Building capacity to care for Veterans and families: Results of a mental health service provider needs assessment

Abstract

Introduction:

Community mental health service providers are an integral element of support in the Canadian mental health system for Veterans, yet their capacity needs specific to caring for Veterans is not well understood.

Methods:

A national needs assessment survey was disseminated to mental health service providers who care for Canadian Armed Forces Veterans and retired Royal Canadian Mounted Police members using a multi-pronged strategy. Outreach focused on community providers registered to deliver services to Veterans Affairs Canada clients, to understand capacity needs, including cultural competency needs. An optional sub-survey assessed capacity needs specific to providing services to those impacted by military sexual trauma. Descriptive analysis of these data was conducted.

Results:

There were 696 people who completed the survey, 669 of whom identified as a service provider. Most respondents (509) agreed to participate in the sub-survey. Of the service provider respondents, 76% were trained in cognitive behavioural therapy. Of the respondents who completed the sub-survey, 12% reported receiving specialized training in caring for someone impacted by military sexual trauma.

Discussion:

While most respondents had training in at least one of the evidence-based therapies for posttraumatic stress disorder (PTSD), respondents had the least training in prolonged exposure therapy and cognitive processing therapy, despite these being strongly recommended in PTSD treatment guidelines. It is unclear from the survey how closely evidence-based therapies are being delivered with fidelity to their protocols. There is a dearth of training among service providers in sexual trauma, signalling an area for future training development.

Lay Summary

Some Veterans released from the Canadian Armed Forces have mental health disorders, such as posttraumatic stress disorder (PTSD). To improve Veteran mental health, there need to be treatments that are helpful. There also needs to be a way for mental health professionals to learn about these treatments. Not much is known about the treatments and topics in which Canadian mental health professionals are trained. In 2021, the Atlas Institute for Veterans and Families surveyed Canadian mental health professionals who provide care to Veterans. The survey asked respondents questions about current training and what they would like to know more about. There were also questions about training specific to Veterans impacted by military sexual trauma (MST). A total of 696 people completed the survey, 669 of whom were mental health professionals. Most respondents had training in cognitive behavioural therapy (76%). This therapy is one of the top recommended treatments for PTSD. Mental health professionals indicated they wanted to learn more about other recommended treatments and newer treatments. Only 12% of those who answered questions about MST indicated they had specialized training. Overall, many professionals have training in at least one treatment for PTSD. Mental health professionals want to learn prolonged exposure therapy and cognitive processing therapy. More information is needed to see whether treatments are being used as intended. Specialized resources for MST may help professionals provide better care to Veterans who experienced sexual trauma.

Introduction

Access to mental health treatment among Canadian Veterans is an issue of national interest, notably, with Veterans Affairs Canada (VAC) announcing efforts to reduce a significant backlog of disability claims.¹ Though most Veterans of the Canadian Armed Forces (CAF) have good mental health, many have problems that affect functioning, well-being, and health care service use.² Compared with the general population, Veterans released since 1998 have a considerably greater prevalence of poor self-rated mental health, anxiety disorders, mood disorders and posttraumatic stress disorder (PTSD).² Of CAF Veterans receiving a disability benefit for a mental health condition, over 70% receive their benefit for PTSD.³

Access to treatment is only one contributor to improving mental health outcomes for Veterans. Implementation science literature has advanced the understanding that, for socially significant outcomes to be realized, there need to be effective innovations (i.e., evidence-based treatments), effective implementation, and enabling contexts.⁴ When it comes to effective treatments, the mental health field has continued to advance with various established evidence-based practices (EBPs) recommended in clinical practice guidelines and often as first-line treatments.⁵ For PTSD, this includes psychotherapies such as cognitive processing therapy (CPT), prolonged exposure (PE) therapy, and eye movement desensitization and reprocessing (EMDR).⁶

Effective EBPs, however, require proper training for mental health service providers. Corresponding support is also needed to address implementation barriers at the patient, provider, and organizational levels to ensure EBPs are part of routine practice, delivered with fidelity to their protocols, and evaluated. Without these elements, gaps will persist between what is known to be effective and what is delivered in real-world settings.^5,7,8,9,10 Furthermore, the effective implementation of practices requires providers to understand the socio-ecological context of patients.^11,12 Doing so for Veterans by enhancing cultural competence is therefore fundamental.¹³

