans have not typically been

BoBS Model, Peer Perspectives, FINAL DRAFT (1)

Samsha work

BoBS Evaluation Close-Out Report, FINAL

Samsha work

Implementing Algorithmic Crisis Alerts in mHealth Systems for Veterans with PTSD

by Mark Flower and Wylie Frydrychowicz

This paper seeks to establish a machine learning driven method by which a military veteran with P... more This paper seeks to establish a machine learning driven method by which a military veteran with Post-Traumatic Stress Disorder (PTSD) is classified as being in a crisis situation or not, based upon a given set of criteria. Optimizing alerting decision rules is critical to ensure that veterans at highest risk for mental health crisis rapidly receive additional attention. Subject matter experts in our team (a psychologist, a medical anthropologist, and an expert veteran), defined acute crisis, early warning signs and long-term crisis from this dataset. First, we used a decision tree to find an early time point when the peer mentors (who are also veterans) need to observe the behavior of veterans to make a decision about conducting an intervention. Three different machine learning algorithms were used to predict long term crisis using acute crisis and early warning signs within the determined time point.

Identifying Precursors to Long-Term Crisis in Veterans Using Associative Classifier

2021 IEEE International Conference on Big Data (Big Data)

Post-Traumatic Stress Disorder (PTSD) is one of the most common mental health disorders prevalent... more Post-Traumatic Stress Disorder (PTSD) is one of the most common mental health disorders prevalent in the US. Most alarming, PTSD occurs at double the rate for combat veterans compared to the general population. Severity of PTSD is associated with risk taking behaviors such as substance abuse, non-suicidal self-injury, sexual risk behaviors, among other negative behaviors. Psychological disorders are often preceded by crisis events, thus monitoring for crisis events can help prevent risky behavior in veterans. Ecological momentary assessment techniques are effective in capturing possible crisis events for veterans. Mobile apps are commonly used to gather such behavioral changes in participants. Crisis events collected from m-health can be analyzed for the identification of long- term PTSD risk. Early identification of risk can help in planning intervention to mitigate the risk. Many scholars have used traditional statistical and machine learning methods for the prediction of mental health issues in individuals. But these models lack transparency in how decisions are made. Providing justifications for the predictions can increase the reliability of the model. Our research focused on developing an explainable prediction model using class association rules to identify veterans at risk of persistent PTSD. The generated association rules serve as precursors to the long-term crisis in veterans. Results of the analysis showed that having no family support, little or no interest in hobbies, stress and lack of sleep are some of the influencing factors of persistent PTSD in veterans.

Community and Veteran Engagement

Talking about Peer Support and Addiction

1 views

Health education through audio-teleconferencing

Hospital forum

Veteran Engagement in Survey Research to Prevent Suicide

by Mark Flower and Claire Hoffmire

Progress in Community Health Partnerships: Research, Education, and Action, Volume 17, Number 1, Spring 2023, pp. 129-134 (Article), 2023

with respect to methods of suicide. 5,6 Furthermore, veterans have described unique experiences a... more with respect to methods of suicide. 5,6 Furthermore, veterans have described unique experiences and preferences regarding suicide risk disclosure, assessment, and intervention. 7 To ensure that suicide risk and prevention research is responsive to veterans' unique needs, experiences, and preferences, veteran engagement is pivotal. Veteran engagement involves meaningfully incorporating veterans' perspectives into the research process. Doing so can help to ensure that research is relevant to the needs, experiences, and preferences of veterans. 8-10 Unfortunately, to our knowledge, veteran engagement in suicide risk and prevention research has historically been limited; veterans have not typically been

Impact of veteran‐led peer mentorship on posttraumatic stress disorder

by Mark Flower and Bob Curry

Journal of traumatic stress, Apr 18, 2024

Peer mentorship shows promise as a strategy to support veteran mental health. A community-academi... more Peer mentorship shows promise as a strategy to support veteran mental health. A community-academic partnership involving a veteran-led nonprofit organization and institutions of higher education evaluated a collaboratively developed peer mentor intervention. We assessed posttraumatic stress disorder (PTSD), postdeployment experiences, social functioning, and psychological strengths at

Industrial workshop in a drug detoxification unit: an approach to rehabilitation

Proceedings. National Conference on Methadone Treatment, 1973

Foreword to the Second Volume of the Special Issue on Veteran Community Engagement

