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PRIDE In All Who Served

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PRIDE In All Who Served is a health promotion group that was designed and refined using human-centered design principles at the Hampton VA Medical Center in 2016. Each one-hour session of the ten-week, manualized, closed group provides an opportunity to connect with other LGBTQ+ Veterans to build a peer support system while improving LGBTQ+ patient health literacy. Connection to social support is a protective factor against suicide, stigma-related stress and other health outcomes for LGBTQ+ individuals. The group facilitation manual provides a comprehensive approach to implementation of the service, staff training, and guidance on how to create a welcoming environment. Veteran reactions to the service include: "I can't believe this group is at the VA!", "My life has gotten better by coming", and "I love this group! I feel better talking to my providers."

This innovation is scaling widely with the support of national stakeholders. See more scaling innovations.

Origin:

January 2016, Hampton VA Medical Center

Adoptions:

67 successful, 11 in-progress, 13 unsuccessful

Awards and Recognition:

iNET Seed Investee, iNET Spread Investee, Diffusion of Excellence National Diffusion Practice

Partners:

Diffusion of Excellence, Health Equity, LGBTQ+ Health Program, Mental Health and Suicide Prevention, VHA Innovators Network

Contact Team

Overview

Problem

LGBTQ+ Veterans are at an increased risk for suicide and other health care inequities, due in part to discrimination and barriers to accessing care. Despite provider-focused education and inclusive policies, a gap in clinical services for LGBTQ+ Veterans remains.

Videos

American Legion National Security Commission Chairman Matthew Shuman is featured in a Veteran's Health Administration's Office of Healthcare Innovation & Learning video promoting VA healthcare in the LGBTQIA+ community.

Links

Solution

The PRIDE in All Who Served program was developed to fill this critical care gap and to provide a resource for reducing healthcare disparities, including suicide risk. Session content focuses on overall wellness, increasing social connectedness, and empowering Veterans to engage in services related to their personal healthcare needs.

A PRIDE in All Who S
... See more

Images

Manual for PRIDE Group Facilitators

Results

Veteran-reported outcomes are tracked before and after attending the group, with significant improvements including:
- increased protective factors (e.g., community involvement, identity certainty)
- reduced likelihood of attempting suicide in the future
- reduced symptoms of depression, anxiety, and concern about not being accepted

Images

Numbers snapshot (2018-2021)

Example Results from Veterans (2108-2021)

Example Results (Item from Brief Suicide-Related Behavior Questionnaire, SBQ-R; 2018-2021)

Metrics

  • Reach of Program = Improved access to affirmative care services for LGBTQ+ Veterans and rural LGBTQ+ Veterans;
  • Effectiveness of Program = Improved identity-related protective factors (e.g., identity acceptance, reduced internalized stigma)
  • Effectiveness of Program = Reduced symptoms of distress (e.g., symptoms of depression and anxiety)
  • Effectiveness of Program = Reduced suicide risk (e.g., reported likelihood of attempting suicide in the future)
  • Adoption, Implementation, Maintenance = Number of VA Facilities and Clinical Resource Hubs Consistently Offering PRIDE in All Who Served

Diffusion tracker

Does not include Clinical Resource Hubs (CRH)

