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A therapy session in a shipping container? If needed.

Two men walking together, away from camera, on a rural path with woods on either side.
Through VA’s BHIP-CCM program, mental health providers bring treatment to rural Veterans who have barriers to getting to VA for consistent care.

A 69-year-old Veteran, grieving the loss of his long-time friend, lived in a rural, isolated location. With only solar power, no cell or Internet service and no transportation, he lacked access to VA mental health services – until recently.

Filling a gap in care
Barriers to consistent healthcare stem from many sources. Veterans with terminal illnesses, work or school demands, caregiver responsibilities, geographical barriers or issues such as anxiety disorders often find it challenging to consistently connect with their VA health care team. 

Amber Rucker, associate chief of mental health for the Cheyenne VA Health Care System’s Behavioral Health Interdisciplinary Program Collaborative Chronic Care Model (BHIP-CCM), recognized these barriers. A solution would require innovation, so she devised a plan where staff could step out of the facility and meet Veterans on their own turf.

“We noticed some Veterans had a hard time accessing traditional BHIP care,” Rucker said. “We thought going to Veterans’ houses or meeting at a local coffee shop would be a more effective method of providing treatment.”

In 2021, Rucker approached her supervisors about bringing mental health services directly to Veterans, with each Veteran’s care plan tailored to their individual needs. Rucker’s VA team loved the idea. 

Funding was approved the following year and team building began. Natalie Maslowski, a licensed clinical social worker, joined the community-based BHIP-CCM team as a front-line supervisor in May 2023. Her eight years of experience with the homeless Veteran program – working within her VA facility and in the community – made her a natural fit to help build this program. The team saw its first Veteran in August 2023.

As for the rural Veteran, he’s been seeing a community-based BHIP case manager, who helped him get a cord of firewood to sustain him through the winter and a therapist to help address his grief.

“I wouldn’t be able to do this otherwise,” he said, appreciating that help has come to him.

Bringing care to clients
The program specifically serves Veterans who experience significant barriers accessing mental health care within VA. 

“We’ve met people over their lunch breaks,” said Maslowski. “Our team even had a therapy session in a shipping container at someone’s jobsite.”

Maslowski expressed the value of treating Veterans where they live and work. 

“It brings a new level of connection to sit in a Veteran’s home, meet their children or go for a walk during sessions,” she said. 

“Even playing fetch with the Veteran and their dog – it’s meaningful to the therapeutic process,” added Rucker. “Community-based BHIP engages Veterans who are hesitant to participate in traditional mental health treatment models.”

Building the program
The BHIP team consists of five roles: therapist (licensed social worker, licensed counselor or psychologist), medicine provider (mental health nurse practitioner, doctor or psychiatrist), peer support specialist, mental health nurse and case manager. Each team member conducts a specific patient assessment to create an integrated understanding of a Veteran’s needs and how to best support them. 

This pilot program, which is specific to Northern Colorado, is the first of its kind in the country. Currently, the team treats 39 Veterans in 18 different cities and the reach is still expanding. 

Client feedback
In a matter of months, the program has made a clear impact. 

“I cannot say enough good things about this program,” said a 67-year-old Veteran living with an anxiety disorder. “For the first time since I got out of the military in 1988, I feel like VA is putting the ‘care’ back in healthcare.” 

To learn more about the Cheyenne VA Health Care System’s community-based BHIP-CCM, contact Natalie Maslowski at 970-689-2673.

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April Love is a writer-editor on the VISN 19 Creative Task Force. She began working for VA Eastern Colorado Health Care System in 2016 and lives in Aurora, Colorado.

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