human services

Assignment Description

Part of this assignment is a compilation of all previous assignments that has been revised. All the course assignments will be combined to create a policy analysis report. The purpose of this assignment is to analyze the extent to which your chosen policy addresses the social justice issue concerning your chosen population and to make recommendations.

Assignment Instructions

As noted above, revise the work you have done in the  Policy Selection and Background (Week 4) and  Policy Analysis (Week 6) assignments (see below) to develop a complete analysis. Additionally, this final submission includes recommendations you would make regarding future changes to the policy to improve its effectiveness in addressing the social justice issue for the chosen population.

include the following sections:

Introduction

Body of Paper

Address the following, based on revising the assignments you submitted previously:

· Analyze the social justice issue and its connection to the chosen population, addressing cultural values, privilege, and power.

· Analyze the chosen policy and its connection to the social justice problem and the targeted population.

· Analyze the historical issues and context leading up to, and including, the development of the policy.

· Evaluate the effectiveness of the policy, including addressing issues with policy design, implementation practices, and external constraints that inhibit effectiveness.

· Evaluate the feasibility of the policy from political, economic, and administrative perspectives.

Conclusion

· Provide a brief summary of the current state of the policy's implementation in regard to the chosen social justice issue and target population.

· Draw conclusions based on your analysis about the continuing effectiveness of the policy. What have been the policy's strengths and weaknesses, and how might these look going forward? Cite specific examples to support your analysis.

Recommendations

· Provide recommendations to improve the policy or to replace it with alternative solutions, including a plan for how you will advocate for these changes. Should the policy be replaced, modified, or extended upon?

· Justify your recommendations for new policies or revisions with a detailed rationale.

· Describe how the new or revised policy for the chosen population will be implemented into policy planning and action.

Guidelines

Additional Requirements

The assignment you submit is expected to meet the following requirements:

· Written communication: Written communication is free of errors that detract from the overall message.

· APA formatting: Resources and citations are formatted according to current APA style and formatting standards.

· Parts of the paper: Include a title page, table of contents, body of paper, references, and running headers.

· Cited resources: A minimum of eight scholarly sources. Most literature cited should be current, with publication dates within the past five years.

· Length of paper:  12 typed, double-spaced pages.

· Font and font size: Times New Roman, 12 point.

Week 4 Assignment (for your reference)

Purpose of the Policy

The VA MISSION Act of 2018, officially signed into law as Public Law No. 115-182, was developed to enhance access, quality, and coordination of healthcare services to U.S. veterans, and specifically to those who face barriers to care (Congress.gov, n.d). It is a major revision of the system of Veterans Affairs (VA) healthcare, which was sponsored by Senator Johnny Isakson and passed with bipartisan support in the 115th Congress. It is about ensuring that veterans receive quality and timely care by a combination of VA healthcare services and community-based healthcare providers. This is done by instituting a more adaptable and responsive model of healthcare delivery that is responsive to systemic inefficiencies, including long wait times, provider shortages, and geographic barriers.

The policy is a direct response to inequities in access to care that disproportionately affect marginalized groups of veterans, including racial and ethnic minorities and LGBTQ+ individuals. These groups are more prone to having severe mental health problems and experiencing barriers to receiving treatment (Nillni et al., 2023). The MISSION Act aims to lessen disparities and achieve more favorable health outcomes by expanding eligibility to non-VA care and improving coordination among providers. Continuity of care and the fact that veterans, because of administrative delays or systems failures, should not experience lapses in their services further enhance their patient-centered care commitment.

Programs and Services Provided Through the Policy

The VA MISSION Act had a broad scope of programs and services that were aimed at enhancing healthcare delivery. It has one of the most important components, the Veterans Community Care Program (VCCP), which offers eligible veterans the opportunity to receive hospital care, medical services, and extended care services by non-VA providers when the VA facilities are unable to adequately meet their needs (Congress.gov, n.d). The eligibility conditions involve cases when the VA fails to provide the necessary services, does not have a full-service facility within the state of the veteran, or is unable to deliver timely services. Such a program is also needed to overcome the access disparities, especially in underserved or rural areas, among veterans.

The policy along with the VCCP also introduced Veterans Care Agreements (VCAs), which provide the VA with an opportunity to enter into an agreement with community providers, where traditional contracting would not work (Congress.gov, n.d). These types of arrangements consider various factors including travel burden, nature of medical conditions and urgency of care. The policy also granted the option of walk-in care whereby the veterans are given the opportunity to receive certain services but not prior appointments and this is particularly useful in the event of emergency mental health care.