Statuses

AL: Birmingham VA Medical Center (Birmingham, Alabama)
  • Started adoption on 07/2022.
AL: Central Alabama VA Medical Center-Montgomery (Montgomery)
  • Started adoption on 01/2019.
AL: Tuscaloosa VA Medical Center (Tuscaloosa)
  • Started adoption on 05/2018.
AZ: Carl T. Hayden Veterans' Administration Medical Center (Phoenix, Arizona)
  • Started adoption on 07/2022.
CA: Jennifer Moreno Department of Veterans Affairs Medical Center (San Diego, California)
  • Started adoption on 03/2021.
CA: Jerry L. Pettis Memorial Veterans' Hospital (Loma Linda, California)
  • Started adoption on 09/2019.
CA: McClellan VA Clinic (McClellan Park)
  • Started adoption on 11/2020.
CA: Oceanside VA Clinic (Oceanside)
  • Started adoption on 07/2020.
CA: Tibor Rubin VA Medical Center (Long Beach)
  • Started adoption on 01/2024.
CO: Aurora VA Clinic (Aurora, Colorado)
  • Started adoption on 10/2021.
CO: Grand Junction VA Medical Center (Grand Junction, Colorado)
  • Started adoption on 02/2019.
CO: PFC Floyd K. Lindstrom Department of Veterans Affairs Clinic (Colorado Springs)
  • Started adoption on 03/2021.
FL: C.W. Bill Young Department of Veterans Affairs Medical Center (Bay Pines)
  • Started adoption on 10/2021.
FL: Malcom Randall Department of Veterans Affairs Medical Center (Gainesville)
  • Started adoption on 01/2024.
FL: Naples VA Clinic (Naples)
  • Started adoption on 10/2021.
HI: Spark M. Matsunaga Department of Veterans Affairs Medical Center (Honolulu) IL: Bob Michel Department of Veterans Affairs Outpatient Clinic (Peoria)
  • Started adoption on 07/2022.
IL: Danville VA Medical Center (Danville, Illinois)
  • Started adoption on 07/2022.
IL: Jesse Brown Department of Veterans Affairs Medical Center (Chicago, Illinois)
  • Started adoption on 07/2022.
IL: Marion VA Medical Center (Marion, Illinois)
  • Started adoption on 07/2022.
IN: Richard L. Roudebush Veterans' Administration Medical Center (Indianapolis, Indiana)
  • Started adoption on 07/2019.
KY: Robley Rex Department of Veterans Affairs Medical Center (Louisville)
  • Started adoption on 01/2024.
LA: New Orleans VA Medical Center (New Orleans)
  • Started adoption on 10/2021.
MA: Edward P. Boland Department of Veterans Affairs Medical Center (Central Western Massachusetts)
  • Started adoption on 10/2021.
MI: Battle Creek VA Medical Center (Battle Creek)
  • Started adoption on 05/2023.
MI: Oscar G. Johnson Department of Veterans Affairs Medical Facility (Iron Mountain)
  • Started adoption on 10/2021.
MI: Saginaw VA Clinic (Saginaw Barnard Road)
  • Started adoption on 06/2020.
MO: St. Louis VA Medical Center-Jefferson Barracks (St. Louis Jefferson Barracks)
  • Started adoption on 11/2018.
MS: Biloxi VA Medical Center (Biloxi)
  • Started adoption on 01/2023.
MS: G.V. (Sonny) Montgomery Department of Veterans Affairs Medical Center (Jackson, Mississippi)
  • Started adoption on 03/2021.
NC: Durham VA Medical Center (Durham)
  • Started adoption on 08/2019.
NC: Fayetteville VA Medical Center (Fayetteville, North Carolina)
  • Started adoption on 03/2019.
NC: Greenville VA Clinic (Greenville, North Carolina)
  • Started adoption on 03/2021.
NC: W.G. (Bill) Hefner Salisbury Department of Veterans Affairs Medical Center (Salisbury)
  • Started adoption on 01/2019.
NH: Manchester VA Medical Center (Manchester)
  • Started adoption on 03/2021.
NM: Raymond G. Murphy Department of Veterans Affairs Medical Center (Albuquerque)
  • Started adoption on 10/2021.
NV: Ioannis A. Lougaris Veterans' Administration Medical Center (Reno)
  • Started adoption on 03/2021.
NY: Buffalo VA Medical Center (Buffalo, New York)
  • Started adoption on 10/2021.
NY: Franklin Delano Roosevelt Hospital (Montrose, New York)
  • Started adoption on 07/2022.
NY: Samuel S. Stratton Department of Veterans Affairs Medical Center (Albany, New York)
  • Started adoption on 01/2023.
OH: Chalmers P. Wylie Veterans Outpatient Clinic (Columbus, Ohio)
  • Started adoption on 05/2019.
OH: Chillicothe VA Medical Center (Chillicothe)
  • Started adoption on 03/2023.
OH: Dayton VA Medical Center (Dayton)
  • Started adoption on 01/2023.
OK: Jack C. Montgomery Department of Veterans Affairs Medical Center (Muskogee, Oklahoma)
  • Started adoption on 01/2020.
OK: Oklahoma City VA Medical Center (Oklahoma City)
  • Started adoption on 10/2020.
OR: Portland VA Medical Center (Portland, Oregon)
  • Started adoption on 01/2023.
OR: White City VA Medical Center (White City)
  • Started adoption on 03/2021.
PA: Abie Abraham VA Clinic (Butler)
  • Started adoption on 01/2024, ended on 04/2024.
PA: Coatesville VA Medical Center (Coatesville)
  • Started adoption on 03/2021.
PA: Pittsburgh VA Medical Center-University Drive (Pittsburgh)
  • Started adoption on 01/2023.
SC: Ralph H. Johnson Department of Veterans Affairs Medical Center (Charleston, South Carolina)
  • Started adoption on 05/2020.
SC: Wm. Jennings Bryan Dorn Department of Veterans Affairs Medical Center (Columbia, South Carolina)
  • Started adoption on 10/2021.
TN: Alvin C. York Veterans' Administration Medical Center (Murfreesboro)
  • Started adoption on 07/2022.
TX: Corpus Christi VA Clinic (Corpus Christi)
  • Started adoption on 03/2023.
TX: Harlingen VA Clinic (Harlingen)
  • Started adoption on 11/2020.
TX: Temple VA Clinic (Temple South General Bruce Drive)
  • Started adoption on 09/2020.
UT: George E. Wahlen Department of Veterans Affairs Medical Center (Salt Lake City)
  • Started adoption on 10/2020.
VA: Hampton VA Medical Center (Hampton)
  • Started adoption on 01/2016.
VA: Richmond VA Medical Center (Richmond, Virginia)
  • Started adoption on 03/2020.
VA: Salem VA Medical Center (Salem, Virginia)
  • Started adoption on 03/2021.
WA: Seattle VA Medical Center (Seattle)
  • Started adoption on 01/2024.
WI: Tomah VA Medical Center (Tomah)
  • Started adoption on 02/2019.
WI: William S. Middleton Memorial Veterans' Hospital (Madison)
  • Started adoption on 01/2023.
WY: Cheyenne VA Medical Center (Cheyenne)
  • Started adoption on 05/2023.
VISN 6 Clinical Resource Hub (Remote)
  • Started adoption on 04/2020.
VISN 17 Clinical Resource Hub (Remote)
  • Started adoption on 02/2021.
VISN 19 Clinical Resource Hub (Remote)
  • Started adoption on 11/2022.