Journal of Humanistic Psychology, Oct 8, 2023

Veteran community engagement is an evolving discipline informed by traditional community-based pa... more Veteran community engagement is an evolving discipline informed by traditional community-based participatory research, veteran studies, and veterans themselves. This Special Issue suggests that research collaborations including military veterans, soldiers, and their families as co-researchers is a critical next step toward a design thinking perspective in social and healthcare systems for this population. This Special Issue was conceptualized through a veteran community-academic partnership formed over a decade ago. This partnership hosted several Warrior Summit conferences from 2013 to present, with the last of this series calling for academic contributions. The resulting papers drawn from the conference and other authors form this issue, and include a wide range of topics: veteran microdosing and psychedelic self-medication; a historical view of the impact of education exchange between U.S. and South Korean military nurses; strategies for engaging veterans in research of a theaterbased intervention for PTSD; interprofessional approaches to addressing veteran identity considerations through collaborations between chaplain service and psychologists in the VA Healthcare System; an international perspective

Impact of veteran-led peer mentorship on posttraumatic stress disorder

Progress in Community Health Partnerships, Mar 1, 2024

Peer mentorship shows promise as a strategy to support veteran mental health. A community-academi... more Peer mentorship shows promise as a strategy to support veteran mental health. A community-academic partnership involving a veteran-led nonprofit organization and institutions of higher education evaluated a collaboratively developed peer mentor intervention. We assessed posttraumatic stress disorder (PTSD), postdeployment experiences, social functioning, and psychological strengths at baseline, midpoint, and 12-week discharge using the PTSD Checklist for DSM-5 (PCL-5), Deployment Risk and Resilience Inventory-2, Social Adaptation Selfevaluation Scale, and Values in Action Survey. Brief weekly check-in surveys reinforced mentor contact and assessed retention. The sample included 307 veterans who were served by 17 veteran peer mentors. Mixed-effects linear models found a modest effect for PTSD symptom change, with a mean PCL-5 score reduction of 4.04 points, 95% CI [−6.44, −1.64], d = 0.44. More symptomatic veterans showed a larger effect, with average reductions of 9.03 points, 95% CI [-12.11,-5.95], d = 0.77. There were no significant findings for other outcome variables. Compared to younger veterans, those aged 32-57 years were less likely to drop out by 6 weeks, aORs = 0.32-0.26. Week-by-week hazard of drop-out was lower with mentors ≥ 35 years old, aHR = 0.62, 95% CI [0.37, 1.05]. Unadjusted survival differed by mentor military branch, p = .028, but the small mentor sample reduced interpretability. Like many community research efforts, this study lacked a

The Milwaukee Continuum: Older Veterans and Nonveterans Use Housing First to Exit Homelessness

Journal of Humanistic Psychology, Aug 8, 2019

Background: Homelessness is about survival and more than an issue of bricks and mortar. It is not... more Background: Homelessness is about survival and more than an issue of bricks and mortar. It is not a static dimension and alludes to a troubled age and brokenness of society. Despite dramatic declines in numbers of people presently homeless, the issue continues to be a public health issue. The number of veterans currently homeless continues to be of national concern despite application of resources. More needs to be done to better understand the concerns of veterans, once homeless and now housed. Method: Qualitative research in the form of interviews provided insights from the veterans on their experience around achieving housing. Qualitative methods are often used in evaluations as they speak of the experience of the program being evaluated by capturing and then communicating the narratives of the participants. This study was grounded in community-based participatory research where a member of community was a part of all phases of the research process. Results: Seven interviews with formerly homeless veterans were conducted. Themes included the following: Burnt

Delayed ITU discharge: causes and impact

Critical Care, Feb 1, 2011

Suicide Prevention Advertising Exposure and Perceptions of Firearm Safe Storage in a Sample of Wisconsin Veterans

Objective: This study summarizes results of a survey of veteran and non-veteran Wisconsin residen... more Objective: This study summarizes results of a survey of veteran and non-veteran Wisconsin residents on their reported exposure to suicide prevention public messages and attitudes about safe storage of firearms. Methods: A 41-item survey was completed by 400 state of Wisconsin residents (Dec. 2021 to Jan. 2022) which asked about: 1) exposure to suicide prevention messaging, 2) perceptions around safe storage of firearms for suicide prevention, 3) current mental health status and current stressors, 4) exposure to suicidal behavior, 5) firearm ownership and firearm storage and 6) demographic information. Comparisons were made between veteran and non-veterans. Results: Overall the results were consistent to previous studies regarding veterans owning more firearms and storing their firearm less securely than non-veterans. Additionally, veterans reported visiting websites, and seeing and hearing more public messages about suicide prevention and firearm safety than non-veterans. Veterans reported that they were less likely to safely storage firearm in the event of a crisis as compared to non-veterans. However, veterans reported that other people should store their firearms more safely than they felt they should. Conclusions: It is interesting that even though veteran might hear and see more messages about suicide prevention and firearm safe storage, that veterans are less likely to safely store their firearms. Even though veteran agree that "others" should safely store firearms, the veteran ("me or I") does not apply this recommendation to themselves. Recommendations on how public messaging should address the issue that veterans overall agree that firearms should be stored safely in the event of a crisis but they do not see this applying to themselves.