Telehealth was another area that was extended by the Act through the removal of geographic constraints and allowing VA providers to deliver care across state boundaries. It is an urgent step towards tackling logistical and stigma-related impediments to mental health treatment. Telehealth may allow veterans, especially those who may have some reluctance to seek face-to-face care due to stigma, to access care in a more privative and convenient way (Randles & Finnegan, 2022).

The next important element is the further development of the Family Caregiver Program that now covers pre-9/11 veterans (Congress.gov, n.d). This program provides caregivers with financial support, training and support services in recognition of the crucial role these caregivers play in recovering and the well-being of veterans. The policy also incorporates education and training programs on both the provider and veteran side, so that veterans are aware of their healthcare options, and providers are prepared to provide high-quality, culturally competent care to the veterans.

All the eligible veterans are of concern in such programs but specifically of importance to those with discrepancies associated with mental health and systemic discrimination. The minority veterans and LGBTQ+ veterans can have more access points and more adaptable service delivery models that can help alleviate some of the barriers they must incur in traditional healthcare settings.

Connection between the Policy and the Social Justice Problem.

The VA MISSION Act is directly related to the social injustice of oppression and discrimination within mental health of veterans. This is also a systemic issue and historical inequalities existed which had traditionally limited access to care and was one of the factors contributing to poorer mental health outcomes among marginalized populations. As has been shown, the racial and ethnic minority veterans have an increased risk of developing PTSD, depression, and anxiety that are often worsened by other issues, including discrimination and socioeconomic disadvantage (Merians et al., 2023). On the same note, LGBTQ+ veterans encounter special issues of stigma and exclusion both in the military and in health care (Harper et al., 2023).

The policy aims at resolving this social justice issue by focusing on structural obstacles to care, especially those involving access and availability of services. The MISSION Act lowers dependency on a centralized system, which could be unable to provide appropriate care to various groups of people (O’Hare et al., 2022). This is an important feature to veterans who might feel sidelined or misinterpreted in conventional VA care.

Nevertheless, the policy enhances access, but it does not completely address the root causes of discrimination. Such issues as implicit bias, the absence of cultural competence in providers, and the stigmatization of mental health remain. According to Randles and Finnegan (2022), even in the presence of the services, stigma is a major obstacle to help-seeking behavior. Thus, the MISSION Act can be considered a significant yet partial measure in the direction of social justice in the mental health of veterans.

The social problem in question is a long-standing issue that has been developing over the years, but has not been resolved yet. The fact that, even though several policy interventions have been implemented, the disparities are still present goes to show that perhaps, more multifaceted solutions may be necessary that would address the needs of both structural and interpersonal factors.

History and Policymaking

The VA MISSION Act has been created as a solution to the existing problems with the VA healthcare system with accessibility and the quality of services. The largest triggering factor of the policy was the 2014 VA scheduling scandal that revealed excessive wait times and systemic inefficiencies that failed to allow veterans to receive timely care (Beaubrun, 2026). This crisis has demonstrated the desperately high need for reform, and it has come along with more public and political pressure to reform the system.

The bill was introduced in 2018 and passed with a large margin of bipartisanship, reflecting a broad spectrum of agreement on the question of the need to meet the healthcare needs of veterans. Before being signed into law on June 6, 2018, it underwent several procedures, including committee hearings and roll call votes (Congress.gov, n.d). The well-established legislative support is indicative of the acknowledgment of the importance of healthcare access to veterans.

In the past, the healthcare policies of veterans have been modified to address the new challenges and changes in society. MISSION Act is founded on the earlier legislation, such as the Veterans Access, Choice, and Accountability Act of 2014, but elaborates and narrows down community care options. This evolution provides a shift in the direction of more integrated and more flexible healthcare systems that are more competent to support diversity.

The historical context also demonstrates that there were long-term inadequacies in addressing the issue of discrimination and inequality. It has been typical that policies have been concerned with improving access, yet without speaking fully to the social determinants of health, like income inequality and systemic bias. Consequently, the marginalized groups still face disparities, although there are improvements in policies.

These historical aspects have impacted on the implementation of the MISSION Act. Despite the benefits of the policy, such as the rise in access, it is faced with several challenges, which limit its effectiveness, including provider shortages, problems with the coordination of services, and the persistence of the stigma. Furthermore, the tendencies historically inclined on formulating policies based on a generalized group of veterans have led to gaps in services offered to women and LGBTQ+ veterans (Harper et al., 2023).