It is against this backdrop that the Atlas Institute for Veterans and Families (atlasveterans.ca; formerly known as the Centre of Excellence on PTSD and Related Mental Health Conditions) was established in 2019. Atlas is a national intermediary organization funded by VAC. Its mandate includes facilitating the uptake of EBPs within the mental health care system to enhance capacity to deliver quality care, taking into account the unique needs of CAF and Royal Canadian Mounted Police (RCMP) Veterans and their families.¹⁴ For Atlas to establish its training and implementation services and develop relevant capacity-building resources, the authors needed to hear about capacity needs from mental health service providers in a variety of professions who care for CAF and RCMP Veterans and families. Administering an assessment to discover needs is also a recommended step for intermediary organizations, like Atlas, that straddle the “synthesis & translation system” and “support system” for individuals and organizations seeking to implement an innovation within the “delivery systems,” as described in the Interactive Systems Framework.¹⁵

The aim was to understand psychotherapy EBP-specific learning and capacity needs and begin to unpack the general capacity needs that exist among a wide range of Canadian mental health professionals delivering psychotherapy services to CAF Veterans and/or former RCMP. Of particular interest were Federal Administered Program Providers (FAPP) registered through Medavie Blue Cross to deliver services to VAC clients, which have a direct billing arrangement in place with VAC.¹⁶ Unlike the network of Operational Stress Injury (OSI) clinics, which are funded by VAC to provide evidence-based mental health services to eligible members (current and former) of the CAF and RCMP and have some standardization in place for performance measurement and outcome monitoring,¹⁷ less is known about the types of EBPs delivered through the FAPP or other community providers. Moreover, concerns have been expressed about the adequacy of services available to Veterans in the community, in some cases, as well as the recognition many community service providers are not familiar with military culture, despite this being an important component of the treatment relationship for Veterans.¹⁸ These concerns signal an opportunity to focus on capacity-building among community providers. To the authors’ knowledge, this is the first national survey exploring capacity needs across a broad range of service providers who provide psychotherapy EBPs to CAF and/or RCMP Veterans and families.

Methods

Survey design and audience

Atlas contracted Cathexis Consulting, a Canadian evaluation consultancy, to administer a national survey to mental health service providers delivering psychotherapy services to CAF Veterans and/or former RCMP (e.g., counsellors, nurses, occupational therapists, peer supporters, physicians, psychiatrists, psychologists, psychotherapists, social workers), with a particular focus on FAPP.

To obtain broad reach and facilitate the quick collection of feedback, the survey was designed as an online questionnaire. It was open from July 22 to September 7, 2021. Given the prevalence of military sexual misconduct, with thousands of CAF members experiencing or witnessing sexual misconduct at some point during their careers,¹⁹ an optional sub-survey to assess capacity needs specific to providing service to those impacted by military sexual trauma (MST) was included. The survey was available in English and French.

There was a total of 18 questions in the main survey, plus the optional sub-survey with four questions related to MST. The main survey was composed of three sections: 1) demographic and professional profile questions, 2) questions about the current state of respondents’ service and training as it related to mental health care for Veterans and their families, and 3) questions about preferences for training and supports related to mental health care for Veterans and their families. Most questions were multiple choice, with the opportunity to select all options that applied, and typically included an open text option for comments, or respondents were asked to rate their answers on a Likert scale. Most respondents completed the survey in 10 minutes or less. The project was cleared by The Royal’s Research Ethics Board (University of Ottawa) to proceed without ethics approval, as it was deemed to be program evaluation and did not require review by the board.

A multi-pronged promotion strategy was employed to disseminate the survey broadly, including contacts within Atlas’ network, and a combination of intermediary organizations, professional colleges and associations, and direct providers representing national, provincial, and municipal catchments. Materials were provided by email in English and French and included pre-written content for newsletters, social media, and email. Advertising was also purchased on the social media sites Facebook and LinkedIn.

Data analysis was conducted in Excel, 2016 (Microsoft, Redmond, WA). A total of 148 responses were excluded from analysis as they were not sufficiently completed. No other vetting of responses occurred.

Results

In total, 696 people completed the survey, the majority of whom replied in English (663 English, 33 entirely or mostly in French). This section outlines the main findings from the survey.

