BACKGROUND/RATIONALE:
Recent policies for military sexual trauma (MST) represent one of VHA’s most significant efforts to meet the needs of women veterans and insure equitable access to care. Military sexual trauma characterizes a range of experiences for which VA provides universal screening and treatment in response to a series of public laws mandating services for women exposed to sexual assault and harassment during active military duty. Screening efforts with the MST clinical reminder have identified MST in 20% of all women veterans who use VA services, making MST one of the most prevalent psychosocial issues among women veterans. Over 1,000 new cases are uncovered each month, yet little is known about mental health needs of MST-exposed patients, or access to and utilization of services.
OBJECTIVE(S):
Our broad objective is to determine the treatment needs and utilization of MST-exposed women and the systems of care in which they are screened and detected. We do this by modeling screening, detection, and treatment as a function of MST practices and facility-level variables. We will also identify variations in MST prevalence and treatment among special populations of women by including patient factors in all models. The specific objectives of this project are to: a) determine patient-level and facility-level factors associated with variation in rates of MST screening, detection of MST, and treatment of MST; b) determine modifiable practices, patient factors and facility factors associated with MST screening compliance and quality; and c) determine modifiable practices, patient factors and facility factors associated with utilization of MST-related treatment.
METHODS:
We will take advantage of the first National Survey of MST Practices, which assesses AHRQ recommended best practices for screening for violence against women. These data will be merged with existing VA data sources. We will construct hierarchical models of MST screening, detection, and access to treatment as a function of patient demographic, military, and clinical characteristics, facility characteristics, and MST-related practices.
FINDINGS/RESULTS:
We have documented that there is significant inter-facility variation in rates of MST screening. In order to understand the importance of screening compliance, we assessed the clinical utility of MST screening. Preliminary findings suggest that positive screens for MST are associated with increased untilization of mental health services. An increase in new speciality mental health treatment episodes was observed following screening, and this increase was significantly greater among patients who screened positive for MST, as compared to those that screened negative.
IMPACT:
These results will be the first comprehensive evaluation of VA’s MST detection and treatment efforts, and an important next step in addressing one of the most wide-spread women’s health issues in VA. The data will help target key issues in the health and mental health treatment of MST-exposed women. Results will also and inform the implementation of mandated treatment efforts by identifying modifiable practice characteristics associated with better detection and treatment of MST. These data will be especially important to facility MST coordinators who are implementing the mandate in the absence of empirical data or feedback such as performance indicators. Long-term results will be refined methods for monitoring and evaluating MST-related treatment, including a well-developed dataset that links MST screening with treatment utilization data so that more VA health services research is able to integrate women’s health issues, such as MST, into their studies.
PUBLICATIONS:
Journal Articles
- Kimerling R, Street AE, Gima K, Smith MW. Evaluation of universal screening for military-related sexual trauma. Psychiatric Services. 2008; 59(6): 635-40.