Conclusion

In summary, the VA MISSION Act of 2018 is an important policy that can improve access to healthcare and mitigate disparities in mental health of veterans. It continues to be dynamic and continues to dictate how the services are to be provided. However, it has been constrained by historical and structural causes which must be countered and always restructured. Policies that will be implemented to achieve true social justice will have to focus on policies that not only will increase access but also will target the causes of discrimination and inequity in the healthcare system.

References

Congress.gov. (n.d). S.2372 - VA MISSION Act of 2018. Retrieved from: https://www.congress.gov/bill/115th-congress/senate-bill/2372

Merians, A. N., Gross, G., Spoont, M. R., Bellamy, C. D., Harpaz-Rotem, I., & Pietrzak, R. H. (2023). Racial and ethnic mental health disparities in US Military Veterans: Results from the National Health and Resilience in Veterans Study.  Journal of psychiatric research,  161, 71-76. https://doi.org/10.1016/j.jpsychires.2023.03.005

O’Hare, A. M., Butler, C. R., Laundry, R. J., Showalter, W., Todd-Stenberg, J., Green, P., ... & Carey, E. (2022). Implications of cross-system use among US veterans with advanced kidney disease in the era of the MISSION act: A qualitative study of health care records.  JAMA Internal Medicine,  182(7), 710-719. doi:10.1001/jamainternmed.2022.1379

Beaubrun, F. L. O. (2026).  Strategies to Reduce Diagnostic Wait Times in VHA Facilities (Doctoral dissertation, Walden University).

Harper, K. L., Herbitter, C., Livingston, N. A., Vogt, D., Iverson, K., Nillni, Y. I., & Galovski, T. (2023). Experiences of discrimination and mental health treatment seeking among LGBQ+ veterans. Psychology of Sexual Orientation and Gender Diversity. https://dx.doi.org/10.1037/sgd0000683

Nillni, Y. I., Horenstein, A., McClendon, J., Duke, C. C., Sawdy, M., & Galovski, T. E. (2023). The impact of perceived everyday discrimination and income on racial and ethnic disparities in PTSD, depression, and anxiety among veterans. PLOS ONE, 18(9), e0291965. https://doi.org/10.1371/journal.pone.0291965

Randles, R., & Finnegan, A. (2022). Veteran help-seeking behaviour for mental health issues: A systematic review. BMJ Military Health, 168(1), 99–104. https://doi.org/10.1136/bmjmilitary-2021-001903

Week 6 assignment (for your reference)

Development of the VA MISSION Act of 2018

The VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 was enacted in response to ongoing problems in the United States Department of Veterans Affairs (VA) healthcare system, particularly with access to timely and adequate healthcare for Veterans. The policy came in the wake of a VA investigation into the VA scheduling scandal in 2014, when veterans were required to wait too long to receive healthcare, waiting times were too extended, and the VA’s records were falsified. The failures highlighted systemic weaknesses, and pressure was placed on the political arena to improve healthcare to deliver better service and make it more accessible (Beaubrun, 2026). So the policymakers advocated a bill to modernize health care for veterans and reduce barriers to their access to health care.

The policy has also been changed throughout the years because of increased knowledge about mental health disparities among veterans. Previous studies have demonstrated that veterans in racial/ethnic minority groups are more likely than white veterans to experience post-traumatic stress disorder (PTSD), anxiety and depression, and that this is linked to socioeconomic disadvantage and discrimination (Nillni et al., 2023). LGBTQ+ veterans experienced unique barriers related to stigma, discrimination and exclusion within the military and healthcare environment that impacted help-seeking and mental health outcomes (Harper et al., 2023). The previous policies at VA failed to focus on overall VA health care disparities or disparities in health care affecting marginalized VA populations.

On June 6, 2018, the VA MISSION Act was passed by Congress on a bipartisan basis, resulting in the repeal of the Veterans Choice Program in favor of a broader healthcare approach (Congress.gov, n.d.). The policy aimed to create a healthcare system for veterans that was centered on them, placed VA resources in the hands of community providers, and made them more flexible and responsive. The main priorities of the VA MISSION Act are: Enhance access to VA health care; Reduce wait times; Improve VA care coordination; Support VA caregivers; and Improve VA health care for veterans. Several programs and services are planned to achieve the goals (Lafferty et al., 2023). In addition, the Veterans Community Care Program (VCCP) is an important component of the VHA plan, through which eligible veterans can receive care from a VA community provider when a VA facility is unable to provide needed care and services due to geographic, provider, or wait-time limitations.