Beyond the Manuscript: Podcast Interview Transcript

Progress in Community Health Partnerships, 2016

The patients engaged in education and research (PEER) health care-associated infection prevention project: A Veteran perspective

by Mark Flower and Nasia Safdar

American Journal of Infection Control, Feb 1, 2022

Detecting & visualizing crisis events in human systems: An mHealth approach with high risk veterans

by Mark Flower and Jim Tasse

International Conference on Information Systems for Crisis Response and Management, 2018

Designing mHealth applications for mental health interventions has largely focused on education a... more Designing mHealth applications for mental health interventions has largely focused on education and patient self-management. Next generation applications must take on more complex tasks, including sensor-based detection of crisis events, search for individualized early warning signs, and support for crisis intervention. This project examines approaches to integrating multiple worn sensors to detect mental health crisis events in US military veterans. Our work has highlighted several practical and theoretical problems with applying technology to evaluation crises in human system, which are often subtle and difficult to detect, as compared to technological or natural crisis events. Humans often do not recognize when they are in crisis and under-report crises to prevent reputational damage. The current project explores preliminary use of the E4 Empatica wristband to characterize acute aggression using a combination of veteran self-report data on anger, professional actors simulating aggressive events, and preliminary efforts to discriminate between crisis data and early warning sign data.

Engaging veterans in identifying key elements of environmental cleaning and disinfection for preventing healthcare-associated infections: A qualitative study

American Journal of Infection Control, 2022

BACKGROUND Environmental cleaning and disinfection are important for preventing healthcare-associ... more BACKGROUND Environmental cleaning and disinfection are important for preventing healthcare-associated infections (HAIs) via contaminated surfaces. Hospital cleanliness plays a large role in patient perception and satisfaction regarding their healthcare. However, patient perceptions of environmental cleaning procedures remain unclear. The objective of the study was to engage patients in achieving patient-centered care and examine patient perspectives on environmental cleaning work systems in healthcare. METHODS A qualitative descriptive study was conducted using semi-structured interviews with hospitalized patients at a Midwestern Veterans Administration Hospital. Interviews were audio recorded, transcribed, then coded to identify recurring themes. RESULTS Fifteen patient interview were conducted. Patients reported expecting a clean hospital room. Some patients expressed feeling "in the way" during cleaning, possibly rushing cleaning procedures. Patients expressed confidence in Environmental Management Service (EMS) staff's skilled work and noted "soft skills" as desirable attributes, including camaraderie which can develop between Veteran patients and Veteran staff during room cleaning. CONCLUSIONS Patients identified environmental cleaning as a priority for HAI patient-centered infection prevention practices. Cleaning occupied rooms may be an important entry point for intervention to address actual or perceived disruption to patients or build upon Veteran peer relationships. Cleaning procedures may become more patient-centric if cleaning procedures were explained and based on patient preferences.

Engaging veterans in identifying key elements of environmental cleaning and disinfection for preventing healthcare-associated infections: A qualitative study

by Mark Flower and Linda McKinley

Background: Environmental cleaning and disinfection are important for preventing healthcare-assoc... more Background: Environmental cleaning and disinfection are important for preventing healthcare-associated infections (HAIs) via contaminated surfaces. Hospital cleanliness plays a large role in patient perception and satisfaction regarding their healthcare. However, patient perceptions of environmental cleaning procedures remain unclear. The objective of the study was to engage patients in achieving patient-centered care and examine patient perspectives on environmental cleaning work systems in healthcare. Methods: A qualitative descriptive study was conducted using semi-structured interviews with hospitalized patients at a Midwestern Veterans Administration Hospital. Interviews were audio recorded, transcribed, then coded to identify recurring themes. Results: Fifteen patient interview were conducted. Patients reported expecting a clean hospital room. Some patients expressed feeling "in the way" during cleaning, possibly rushing cleaning procedures. Patients expressed confidence in Environmental Management Service (EMS) staff's skilled work and noted "soft skills" as desirable attributes, including camaraderie which can develop between Veteran patients and Veteran staff during room cleaning. Conclusions: Patients identified environmental cleaning as a priority for HAI patient-centered infection prevention practices. Cleaning occupied rooms may be an important entry point for intervention to address actual or perceived disruption to patients or build upon Veteran peer relationships. Cleaning procedures may become more patient-centric if cleaning procedures were explained and based on patient preferences.