AR: John L. McClellan Memorial Veterans' Hospital (Little Rock, Arkansas)
  • Started adoption on 01/2023.
  • Centralized decision-making that hinders ability to complete tasks (i.e. bureaucracy)
DE: Wilmington VA Medical Center (Wilmington, Delaware)
  • Started adoption on 07/2022.
  • Unable to attain necessary staff
GA: Carl Vinson Veterans' Administration Medical Center (Dublin)
  • Started adoption on 10/2021.
  • Lack of sufficient leadership/key stakeholder buy-in
IL: Captain James A. Lovell Federal Health Care Center (North Chicago)
  • Started adoption on 07/2022.
  • Unable to attain necessary staff
KY: Franklin R. Sousley Campus (Lexington Leestown)
  • Started adoption on 01/2024.
  • Unable to attain necessary staff
MT: Fort Harrison VA Medical Center (Fort Harrison)
  • Started adoption on 03/2023.
  • Lack of foundational affirmative care
NE: Omaha VA Medical Center (Omaha, Nebraska)
  • Started adoption on 07/2022.
  • Staff left agency
NJ: East Orange VA Medical Center (East Orange)
  • Started adoption on 01/2024.
  • Unknown
PA: James E. Van Zandt Veterans' Administration Medical Center (Altoona)
  • Started adoption on 03/2023.
  • Staff changes
TN: James H. Quillen Department of Veterans Affairs Medical Center (Mountain Home, Tennessee)
  • Started adoption on 07/2022.
  • Insufficient recruitment
WA: Jonathan M. Wainwright Memorial VA Medical Center (Walla Walla)
  • Started adoption on 01/2023.
  • staffing changes and Cerner issues
WI: Clement J. Zablocki Veterans' Administration Medical Center (Milwaukee, Wisconsin)
  • Started adoption on 07/2022.
  • Unable to attain necessary staff
VISN 9 Clinical Resource Hub (Remote)
  • Started adoption on 11/2020.
  • Lack of sufficient leadership/key stakeholder buy-in
  • Centralized decision-making that hinders ability to complete tasks (i.e. bureaucracy)

