THE WHY AND HOW OF PATIENTCENTERED CARE: LEARNING FROM 

OEF/OIF VETERANS 

Gala True, PhD 

Center for Evaluation of Patient-Aligned Care Teams (CEPACT)

Center for Health Equity Research and Promotion (CHERP) 

University of Pennsylvania School of Medicine

Ray Facundo, MSW 

Director, Veterans Center at Portland State University

Sergeant, U.S. Army, Operation Iraqi Freedom 2005-2006 & 

2008-2009
Today’s objective is to deepen our understanding of 

OEF/OIF Veterans’ experiences of VA care through 

Veterans’ Voices 

•Importance of patient-centered post-deployment care 

•Consequences of lack of patient-centeredness 

•Steps VA can take to improve delivery of patient-centered care
What is your personal experience with 

military service? (check any that apply)

1. I have served/am currently serving in the 

military. 

2. I have a close family member or friend who 

has served/is currently serving in the military. 

3. Neither 
Source: Department of Veterans Affairs, & Office of Patient-Centered Care and Cultural Transformation. 

(2013). 21st Century Health Care the VA Way: Designing and Delivering the Future of Healthcare Today 

[PowerPoint presentation]. Retrieved from http://vaww.infoshare.va.gov/sites/OPCC/default.aspx 
Through a 

veterancentered 

lens 

• Veterans as 

experts

• Patient-oriented, 

communityengaged research

• Shared knowledge 

production & 

dissemination 

• Identify challenges 

and advocate for 

solutions 
Photovoice as an Educational 

Intervention to Improve Care of 

OEF/OIF Veterans* 

• 40 Veterans ≥1 deployment in support of OEF/OIF

• Given cameras, asked to tell their stories with focus 

on 4 questions: 

• How does a deployment impact your physical, mental, and 

emotional health?

• What challenges do you face in making the transition home? 

• What barriers and facilitators exist when it comes to 

accessing care? 

• Where do you find strength and support? 

*VA HSR&D Grant PPO 10-255, PI: True 
OEF/OIF Veterans face multiple barriers 

to seeking out and engaging in care;

encountering healing environment &

relationships is essential
This is the menacing posture that I talked about; me trying to look 

hardcore. I am locked and loaded, but I am not really so hardcore 

at all. I always had this mentality like-- if it is me or you, I want to go 

home-- but I never wanted to shoot anybody.

 Chantelle B.
We had a lot of females that 

got raped. We had males that 

got raped. 

 

You’re in that situation where 

people don’t want to see, 

don’t want to hear, don’t want 

to speak. 

It’s like a triple effect. 

So, it’s not reported. 

 

And when the soldiers come back, they’re living with that. 

A lot of them could lose their job.

Seeking help could be a flag in your record. 

So you have a lot of people who don’t want to say. 

 

Raquel R. 
Five years after leaving Iraq

I still have anxiety driving.

When I am confined, with no way to 

escape, 

it feels like I am being funneled into a 

kill zone. 

Tracy P. 
The cocoon echoes a fear of mine, that stage of hiding yourself 

away. A lot of times, I put myself into that sort of a cocoon, and I shut 

people out. 

 Toby B.
Many veterans do not experience a healing 

environment or relationships at VA
I shot this to express how I feel 

about the VA;

It is like a maze. 

 

The system is not set up for 

people to talk through 

things. 

When I finally got a doctor 

through the VA, 

my practitioner was asking me 

this battery of really intrusive 

questions, 

but there was no space to 

work it out. 

 

There is a serious lack of 

listening at the VA.

People will ask you questions, 

but no one is listening to you. 

 Chantelle B.
I was in Walter Reed Hospital 

for a year and a half, and 

then transferred to the VA.

 

It was an uphill fight. 

I’ve been switched to other 

VA hospitals [for care]. 

I’ve been all over the place. 

Here’s where the hospitals 

are listed, but I’ve never 

been to Martinsburg, 

and I’m not white. 

Even though I’ve been home since 2005, I’m still going through stuff... 

I feel like I’m lost. Like I’m lost in the cracks or something. 

Like they just don’t know that I exist. 

Brian Y.
You’ve heard the expression: ‘I’m a mushroom. They keep me in the dark and 

feed me crap.’ You feel like you’re not getting all the information you need. 

Even though [the information] is all there at our fingertips, we get 

overwhelmed. You sit in your little corner and try to absorb what you can, but 

a lot of it you’re going to miss.

 Scott S. 
This is why veterans should go to the VA; 

you never know what the future’s going to 

hold for you, or how things that happened 

on deployment could affect your future. 

When I went to my first assessment at the 

VA, they asked me about my deployment. 