Demographics

Of the 696 who completed the survey, 695 provided information about their professional roles (multiple options could be selected). Of those, 669 identified as a service provider with the following professions represented (respondents could select multiple responses): 278 psychologists, 228 psychotherapists, 183 social workers, 130 counsellors, and 14 other professions, such as marriage family therapist, former service provider, registered nurse, occupational health nurse, and mental health educator. In addition, 29 respondents identified as being an administrator or manager of a service provider (in some cases, respondents had dual roles as service providers), and six did not provide further detail. Considering the intent to learn about capacity needs across the system, select results are presented with additional perspectives to convey a broader understanding of these needs.

A total of 65% of service provider respondents (437) were FAPP registered with Medavie Blue Cross and 17 respondents indicated they were employed by an OSI clinic. Survey respondents were located across Canada, with respondents from each province and one territory, though most respondents were from Ontario (46%). The majority were in urban settings, while 9% said they were in a rural setting.

Existing capacity

Of respondents who identified as service providers (669), 22% reported spending around half of their time or more providing care to Veterans, and 3% reported spending around half of their time or more providing care to Veterans’ families.

Most respondents received training in EBPs for PTSD and related mental health conditions (respondents to this question [n = 680] could select multiple options). Among the most common responses, 76% had training in cognitive behavioural therapy (CBT), 44% in EMDR, 44% in trauma-focused CBT, 41% in cognitive therapy (CT), 31% in PE, and 31% in CPT.

Many received some training in caring for a Veteran or Veteran’s family member, with 35% reporting they received specialized training, 17% reporting they received awareness training, and 2% reporting being trainers on this topic.

Capacity needs

Established EBPs and emerging therapies

Respondents expressed interest in receiving resources or training on the following practices (respondents to this question [n = 680] could select multiple options): accelerated resolution therapy (42%), Unified Protocol for Transdiagnostic Treatment (36%), trauma-focused couples CBT (34%), CPT (33%), EMDR (30%), trauma-focused CBT (30%), PE (25%), CT (15%), and CBT (10%).

Topics and approaches of interest

Respondents indicated interest in resources or training on the following topics (multiple options could be selected; n = 643): moral injury (82%), MST (69%), intimate partner violence (57%), traumatic brain injury (54%), problematic substance use (52%), suicide awareness and crisis intervention (48%), sanctuary trauma (47%), and the precariously housed (26%).

Respondents expressed interest in resources or training on the following programs, approaches, and/or techniques to support mental health (multiple options could be selected; n = 623): mindfulness (80%), trauma-informed care (79%), breathing-meditation (64%), and mental health first aid (40%).

Priority populations and contexts

Respondents were also asked about interest in resources or training for certain specialized populations and contexts, and indicated interest as follows (multiple options could be selected; n = 643): Canadian military culture (78%), women in the Canadian military (74%), Veteran (CAF and RCMP) families (73%), RCMP culture (71%), Black, Indigenous, and People(s) of Colour (BIPOC) in the Canadian military (68%), Indigenous cultural safety (61%), and Two-Spirit, lesbian, gay, bisexual, transgender, queer (2SLGBTQ) in the Canadian military (55%).

Table 1.

Geographic distribution of respondents (n = 689)

Province or Territory	No. (%) of respondents
Alberta	93 (13)
British Columbia	94 (14)
Manitoba	17 (2)
Newfoundland and Labrador	13 (2)
New Brunswick	24 (3)
Northwest Territories	0 (0)
Nova Scotia	61 (9)
Nunavut	0 (0)
Ontario	314 (46)
Prince Edward Island	8 (1)
Quebec	53 (8)
Saskatchewan	10 (1)
Yukon	2 (0)

Note: Of the (N = 696) responses, a total of (n = 689) respondents completed the geographic distribution questions.

Table 2.

Time spent providing services to Veterans and Veterans’ families

Variable	No. (%) of respondents
Time providing services to Veterans (n = 668)
I’m not sure	39 (6)
None of my time	99 (15)
Less than half of my time	383 (57)
Around half of my time	83 (12)
Most or all of my time	64 (10)
Time providing services to Veterans’ families (n = 667)
I’m not sure	57 (9)
None of my time	253 (38)
Less than half of my time	337 (51)
Around half of my time	18 (3)
Most or all of my time	2 (0)

Note: Of the (N = 696) responses, a total of (n = 669) identified as a service provider and were presented these questions. A total of (n = 668) respondents completed the question about providing services to Veterans and (n = 667) respondents completed the question about providing services to Veteran families.