Multimedia

Videos

PRIDE Awareness Month, June 2021

PRIDE Awareness Month, June 2021

PRIDE Awareness Month, June 2021

PRIDE In All Who Served iEX Talk, October 2021

Presentation for US Professional Association for Transgender Health, November 2023

Implementation

Timeline

  • Pre-Implementation
    1. Seek leadership endorsement for participation
    2. Identify a co-facilitator
    3. Conduct informal needs assessment to identify pre-implementation tasks
    4. Complete your facility application for inclusion in the next cohort and complete all required pre-work (e.g., read Facilitator's Manual in its entirety, complete TMS modules)
  • Implementation (~4 months)
    1. Join weekly implementation cohort calls (16 weeks total)
    2. Launch group
    3. Join PRIDE Community of Practice Calls (quarterly)
    4. Join PRIDE Open Office Hours (monthly)
    5. Document outcomes and report data for evaluation to PRIDE National Team as requested
  • Sustainment
    1. Continue participation in PRIDE Community of Practice
    2. Continue participation in PRIDE Open Office Hours
    3. Identify next start date for subsequent group cycle

Departments

  • LGBTQ+ Veteran care
  • Whole health

Core Resources

Resource type Resource description
PEOPLE
  • Group Facilitator (2 hours/week during consultation phase; 1 hour/week for sustainment)
  • Clinical Application Coordinator (2-5 Hours for clinic build)
PROCESSES
  • PRIDE Facilitation Manual (provided to all partner sites)

Optional Resources

Resource type Resource description
PEOPLE
  • LGBTQ+ Veteran Care Coordinator (internal consultant)
  • Intimate Partner Violence (IPV) Coordinator (internal consultant)
  • Infectious Disease provider (internal consultant)
  • Women Veterans Program Manager (internal consultant)
  • Whole Health Coordinator (internal consultant)
TOOLS
  • Telehealth Service Delivery

Support Resources

Resource type Resource description
PEOPLE
  • PRIDE National Team
PROCESSES
  • PRIDE Facilitation Manual
  • Ongoing consultation, problem solving, resource sharing, and implementation support
  • Welcome package with symbols of safety
TOOLS
  • Staff Training (optional)

Risks and mitigations

Risk Mitigation
LGBTQ+ Veteran risk for suicidal ideation Pre-Screen appointments to review risk factors, develop safety plan, and refer to appropriate supports
Increasing LGBTQ+ Veteran health literacy and visibility may increase pressure to improve access to care for this group (e.g., PrEP availability, Endocrinology) Consultation calls to assist sites in navigating these situations and developing a coordinated care model within their facility structure
Facility environment (lack of visibility, community resources, rurality, or provider biases) Consultation calls to problem solve local barriers

Contact

Comment

Comments and replies are disabled for retired innovations and non-VA users.

VA User (Social Worker, Outpatient Substance Abuse) Innovation adopter posted

I led a Pride In All Who Serve group at VA Hudson Valley and am currently leading my second cohort. This is a great opportunity for our LGBTQ+ veterans and the feedback from our veterans has been positive.

1
VA User (Social Worker, Outpatient Substance Abuse) Innovation adopter deleted

This comment has been deleted.