They asked ‘Were you ever exposed to 

any environmental things that might 

concern you?’ And I said ‘Yeah, we were 

next to a burning garbage dump for an 

entire year.’ 

And I’m thinking it’s good you’re 

documenting this because later down the 

road if I get lung cancer or something it 

might not be from the cigarettes that I 

used to smoke. 

Anonymous
Lack of patient-centeredness may lead to 

Veterans avoiding or abandoning VA care 

& to staff burnout/loss of sense of mission
 

. I received every single award you 

can receive, so I took a picture of 

them to show how dedicated I was 

while I was in the Army.

No one knows what I did on 300-

plus combat missions. I lost friends, I 

received PTSD, I got a traumatic 

brain injury, I lost my hearing. Here 

[at the VA] I’m just another addict. 

What am I supposed to do... stick 

[my awards] on my shirt and walk 

around?

Jamie B. 
The VA is a reflection 

of society as a 

whole—it is difficult 

to see a female 

veteran as someone 

exposed to the 

horrors of war. 

Care providers look 

at me and 

immediately make 

assumptions: 

‘You look like you can afford to get a mammography in the 

civilian sector.’ ‘Were you a nurse?’ ‘A pretty girl like you—you 

didn’t see combat did you?’ ‘Are you here for a job?’

 Tracy P.
I feel like an alien in civilization. 

It makes it tough for me to function in normal American society. 

I’ve spent lot of time out in the woods.

Some people call it homeless; I call it being an outdoorsman. 

 Micky D. 
Veterans identified sources of support 

and strength for recovery, 

steps to building rapport and trust with VA 

providers and staff
Another form of art therapy is writing. I wrote a lot while I was deployed, 

although I never really wrote about my military experience. I still don’t write 

about my military experience unless I am in the company of other veterans. 

 Chantelle B.
If I’m going to make it in the 

civilian world, I’m going to 

need an education. 

So I went back to school.

It was there I learned my love 

for photography.

I developed a roll of pictures in 

class, and I was astounded 

how well the image had come 

out, and I took pride in it.

And it was from there that I 

guess you’d say my head 

opened up. 

Joseph K.

 
I was incarcerated in Camden County jail. It’s one of the worst county jails in 

America. There’s no dignity; you’re treated like an animal. 

A social worker from the VA found me in the jail. She came to pick me up 

and take me to Fresh Start, the recovery house for veterans. 

This is where I lived, at Fresh Start. The VA basically saved me. 

 Drew B.
This is one of those buildings under construction. I see my life in that way. Like that 

neighborhood, I’m kind of under revitalization, you know? I was a Marine. I hit my 

peak at one point and I kind of deteriorated, but I’m trying to fix my life back 

together. MDK
This bench is in front of the Medical Center.

They just did it for the view, not for what for it does for the soul.

But it helps me a great deal. 

I sit there all the time. Keith H.
The VA is not always personal or helpful. 

The VA website is not personal. Not helpful. 

 

As a physician, it’s easy to start seeing patients 

as just part of your job. 

What’s special about the VA 

is that you have a reason not to do that. 

 

You have a reason to come to the VA and say, 

‘Everybody I am serving is special in a certain way.’ 

I’m sure it’s hard to work here for years, 

and still think that way every day when you walk in. 

If I were in charge of the VA, 

I would put up posters of something that reminds you 

on the way from your car to your office, 

something to remind you of how special your job is. 

 

 Dustin G.
When I came back from my first 

deployment, I didn’t think about 

claiming unemployment because of the 

stigma. 

The second time around a VA counselor 

said; ‘One thing I’ve been telling all the 

guys to do, if you don’t have a job to go 

back to, is start collecting 

[unemployment] immediately.’ 

Later, I decided to go to school 

for social work. I was like, ‘Hey 

maybe I should be like [that VA 

guy]. This could be a good career 

for me; helping other vets.’ 

 Ray Facundo 

Funding & Acknowledgements

• This project was made possible by a VA HSR&D Pilot 

Grant (PPO 10-255)

• Additional support from the VISN 4 Center for 

Evaluation of Patient Aligned Care Teams (CEPACT) 

and the Center for Health Equity Research and 

Promotion (CHERP)

• Steven Hunt, MD, MPH, Co-Director National PostDeployment Integrative Care Initiative, Puget Sound 

VA Healthcare System (Co-Investigator) 

• Anneliese Butler, MSS, From War to Home Project 

Manager

• Thank you to all of the Veterans who contributed to 

this project 
Questions? 

Contact: 

Ray Facundo email: rfacundo@pdx.edu

PSU Veterans Resource Center: http://www.pdx.edu/veterans/vrc

Gala True email: Jennifer.True2@va.gov

From War to Home: www.FromWarToHome.va.gov (coming July 2014)