Table 3.

Combined summary of interest across all practices and topics

	No. (%) of respondents
Established EBPs and emerging therapies (n = 680)
ART	283 (42)
Unified protocol for transdiagnostic treatment	245 (36)
Trauma-focused couples CBT	232 (34)
CPT	226 (33)
EMDR	207 (30)
Trauma-focused CBT	203 (30)
PE	167 (25)
CT	105 (15)
CBT	69 (10)
Topics of interest (n = 643)
Moral injury	524 (82)
Military sexual trauma	443 (69)
Intimate partner violence	363 (57)
Traumatic brain injury	347 (54)
Problematic substance use	333 (52)
Suicide awareness and crisis	311 (48)
Sanctuary trauma	305 (47)
Precariously housed	164 (26)
Approaches of interest (n = 623)
Mindfulness	500 (80)
Trauma-informed care	490 (79)
Breathing-meditation	401 (64)
Mental health first aid	248 (40)
Priority populations and contexts (n = 643)
Canadian military culture	500 (78)
Women in the Canadian military	477 (74)
Veteran (CAF and RCMP) families	468 (73)
RCMP culture	456 (71)
BIPOC in the Canadian military	437 (68)
Indigenous cultural safety	389 (61)
2SLGBTQ in the Canadian military	355 (55)

Note: Of the (N = 696) respondents, a total of (n = 680) responded to established EBP and emerging therapies, a total of (n = 643) responded to topics of interest, a total of (n = 623) responded to approaches of interest, and (n = 643) responded to priority populations and contexts.

EBP = evidence-based practice; ART = Accelerated resolution therapy; CBT = cognitive behavioural therapy; CPT = cognitive processing therapy; PE = prolonged exposure; EMDR = eye movement desensitization and reprocessing; CAF = Canadian Armed Forces; RCMP = Royal Canadian Mounted Police; BIPOC = Black, Indigenous, and People of Colour; 2SLGBTQ = Two-Spirit, lesbian, gay, bisexual, transgender, queer.

Supporting the implementation of EBPs

Lastly, respondents were asked about preferences to receive resources, training, and implementation support (multiple responses could be chosen; n = 683). The majority were interested in accessing resources through live (virtual) training (82%), through self-directed (virtual) modules (76%), via an online resource portal (67%), via toolkits (64%), via videos (62%), and via print resources (60%). Many were also interested in podcasts or audio (51%), live (in person) training (48%), and communities of practice or learning collaboratives (33%). Some respondents were interested in implementation support and planning (23%), evaluation support and planning (22%), and quality improvement support (16%).

Current capacity related to MST

Most respondents (74% or 509/685) agreed to participate in a survey dedicated to MST. Few (6% or 31/491) respondents reported spending around half of their time, or more, providing service to those affected by MST, and only 6 out of 491 respondents (1%) reported spending around half of their time or more providing service to family members of someone affected by MST. Only 12% of respondents (55/468) reported receiving specialized training for caring for someone affected by MST, while 24% (111) reported receiving awareness-level training. An open-ended field was provided to list where respondents received specialized training. While 3 listed a retired U.S. Veteran, the remainder of the responses varied greatly, from provincial sexual assault services centres, to universities, evidence-based psychotherapies trainings, or training on a military base.

Discussion

Considering the importance of using EBPs to treat PTSD and related mental health conditions, it is encouraging to see most survey respondents had some training in EBPs. However, training in PE and CPT were least represented (31% and 31%, respectively) despite these two EBPs being strongly recommended in PTSD treatment guidelines set out by the American Psychological Association (APA) and the 2023 Veterans Health Administration and Department of Defense (VA/DoD) guidelines⁶ (while American, the APA guidelines are referenced by VAC²⁰ and both are included among the list of guidelines in Canada’s Federal Framework on PTSD²¹). This suggests an avenue for directing investments in training for community-based mental health service providers supporting Veterans. Perhaps surprisingly, fewer respondents expressed interest in receiving training in CPT and PE (33% and 25%, respectively), though it is unclear why. It could be worth future exploration through a targeted needs assessment or key informant interviews, to understand whether there are barriers related to cost, time commitment, organizational or client factors, or other considerations affecting interest. Understanding the capacity of the system to deliver EBPs to treat PTSD and related mental health conditions would be foundational to informing investments and system changes in Veteran care. Results from this survey, along with future investigation into barriers, is essential information for the Veteran mental health ecosystem, including VAC, which has an active role in health care for Veterans.

