Developing a Marijuana Counseling Module to Improve Mental and Physical Health Outcomes

Problem/Background: Many years of recent United States military conflict have produced a large number of experienced combat veterans who face the challenge of reintegrating back into a civilian lifestyle. Mental health conditions such as Post Traumatic Stress Disorder (PTSD) are common among these veterans. Marijuana use is common among veterans suffering from mental health conditions. Veterans frequently present to the Veteran's Affairs (VA) Hospital outpatient mental health clinic reporting marijuana use. Clinicians at the VA who are faced with providing treatment to veterans receive little to no education about the effects marijuana use has on mental health conditions. Clinicians who are not confident in their knowledge are unable to provide appropriate evidenced-based education to veterans with mental health conditions who are using marijuana. The purpose of this quality improvement project was to develop an evidenced-based education module about the effects of marijuana use and present the material to mental health clinicians. Methods: Clinicians working in the outpatient mental health clinic at the VA hospital participated in one of three different educational module presentations lasting 15-20 minutes. Pre-and post-education surveys with 14 Likert formatted questions were filled out by all participants to assess knowledge, confidence and use of screening options for marijuana use. A 30-day follow-up survey with 8 Likert formatted questions was filled out by clinicians. Participant demographic information was measured and described using summary statistics and frequency distributions. Quantitative survey data was analyzed using paired sample two-tailed t-tests. Key Findings: Pre- and post-education survey data for a total of 42 clinicians and follow up survey data for 22 clinicians was used for analysis. Likert responses were assigned scores using =Strongly Agree, 1=Agree, 2= Undecided, 3= Disagree and 4=Strongly Disagree. Lower scores in the post-education survey indicate improvement due to clinicians entering responses closer to "Strongly Agree." Combined averages of pre- and post-education question scores related to knowledge (questions 1,4,8,9 averaging pre-7.26 and post-5.79), confidence (question 6, pre-1.76 and post-1.29) and use of screening interventions (questions 12,13, 14 averaging pre-6.94 and post- 5.83) showed improvement. Paired sample two tailed t-tests were used to analyze the data obtained from the surveys. Statistically significant improvements in knowledge (questions 1,4,8,9, p<0.006), confidence (question 6, p<0.005) and use of screening interventions (questions 12,13,14, p<0.05) were observed in 8 of the 14 pre-and post-education survey questions and 2 of the 8 follow up survey questions (question 6 p<0.001 and 13 p<0.05). Conclusion: Results from this project demonstrated that presenting an educational module on the effects of marijuana to clinicians can be an effective technique for producing statistically significant improvements in clinician knowledge, understanding and confidence. Clinicians can then use the newly acquired information from the module to increase safety and improve outcomes through therapeutic conversation, the implementation of interventions and treatment plan modification in marijuana using veterans.