The policy also provided for Veterans Care Agreements (VCAs), an alternative to contracting in areas where the contracting process might not work. Interstate barriers were removed, and access to healthcare increased at a distance. There was a significant expansion of telehealth services due to two factors. First, removing interstate barriers; second, easier access to care remotely. Stigma and geographic barriers to accessing mental health care were identified, and telehealth was particularly vital for veterans who might have experienced these barriers and required services more readily (Randles & Finnegan, 2022). In addition, the Family Caregiver Program expanded eligibility to veterans of past wars and provided financial support, education, and assistance to caregivers, who are key to veterans’ recovery and healing.

Effectiveness of the Policy for the Target Population

Although the VA MISSION Act is still relatively young, it has already brought about positive changes in the healthcare environment for veterans, particularly by expanding access to health services beyond the VA health system. The policy has enabled more veterans in rural and underserved areas to access health care services, including those who previously did not receive VA services. Logistical barriers to care have also been reduced through greater flexibility in care and by accessing services in the community and via telehealth. The policy helps to raise awareness about social justice issues, in part because, for many veterans, their mental health disparities are evident when accessing services from systems that have denied them access. A greater number of providers and less use of centralized VA facilities for some particularly marginalized veterans, including racial minorities and members of the LGBTQ+ community. Research indicates that racial discrimination and socioeconomic inequity are major factors in symptoms of post-traumatic stress disorder (PTSD), depression and anxiety differences among minority veterans (Nillni et al., 2023). The policy increases healthcare access, which can help reduce treatment delays and improve outcomes.

While some of these changes have been effected, some evidence suggests that the policy has not been fully able to meet the needs of marginalized groups of veterans. Expansion is not sufficient to reduce structural inequities, which drive inequities in mental health. Social dysfunction and treatment engagement that is associated with discrimination, stigma, and income inequality, and not being well served by culturally appropriate treatment, continue to plague Veterans. Harper et al. (2023) found that LGBTQ+ veterans are likely to encounter discrimination from health care providers, which reduces access to health care. Veterans who answer “bisexual” in particular to the question of sexuality experience worse mental health distress, and are less likely to access formal health care systems. The policy thus takes some steps towards social functioning to a certain degree by making services accessible, but fails to address the deeper social determinants that affect mental health outcomes. Even if services are available, veterans who still face discrimination can continue to face barriers.

Equity, dignity, and access to care are the social values aspects of the policy. Social justice, cultural competence, and respect for self-determination are values that inform social work practice, as stated in the NASW Code of Ethics (2021). The values will be realized in the MISSION Act’s patient-centered care models and in increased treatment options. Telehealth and community care also promote autonomy by enabling veterans to play a greater role in the decision-making regarding their care and treatment. However, there are still some conditions for cultural responsiveness and cultural inclusiveness. Previous veteran health policies tended to center on the needs of White male veterans, leaving women, minorities, and LGBTQ veterans (Harper et al., 2023) unmet. Despite policy changes, there are still populations whose needs have yet to be met.

Ethically, the policy is a blend of best-practice guidelines and is sometimes not fully consistent with social work ethical expectations. The best practices in mental health care for veterans emphasize culturally competent, identity-affirming, trauma-informed, and equitable care (Randles & Finnegan, 2022). Some cultural competency training has been done for providers by the VA, but not all. VA has also established LGBTQ+ Veteran Care Coordinators and expanded mental health programs. When there are no systematic requirements for cultural competency, it is difficult to uphold the ethical practice of diversity and social justice. An active stance on social work ethics is needed to eradicate structural oppression and discriminatory practices (NASW, 2021). Ethical standards and best practices are not fully met because disparities persist even with policy implementation.

Feasibility of the Policy

The VA MISSION Act has significant political promise. During congressional deliberations, the bill had widespread bipartisan support, as veterans’ health care is seen as a nonpartisan issue. As a result of the VA scheduling crisis, the public became aware of it, and political momentum for change began to build. There have been further legislative steps to enhance health care services for veterans, such as the PACT Act (McAndrew et al., 2026). As far as the policy’s economic aspects are concerned, there are pros and cons. The investments in additional community care, caregiver support programs, and the development of telehealth are significant. Using private providers increases healthcare expenses because their services may cost more than VA services. Untreated mental health issues among veterans, however, result in long-term societal costs of disability, unemployment, homelessness and suicide. The economic benefits of early intervention and better access to health services could be realized over time, as downstream health and social services costs would be reduced.