While this survey sheds light on the current state of training in EBPs among a range of mental health providers who care for Veterans and/or Veteran families in their practices, the survey did not explore the extent to which EBPs are delivered with fidelity. This is an important area that warrants further exploration, especially as there is growing evidence to suggest that when EBPs are delivered with low degrees of fidelity, clinical outcomes are negatively impacted.¹⁰As clinical consultation is recognized as a key strategy for maintaining, developing, and enhancing provider competence and mitigating clinical errors,^8,10,22 exploration into current capacity related to consultation would be worthwhile.

Given that drop-out rates are a concern for PTSD treatments and there is a need to better understand factors for treatment response/non-response,²³ continuing research on both established and emerging therapies, then effectively mobilizing the best available evidence to mental health service providers, would be a worthwhile endeavour. These are functions an intermediary organization such as Atlas can support in the Canadian landscape.

Most respondents indicated having Veterans in their practices, though the majority (55%) spent less than half of their time caring for Veterans. It is not surprising then that Canadian military culture was the top-rated population of interest when respondents were asked about learning needs related to specialized populations and contexts (78%). This interest is particularly encouraging, given the importance Veterans place on service provider familiarity with military culture for their therapeutic relationships.¹⁴ The expressed need for training in military culture also reinforces previous work that explored cultural competencies for delivering health care to military and Veteran families in Canada.²⁴ As service providers demonstrate this competency, a further consideration for policy makers and provider organizations is how to ensure this information, along with the EBPs in which a provider is trained, is made available to Veterans. This could support them to make informed choices about providers.

Six percent of respondents were unsure whether they saw Veterans in their practices. This signals a need to raise awareness about the diversity of the Veteran experience in Canada, as well as to support mental health service providers in screening for past military service, ideally following a recommended identifier.²⁵

MST in Canada is defined as any sexual or sexualized activity that occurs without a person’s consent during their service as a member of the CAF and the physically or psychologically traumatic impacts of this activity on the affected person.²⁶ Higher rates of PTSD have been found among those who have experienced MST than those without an experience of military sexual assault.²⁷ The prevalence of MST, coupled with the relatively small number of service providers who reported providing services related to MST, highlights the need to better equip service providers with tools and training on how to ask questions related to MST.

Furthermore, the fact that MST may contribute to the emergence of moral injury,²⁸ and moral injury was the topic of most interest among survey respondents (followed closely by MST), signals a potential priority topic for educational resources and opportunities. There has been significant growth in interest in moral injury, yet as researchers noted, “the acceptance of the idea of MI [moral injury] has outpaced scientific knowledge.”^{29(p. 13)} This is demonstrated, for example, in the varying uses of the term moral injury, lack of agreement about the boundary conditions of the syndrome of moral injury, and a lack of a gold standard of measurement.²⁹ Thus, there is a need to both build knowledge of moral injury among service providers and to continue to advance research in the field.

Future considerations

This needs assessment provided an initial direction for how Atlas — and the sector at large — could best support service providers caring for CAF and RCMP Veterans and Veterans’ families. To date, it informed the selection of virtual training in different EBPs, such as PE and CPT, the development of resources on caring for CAF Veterans who experienced MST, and the initial development of resources related to CAF military culture. Although much was learned through this needs assessment, there is more to understand. A future iteration could explore needs related to topic areas not included in this survey, and/or probe more deeply about why particular topics are — or are not — a current need. As this needs assessment primarily targeted FAPP delivering mental health services, a future needs assessment could seek to understand the capacity needs of primary care providers who may be qualified to deliver mental health services within their scope of practice.

To keep the number of survey questions manageable, demographic questions focused on the geography of providers (given the relevance for access to mental health services), rather than other characteristics, such as gender. While some research suggested a therapist’s gender, on its own, does not seem to directly influence clinical outcomes, there is limited research around the role of a therapist’s gender in the context of a clinical relationship.³⁰ A future needs assessment could seek to solicit more respondent characteristics, as this could be useful for future research and to better understand who is serving the mental health needs of Canada’s Veterans and their families.