Veteran Engagement in Survey Research to Prevent Suicide

Progress in Community Health Partnerships: Research, Education, and Action

with respect to methods of suicide. 5,6 Furthermore, veterans have described unique experiences a... more with respect to methods of suicide. 5,6 Furthermore, veterans have described unique experiences and preferences regarding suicide risk disclosure, assessment, and intervention. 7 To ensure that suicide risk and prevention research is responsive to veterans' unique needs, experiences, and preferences, veteran engagement is pivotal. Veteran engagement involves meaningfully incorporating veterans' perspectives into the research process. Doing so can help to ensure that research is relevant to the needs, experiences, and preferences of veterans. 8-10 Unfortunately, to our knowledge, veteran engagement in suicide risk and prevention research has historically been limited; veterans have not typically been

BoBS Model, Peer Perspectives, FINAL DRAFT (1)

Samsha work

BoBS Evaluation Close-Out Report, FINAL

Samsha work

Implementing Algorithmic Crisis Alerts in mHealth Systems for Veterans with PTSD

by Mark Flower and Wylie Frydrychowicz

This paper seeks to establish a machine learning driven method by which a military veteran with P... more This paper seeks to establish a machine learning driven method by which a military veteran with Post-Traumatic Stress Disorder (PTSD) is classified as being in a crisis situation or not, based upon a given set of criteria. Optimizing alerting decision rules is critical to ensure that veterans at highest risk for mental health crisis rapidly receive additional attention. Subject matter experts in our team (a psychologist, a medical anthropologist, and an expert veteran), defined acute crisis, early warning signs and long-term crisis from this dataset. First, we used a decision tree to find an early time point when the peer mentors (who are also veterans) need to observe the behavior of veterans to make a decision about conducting an intervention. Three different machine learning algorithms were used to predict long term crisis using acute crisis and early warning signs within the determined time point.

Identifying Precursors to Long-Term Crisis in Veterans Using Associative Classifier

2021 IEEE International Conference on Big Data (Big Data)

Post-Traumatic Stress Disorder (PTSD) is one of the most common mental health disorders prevalent... more Post-Traumatic Stress Disorder (PTSD) is one of the most common mental health disorders prevalent in the US. Most alarming, PTSD occurs at double the rate for combat veterans compared to the general population. Severity of PTSD is associated with risk taking behaviors such as substance abuse, non-suicidal self-injury, sexual risk behaviors, among other negative behaviors. Psychological disorders are often preceded by crisis events, thus monitoring for crisis events can help prevent risky behavior in veterans. Ecological momentary assessment techniques are effective in capturing possible crisis events for veterans. Mobile apps are commonly used to gather such behavioral changes in participants. Crisis events collected from m-health can be analyzed for the identification of long- term PTSD risk. Early identification of risk can help in planning intervention to mitigate the risk. Many scholars have used traditional statistical and machine learning methods for the prediction of mental health issues in individuals. But these models lack transparency in how decisions are made. Providing justifications for the predictions can increase the reliability of the model. Our research focused on developing an explainable prediction model using class association rules to identify veterans at risk of persistent PTSD. The generated association rules serve as precursors to the long-term crisis in veterans. Results of the analysis showed that having no family support, little or no interest in hobbies, stress and lack of sleep are some of the influencing factors of persistent PTSD in veterans.

Veteran Engagement in Health Services Research: a Conceptual Model

Journal of General Internal Medicine

With 20 million living veterans and millions more immediate family members, and approximately 9 m... more With 20 million living veterans and millions more immediate family members, and approximately 9 million veterans enrolled in the nationally networked VA healthcare system, representing the interests and needs of veterans in this complex community is a substantial endeavor. Based on the importance of engaging Veterans in research, the VA Health Services Research and Development (HSR&D) Service convened a Working Group of VA researchers and Veterans to conduct a review of patient engagement models and develop recommendations for an approach to engage Veterans in health research that would incorporate their unique lived experiences and interests, and their perspectives on research priorities. The Working Group considered the specific context for Veteran engagement in research that includes other VA stakeholders from the operational and clinical leadership of the VA Health Administration (VHA). The resulting model identifies the range of potential stakeholders and three domains of relev...

Podcast Interview Transcript