Table 3 Key challenges, barriers and facilitators to expansion of HBPC across 12 VA Medical Centers

 Target population eligibility and need for HBPC unknown

X

X

X

X

X

X

X

X

X

X

X

X

 Distance & other rural conditions (e.g., connectivity)

X

X

X

X

X

X

X

X

X

X

X

X

 Hiring: recruitment and delays

X

X

X

X

X

X

X

X

X

 Patients may have co-pay to use HBPC and other VA services

X

X

X

X

X

X

X

X

X

 Remote areas of reservation too distant

X

X

X

 Potential patients do not meet VHA medical benefit eligibility

X

X

 Established mature HBPC program, standardized outcome measures and local VAMC referral patterns

X

X

X

X

X

X

X

X

X

X

X

X

 Outreach activities to enroll American Indian veterans for VA benefits and/or explain HBPC service

X

X

X

X

X

X

X

X

X

X

X

X

 Seed and sustainment funding for expansion

X

X

X

X

X

X

X

X

X

X

X

 Personal characteristics of HBPC program staff

X

X

X

X

X

X

X

 American Indian community advocate

X

X

X

X

X

 Formal or informal referral mechanism for HBPC referral with IHS/THP

X

X

X

X

X