In a Veteran mental health system, there is a range of actors that can have a role in influencing the uptake of EBPs among service providers, such as government decision makers, intermediary organizations, purveyors, regulators, and researchers.³¹ Clearly understanding what barriers for implementation exist and at what level (e.g., patient, provider, organization) will allow for the refinement and enhancement of supports both from Atlas and system stakeholders, broadly.

Limitations

To the authors’ knowledge, this needs assessment is the first of its kind to examine the current state of learning and capacity needs of a broad range of mental health service providers caring for CAF and RCMP Veterans and their families. However, there are some limitations to note. As the total number of mental health providers in Canada is unknown, findings are not representative of providers in Canada, nor are they representative of any one professional group. Findings should be interpreted as illustrative, rather than representative. Similarly, the number of respondents from some regions of Canada are low, so data cannot be generalized across all areas of the country. Respondents to this survey may be more likely to have an interest in the topics covered in the survey since they are already connected to Veteran and family mental health care. Thus, the learning needs of providers who are newer to caring for Veterans and their families may be under-represented. One survey question inquired about which “implementation supports” would be helpful. This term was intentionally used to understand capacity needs through an implementation science lens; however, the term was not defined. Recognizing there may be less familiarity with this discourse, the wording of the question could have been limiting. The survey was also restricted in terms of depth of exploring implementation considerations. Therefore, survey results do not provide an adequate sense of the barriers to the spread and scale of psychotherapy EBPs within the Veteran mental health care system within the Canadian context.

Conclusion

Effectively addressing the mental health needs of CAF and RCMP Veterans requires an accessible and responsive service system with service providers adequately equipped to deliver appropriate EBPs with fidelity. Mental health care for Veterans should be bolstered by cultural competency and prioritize population-specific understanding. While implementation science can guide strategies to spread, scale, and sustain the use of EBPs across mental health service systems, little is known about the current landscape of mental health service provider capacity needs in Canada to implement these practices. Findings of this needs assessment provide an initial view of learning and capacity needs, primarily among community-based mental health providers. The findings can inform Atlas’ work as an intermediary organization, while offering insights to system stakeholders interested in the uptake of psychotherapy EBPs across Veteran mental health services, and/or developing or delivering trainings/resources, including those related to MST and cultural competency. Future work should consider expanding the reach of the needs assessment to be inclusive of more providers, like primary care providers, who may be treating Veteran mental health needs through provincial- or territorial-delivered health care, and should further examine implementation barriers and facilitators.

Biographies

MaryAnn Notarianni, MSW, is Deputy CEO and Executive Vice President, Knowledge Mobilization, at the Atlas Institute for Veterans and Families, where she provides strategic leadership to initiatives designed to make evidence more accessible to improve Veteran and Family mental health. She holds a master of social work and a bachelor of public affairs and policy management, with a specialization in social policy, from Carleton University. Notarianni is also a Certified Health Executive with the Canadian College of Health Leaders.

Shannon Tracey, BHSc, MSc, is a senior implementation specialist at the Atlas Institute for Veterans and Families. She holds a master of science in health systems and an honours bachelor of health sciences, both from the University of Ottawa.

Ashlee Mulligan, MSc, is Director of Partnerships of Stakeholder Engagement at Atlas Institute where she works to promote engagement, collaboration, and knowledge exchange, in view of foundationally embedding the lived experience and expertise of Veterans and Veteran families in the networks we are building, and work we do. Mulligan has a master of science (specialization neuroscience) and a background in women’s studies and psychology.

Tara McFadden, BA, MEd, is Director, Implementation, at the Atlas Institute for Veterans and Families. She holds a master of education, with a specialization in school and counselling psychology, and a bachelor of arts in psychology from the University of Saskatchewan.

Andrea Librado, PsyD, is a senior implementation specialist at the Atlas Institute for Veterans and Families. In her work, she combines clinical knowledge with implementation science and practice to support the uptake of effective mental health practices and interventions.

Appendix. Veteran Mental Health Survey for Service Providers

First, tell us about yourself.

Logic: Show/hide trigger exists.