VA User (Nurse) posted

What a timely initiative! Much needed for our veterans!❤😊

3
VA User (PRRC Nurse/Recovery Coordinator) Innovation adopter posted

Good afternoon,

I would like to initiate and lead a "Pride in All Who Served," at our facility. I am at the VA of Western New York in Buffalo. I have read about the purpose of this group and find there is a great need for LGBTQ Veterans at our VA. I need to know how I can get official permission to get this education/support group launched.

I can devote two to three hours per week to lead this gathering, including the consultation session to get started. If anybody can point me in the right direction, please email me at timothy.ward5@va.gov.

3
VA User (LGBTQ+ Veteran Care Coordinator) Innovation adopter posted

The Salt Lake City VA has had great success in implementing "Pride in All Who Served" at our facility. We have received excellent feedback regarding the content of the group manual. The monthly calls are supportive and helpful with the program as well as implementing affirming healthcare overall. I highly recommend it!

3
VA User (LGBTQ+ Veteran Care Coordinator) Innovation adopter deleted

This comment has been deleted.

VA User (Local Recovery Coordinator) Innovation adopter posted

I am the LGBT VCC at a small, rural facility in WI. I was introduced to this project early on and was fortunate to collaborate as an early spread site. This group has been just what our site needed to meet the needs of rural LGBT Veterans who are struggling with limited resources in the community and limited knowledge of VA resources available. Feedback has been overwhelmingly positive in terms of finding meaning, validation of identity and sense of belonging and community. Additionally the evaluations and feedback has been invaluable in terms of Veterans engaging both VA and community partners in LGBT Veteran services. This project has also been a catalyst for increasing visibility and dialogue on the importance of meeting the needs of LGBT Veterans. It has also helped in creating buy-in with leadership in terms of prioritizing and highlighting healthcare disparities and addressing those needs head on.

4
VA User (Psychiatrist) Innovation adopter posted

I'm the LGBT VCC at a small rural outpatient clinic and residential rehabilitation center. I would love to bring this to us in VISN 20, Oregon.

3
VA User (LGBT Coordinator) posted

Hi there, I am new to the VA and work in Columbus, OH as the LGBT Care Coordinator. I would like to learn about the program and try to get it adopted in VISN10

3
VA User (Program Support Assistant) posted

I am not a direct care provider and I work for RCS/Vet Centers. I would like to learn about the program and try to get it adopted in VISN9/TVHS and in 10RCS/Vet Center Program.

2

Email

Email with questions about this innovation.

About

Origin story

Dr. Tiffany Lange wanted to fill a critical patient service gap for a vulnerable population. However, there were no evidence-based interventions for LGBTQ+ Veterans. Through an iterative process, the group content and process has been shaped by Veteran feedback, relevant literature, and VA initiatives (e.g., Whole Health). Group participants were active in i ... Dr. Tiffany Lange wanted to fill a critical patient service gap for a vulnerable population. However, there were no evidence-based interventions for LGBTQ+ Veterans. Through an iterative process, the group content and process has been shaped by Veteran feedback, relevant literature, and VA initiatives (e.g., Whole Health). Group participants were active in identifying meaningful topics for care, provided recommendations about design of handouts, and contributing to a list of community resources. The spread of this service is a source of pride and purpose for the “original group” members.

Original team

Tiffany Lange, PRIDE Program Developer (she/her)

Implementation & Training Lead (2016-2021)

Heather A. Sperry (she/her)

Director of Clinical Implementation (2021-present)

Michelle M. Hilgeman (she/her)

Director of Evaluation (2017-present)

Michelle Wilcox (she/her)

Deputy Director of Clinical Implementation (2021-present)

Robert J. Cramer (he/him)

Evaluation Team (2017-present)

Courtney Houghton (she/her)

Executive Assistant (2021-present)

Teddy Bishop (he/they)

Deputy Director of Evaluation (2019-present)

Blaine Fitzgerald (she/her)

PRIDE Diffusion Specialist (2020-2023)

Sierra Phillips (she/her)

Community Partnerships Program Manager (2021-present)

Anna Craycraft (she/her)

Education Program Manager (2021-present)

Shilpa Trivedi (she/her)

Evidence-Based Practice (EBP) Program Manager (2022-present)