According to the U.S. Department of Veterans Affairs, some 140,000 American Indian and Alaska Native (AI/AN) Veterans currently live in the United States. They are part of a proud tradition of service that spans every major conflict in the nation’s history. The percentage of AI/AN people serving in the armed forces exceeds the national average, further underscoring their commitment to country.
Yet for many AI/AN Veterans, the sacrifices did not end on the battlefield. Rates of suicide and post-traumatic stress disorder (PTSD) among these Veterans are higher than the average overall. Many historical factors contribute to this disparity, including the fact that a high percentage of AI/AN Veterans live in isolated rural areas with limited or no access to mental health care services.
With the help of Colorado School of Public Health faculty and staff, the VA’s National Center for PTSD Mobile Mental Health recently launched a digital tool to help Native Veterans bridge geographic and cultural gaps and find strategies for a healthy transition to civilian life.
The Veterans Wellness Path app, downloadable for free on smartphones from the Apple Store or Google Play, was developed in collaboration with VA partners from the Office of Rural Health and the VA South Central Mental Illness Research, Education, and Clinical Center. Native Veterans, their family members, and their health care providers assisted with insights about suicide prevention and PTSD, and identified “the need for better connection to information and resources from VA,” as noted in a description of the app’s creation.
The app includes links to immediate services for Veterans in crisis, but its aims are much broader, said Rene Begay, senior professional research assistant with the Centers for American Indian & Alaska Native Health (CAIANH) at ColoradoSPH. Begay, herself a member of the Navajo Nation, was part of the CAIANH team that helped to design the digital tool. She consulted with Native Veterans and their families for feedback about the app’s content and visual appeal.
“The app was focused heavily on suicide prevention early on,” Begay said. “But then we moved to holistic mental health improvements. A lot of Native communities think about health holistically – mind, body, and spirit – so we moved toward creating tools and education specific to those areas.”
The app offers a rich combination of resources, centered around a personalized “Wellness Path” screen on the phone. Proceeding in a clockwise motion down the “path,” the user can visit any of four main areas, based on “their different points in healing and wellness,” Begay said:
“Hopefully, the app will help [Native Veterans] get regrounded and reconnect with their families and friends and their culture,” Begay said.
For help with the visual appearance of the app, the CAIANH team hired Walt Pourier, a member of the Oglala Lakota tribe and founder of Nakota Designs Inc. in Denver, Begay said. The design aimed to appeal to the diverse AI/AN community, which comprises 574 tribes and villages. For example, users can customize the home screen image based on environments seen in the United States: wetlands, woodlands, plains, desert, or coast.
An icon for the app brings together visual components – an American flag, Medicine Wheel, feathers, and a path protected by arrowheads – that are each connected to the health of Native Veterans. A screen in the app describes the meaning and importance of each component. The icon and other visual elements were designed to draw in Native Veterans, regardless of their background, Begay said.
In working on the app design, “I had to check my bias, being from the Navajo Nation and raised on the reservation, Begay acknowledged. “This app is a national app. We wanted it be more inclusive than exclusive.” In the end, tribal similarities outweighed the differences, she added.
An ongoing effort to reach out to Native Veterans
The work on the app grew out of years of effort by CAIANH to support Native Veterans and help the VA reach out to the large number who live in rural areas, said Cynthia Goss, a senior professional research assistant and the lead of the Veterans Wellness Path project team.
The work on the app was “a follow-up to a previous project where we tried to get information out to health care providers to help them provide better care for Native Veterans,” Goss said. That work included building tools to improve providers’ cultural competency, but it also led to a new realization, she explained.
“We were educating VA and community health care providers about Native Veterans, but we didn’t have public-facing behavioral health information for Native Veterans themselves,” Goss said. The idea for the Veteran Wellness Path app followed, with contributions from a CAIANH team that initially included Drs. Jay Shore and Carol Kaufman as senior investigators, Goss, and Madeline Wrolson, MPH ’24, of the Rocky Mountain Public Health Training Center.
That group began with a focus on suicide prevention and PTSD, Goss said, with Begay later “lured into” the project to contribute her expertise and help to craft and expand the app with insights from Native Veterans and their families, Goss said.
Two-way learning
Both Goss and Begay expressed not only their satisfaction in helping Native Veterans and their families, but also gratitude for the opportunities for personal growth they garnered from working on the Veteran Wellness Path project.
“I see this as a chance to give back to our Native Veterans,” Goss said. “They have taught me so much and I have learned so much from them and their stories of life after service. I hope we can use this [project] to continue learning and to keep the conversations going so we can continue to give back.”
The work on the app took a personal turn last year for Begay when she learned that a young family member who was a Veteran had passed away after struggling with personal issues.
“For me, I feel like I dedicate this app to my family and my relative who passed on,” Begay said. “I’m not alone in feeling this grief and loss, because there are many Natives who are going through this, who deal with it constantly. Hopefully this app will help them with the mental health challenges and burdens that we go through.”