Which of the following applies to you? (Select all that apply)

□ I’m a service provider

□ I’m an administrator or manager of a service provider

□ None of the above

□ Other (please describe): _________________________________________________

Logic: Hidden unless: Question “Which of the following applies to you? (Select all that apply)” is one of the following answers (“I’m a service provider”)

What type of service provider are you? (Select all that apply)

□ Counsellor

□ Psychotherapist

□ Physician

□ Nurse practitioner

□ Registered nurse

□ Occupational therapist

□ Psychiatrist

□ Psychologist

□ Social worker

□ Peer supporter

□ None of the above (please specify): _________________________________________________

Logic: Hidden unless: Question “Which of the following applies to you? (Select all that apply)” is one of the following answers (“I’m an administrator or manager of a service provider”)

What services are offered at your organization? (Select all that apply)

□ Counseling

□ Psychotherapy

□ Primary care

□ Occupational therapy

□ Psychiatry

□ Psychology

□ Social work

□ Peer support

□ Other (please describe): _________________________________________________

Logic: Hidden unless: Question “Which of the following applies to you? (Select all that apply)” is one of the following answers (“I’m a service provider”)

In your role as a service provider, how much time do you spend providing services to Veterans (CAF or RCMP)?

□ I’m not sure

□ None of my time

□ Less than half of my time

□ Around half of my time

□ Most or all of my time

In your role as a service provider, approximately how much time do you spend providing services to Veteran Family members (including chosen family)?

□ I’m not sure

□ None of my time

□ Less than half of my time

□ Around half of my time

□ Most or all of my time

Logic: Hidden unless: Question “Which of the following applies to you? (Select all that apply)” is one of the following answers (“I’m an administrator or manager of a service provider”)

In your organization, approximately how much time do service providers spend supporting Veterans (CAF or RCMP)?

□ I’m not sure

□ No time

□ Less than half of their time

□ Around half of their time

□ Most or all of their time

In your organization, approximately how much time do you spend providing services to Veteran Family members (including chosen family)?

□ I’m not sure

□ None of my time

□ Less than half of my time

□ Around half of my time

□ Most or all of my time

Page exit logic: Skip / Disqualify LogicIF: Question “Have you received training on any of the following topics?

(Select all that apply)” is one of the following answers (“None of the above”) THEN: Jump to page 4 - (untitled)

The next questions are about supports, resources, and trainings that The Centre of Excellence on PTSD might provide.

Logic: Show/hide trigger exists.

Have you received training on any of the following topics? (Select all that apply)

□ Providing care to a Veteran (CAF or RCMP)

□ Providing care to a Veteran Family member

□ Providing care to someone living with post-traumatic stress or a PTSD diagnosis

□ Providing care to someone who has a close family member living with post-traumatic stress or a PTSD diagnosis

□ None of the above

Logic: Hidden unless: Question “Have you received training on any of the following topics? (Select all that

apply)” is one of the following answers (“Providing care to a Veteran (CAF or RCMP) or a Veteran Family

member”,”Providing care to someone living with post-traumatic stress or a PTSD diagnosis”,”Providing care to

someone who has a close family member living with post-traumatic stress or a PTSD diagnosis”)

Which type of training have you had?

	Awareness training	Specialized training	I am a trainer
Providing care to a Veteran (CAF or RCMP) or a Veteran Family	□	□	□
Providing care to someone with a PTSD diagnosis	□	□	□
Providing care to someone who has a close family member with a PTSD diagnosis	□	□	□

Do you have specialized training or interest in any of these areas? (Select all that apply)

The options presented include both established and emerging therapies, and do not represent all available interventions for those living with post-traumatic stress or PTSD.

	I have specialized training	I am interested
Accelerated resolution therapy (ART)	□	□
Cognitive behavioural therapy (CBT)	□	□
Cognitive processing therapy (CPT)	□	□
Cognitive therapy (CT)	□	□
Eye movement desensitization and reprocessing (EMBR)	□	□
Prolonged exposure therapy (PE)	□	□
Trauma-focused cognitive behavioural therapy	□	□
Trauma-focused couples cognitive behavioural therapy	□	□
Unified Protocol for Transdiagnostic Treatment	□	□

Do you have interest in any of the following programs, techniques, or approaches? (Select all that apply)

□ Mindfulness

□ Breathing-meditation

□ Mental Health First Aid

□ Trauma Informed Care

□ Other (please describe): _________________________________________________

Do you have interest in resources or trainings of the following specialized populations or contexts? (Select all that apply)

□ Black, Indigenous, and People(s) of Colour (BIPOC) in the Canadian military

□ Canadian military culture

□ Indigenous cultural safety

□ RCMP culture

□ Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer (2SLGBTQ) in the Canadian military