Administrative feasibility is more complicated. Implementation challenges have included a lack of providers, coordination between VA and community systems, reimbursement, and communication. O’Hare et al. (2022) found that a lack of healthcare coordination can result in less seamless healthcare experiences during cross-system utilization. For veterans being cared for by multiple systems or providers, there can be a lack of consistency, timeliness, or clarity. Increased telehealth use has improved administrative efficiency and access to services, but not all veterans have digital literacy or access to technology. It is possible, but implementation issues make it less effective.

Policy Constraints Affecting Effectiveness

The VA MISSION Act is failing to achieve the goals of reducing veteran mental health disparities in part because of certain policy limitations. A significant constraint is that the policy is largely geared towards health access and less towards structural factors that contribute to mental health inequities. Despite the significant strides made in some areas, discrimination, poverty, social exclusion and stigma remain as factors that affect veterans’ mental health, particularly for individuals who are minorities and LGBTQ+ veterans (Nillni et al., 2023). Another important limitation is the lack of cultural competency requirements for health care providers. Increased access to treatment is a positive development, but providers may not have experience with military culture, race trauma, LGBTQ+ identity, and the experiences of Veterans. Even when culturally responsive services are not provided, a veteran might not seek them because of culturally shaped access opportunities.

Davenport County is also experiencing shortages in the health care industry. Veteran community providers may lack the knowledge of veteran experiences needed to provide sub-optimal treatment (Lafferty et al., 2023). Mental health provider shortages are among the other factors contributing to delayed care, as eligibility increases. Since the policy was put in place, additional constraints have come to light. COVID-19 has intensified mental health needs for veterans and put a strain on health care systems. Social disruptions and economic instability further exacerbated the mental health problems, especially for vulnerable populations. The use of telehealth enhanced access to services, resulting in positive changes for veterans who experience stigma and transportation issues.

The policy also fails to include sufficient longitudinal research on veteran populations that takes into account issues of discrimination and intersectionality. Some evidence of inequalities and insufficient evidence regarding the long-term impacts of these inequalities on mental health outcomes are hindering policy development. In response to the barriers, macro-level advocacy is required, including promoting the need for cultural competency training, funding for community mental health initiatives and services, more identity-affirming services, and research on intersectional differences. The changes align with NASW ethical principles that are grounded in social justice and the provision of equitable services.

References

Beaubrun, F. L. O. (2026). Strategies to reduce diagnostic wait times in VHA facilities (Doctoral dissertation, Walden University).

Congress.gov. (n.d.). S.2372 – VA MISSION Act of 2018. https://www.congress.gov/bill/115th-congress/senate-bill/2372

Harper, K. L., Herbitter, C., Livingston, N. A., Vogt, D., Iverson, K., Nillni, Y. I., & Galovski, T. (2023). Experiences of discrimination and mental health treatment seeking among LGBQ+ veterans. Psychology of Sexual Orientation and Gender Diversity. https://doi.org/10.1037/sgd0000683

Lafferty, M., Govier, D. J., Golden, S. E., Disher, N. G., Hynes, D. M., & Slatore, C. G. (2023). VA-delivered or VA-purchased care: Important factors for veterans navigating care decisions. Journal of General Internal Medicine, 38(7), 1647–1654. https://doi.org/10.1007/s11606-023-08128-0

McAndrew, L. M., Burgo-Black, L., Hunt, S. C., Kossoudji, A., Mains, K. C., Shuping, E., & Llorente, M. D. (2026). Exposure-informed care: Why it is important and how the Veterans Affairs does it. Medical Care, 64(2S), S103–S110. https://doi.org/10.1097/MLR.0000000000002238

National Association of Social Workers. (2021). NASW code of ethics. https://www.socialworkers.org/About/Ethics/Code-of-Ethics

Nillni, Y. I., Horenstein, A., McClendon, J., Duke, C. C., Sawdy, M., & Galovski, T. E. (2023). The impact of perceived everyday discrimination and income on racial and ethnic disparities in PTSD, depression, and anxiety among veterans. PLOS ONE, 18(9), e0291965. https://doi.org/10.1371/journal.pone.0291965

O’Hare, A. M., Butler, C. R., Laundry, R. J., Showalter, W., Todd-Stenberg, J., Green, P., et al. (2022). Implications of cross-system use among U.S. veterans with advanced kidney disease in the era of the MISSION Act: A qualitative study of healthcare records. JAMA Internal Medicine, 182(7), 710–719. https://doi.org/10.1001/jamainternmed.2022.1379

Randles, R., & Finnegan, A. (2022). Veteran help-seeking behaviour for mental health issues: A systematic review. BMJ Military Health, 168(1), 99–104. https://doi.org/10.1136/bmjmilitary-2021-001903