□ Women in the Canadian military

□ Veteran (CAF and RCMP) Families

Do you have interest in resources or trainings on the following topic related to Veteran mental health? (Select all that apply)

□ Intimate partner violence

□ Military sexual trauma

□ Moral injury

□ Problematic substance use

□ Sanctuary trauma

□ Traumatic brain injury

□ Suicide awareness and crisis intervention

□ Precariously housed

□ Other (please describe): _________________________________________________

Which types and formats of implementation supports would help you? (Select all that apply)

□ Print resources

□ Live training (in-person)

□ Live training (virtual)

□ Modules (self-directed and virtual)

□ Podcasts or audio resources

□ Toolkits (e.g. checklists, templates, sample policies, algorithms, etc.)

□ Videos

□ Implementation planning and support

□ Evaluation planning and support

□ An online portal for resources

□ Communities of practice or learning collaboratives

□ Quality improvement support

□ Other (please describe): _________________________________________________

Is there anything you think the Centre of Excellence on PTSD should know as it develops evidence-based resources and trainings for service providers caring for Veterans and Veteran Family members?

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A priority for the Centre of Excellence on PTSD is helping service providers support people affected by sexual misconduct in connection with their military service.

Would you be willing to answer 4 more questions about providing care to those affected by sexual misconduct in connection with their military service or their family members?

( ) Take me to the additional questions

( ) Skip the additional questions

Logic: Hidden unless: Question “Which of the following applies to you? (Select all that apply)” is one of the following answers (“I’m a service provider”)

In your role as a service provider, how much time do you spend providing services to people affected by sexual misconduct in connection with their military service?

( ) I’m not sure

( ) None of my time

( ) Less than half of my time

( ) Around half of my time

( ) Most or all of my time

In your role as a service provider, approximately how much time do you spend providing services to the family members (including chosen family) of people affected by sexual misconduct in connection with their military service?

( ) I’m not sure

( ) None of my time

( ) Less than half of my time

( ) Around half of my time

( ) Most or all of my time

Logic: Hidden unless: Question “Which of the following applies to you? (Select all that apply)” is one of the following answers (“I’m an administrator or manager of a service provider”)

In your organization, approximately how much time do service providers spend providing services to people affected by sexual misconduct in connection with their military service?

( ) I’m not sure

( ) No time

( ) Less than half of their time

( ) Around half of their time

( ) Most or all of their time

In your organization, approximately how much time do you spend providing services to the family members (including chosen family) of people affected by sexual misconduct in connection with their military service?

( ) I’m not sure

( ) None of my time

( ) Less than half of my time

( ) Around half of my time

( ) Most or all of my time

Have you ever received training to support people affected by sexual misconduct in connection with their military service?

( ) I’m not sure

( ) Awareness training

( ) Specialized training

( ) I am a trainer

If you can remember, who provided this training?

Is there anything you think the Centre of Excellence on PTSD should know as it develops evidence-based resources and trainings for service providers on the topic of supporting people affected by sexual misconduct in connection with their military service?

Thank you for your responses. We have a few final questions.

Are you a Federal Administered Program Provider with Medavie Blue Cross?

Federal Administered Program Providers are registered on an approved provider list with Medavie Blue Cross to deliver services to Veterans. Their clients are eligible to submit claims for services to Medavie Blue Cross

□ Yes

□ No

□ Unsure

Do you work at an Operational Stress Injury (OSI) Clinic funded by Veterans Affairs Canada (VAC)?

□ Yes

□ No

□ Unsure

Validation: Max character count = 3 Min character count = 3

What are the first three characters in your postal code?

This information helps us understand the general location of respondents (province, urban/rural/suburban area). Sharing this will not reveal your specific location

Logic: Show/hide trigger exists.

Would you like to know more about the Centre of Excellence on PTSD?

□ No, I’m not interested

□ Yes, add me to your mailing list

□ Yes, add me to your mailing list and feel free to contact me in the future

Logic: Hidden unless: Question “Would you like to know more about the Centre of Excellence on PTSD?” is one of the following answers (“Yes, add me to your mailing list”,”Yes, add me to your mailing list and feel free to contact me in the future”)

Name and pronouns: ___________________________________________________

Organization: ________________________________________________________

Job title: ___________________________________________________________

Phone: _______________________________________________________________

Email: _______________________________________________________________

Funding Statement

No funding was received for this article.