VA Nebraska-Western Iowa Health Care System

1. VA Nebraska-Western Iowa Health Care System VA NWIHCS Women Veteran Program Spring 2010

2. NWIHCS Mission: Honor America’s veterans by providing exceptional health care that improves their health and well-being.

3. Women In The Military • Women have provided military service to our county since the revolutionary war • Women disguised themselves as men to serve on the battlefield • They were discovered when injured & quickly sent home • Women have served during peace times and in all major conflicts • In 1948 Truman signed the Women’s Armed Services Integration Act - making women a permanent part of the military • Previously women were quickly discharged when not immediately needed or if she were to marry or become pregnant

4. Women In The Military • Women have not always been considered “veterans” but rather “volunteers” • Nor were they provided veteran benefits such as medical care or a flag at their burial • e.g.: WWII Women Air Force Service Pilots (WASPs) were not granted “veteran” status until 1977 • Women served in traditionally female roles (nurses, administrative support, operators, etc.) until the Persian Gulf War. • At that time, through media coverage, it became clear that women soldiers were experiencing the same war time dangers as their male counterparts. • Women are still barred from infantry, armor & artillery units {“combat roles”}

5. Today’s Female Veteran • Women are serving in greater numbers • 190,000+ women have served in OEF/OIF vs. 41,000 in Desert Storm • 20% of the current “freshman” military class are women • Women are the fastest growing veteran population • OEF/OIF female veterans will double the number of women being served by the VA within the next 5 years • 12% of OEF/OIF Veterans are women (7.5% of all living veterans are women) • 44% of OEF/OIF women veterans are enrolling for VA care (15% utilization in previous eras) • A greater number of soldiers returning home are young women of childbearing age.

6. Influx of Women Veterans • Based on the number of women on active duty and entering military service, the percentage of female veterans is projected to increase: • from 7.7 percent in 2008 • to 10.0 percent in 2018 • to 14.3 percent in 2033 • Increasingly, women veterans enroll • Female enrollees 2008: 453,250 • Female enrollees 2013 (proj.): 657,974 • High utilization by women who served in Operations Iraqi Freedom & Enduring Freedom (OIF/OEF)

7. Women Veterans Are Younger • Average age of VA users • Female veteran = 48 • Male veteran = 61 • Among women veterans returning from OEF/OIF: • 85.3% are below age 40 • 58.0% are between ages 20-29 VA Healthcare Utilization Among 94,010 Female OEF/OIF Veterans through 1st Qtr. FY 2008 Environmental Epidemiology Service

8. Today’s Female Veteran • OEF/OIF veterans are changing the face of the VA • New expectations for service & care • Women are changing the way we define “veteran” • We need to understand that the word “veteran” does not just apply to men; it never has • VA Culture Shift • More women understand their status as “veterans” and are learning about and utilizing their benefits

11. Health Care for Women Veterans • Primary & Specialty Care • The Veterans Health Care Act of 1992 allowed for gender specific care for women. • Gender Specific Care: • Gynecology Services • Mammography • Bone Density Scans • Cervical Cancer Screening • Family Planning • Maternal Care • Infertility Assessment and (limited) Treatment • Treatment for Sexual Trauma

12. VA Nebraska Western Iowa Health Care System • Medical Center is located in Omaha, Nebraska • Community Based Outpatient Clinics (CBOCs) include: • Shenandoah, IA • Bellevue, NE • Grand Island, NE: which also includes the Substance Abuse Inpatient and Community Living Center • Lincoln, NE • Norfolk, NE • North Platte, NE

13. Military Sexual Trauma (MST) • Sexual assault: Any sort of sexual activity in which someone is involved against his or her will. • Can involve unwanted touching, grabbing, oral sex, anal sex, sexual penetration with an object and/or sexual intercourse. Physical force may or may not be used. • Sexual harassment: Repeated, unsolicited, and threatening verbal or physical contact of a sexual nature • Screening every VA patient for MST and documenting the results in the medical chart is legally mandated. • Medical treatment is also mandated, regardless of VA eligibility

14. MST Prevalence in OEF/OIF Veterans-National Data • MST reported by 14.5% women, 0.6% men • Of those, 72% of women, 74% of men diagnosed with mental health conditions • MST associated with increased risk of: • Depression, PTSD, substance use disorders • Six-fold increase in risk for 3+ MH conditions Cross-sectional sample of 89,960 OEF/OIF veterans Source: Kimerling et al. (2008)

15. MST Related Care Requirements for eligibility: • Veteran states he/she experienced MST • Provider believes treatment provided is related to experiences of MST • Care for mental and physical conditions resulting from or related to MST is provided at no cost to the Veteran • Veterans are not charged for inpatient, outpatient or pharmaceutical co-payments related to MST but may still be charged applicable co-payments for care not related to MST • This benefit is not time limited

16. MST Related Care A veteran does not need to be service-connected nor have previously reported a sexually traumatic event to be eligible for MST services. Even veterans that do not meet general eligibility requirements for VA health care are treated for physical and mental health consequences of MST The veteran with a dishonorable discharge may also be eligible for free MST care. Contact the MST Coordinator.

17. Referral To Mental Health Services • VA policy states all MST+ patients be offered MH referral • Referrals are presented in a way it will maximize its acceptability to patient • Normalize: • “Many Veterans, who have had similar experiences, have found it helpful to speak with a counselor” • “We have specially trained staff available; would you like to speak with someone?” • Reassure patient that the referral is not irrevocable

18. Homeless Women Veterans • 5% of homeless Veterans are women. • Risk factors for homelessness among women include: • Trauma • Combat • Sexual • Poverty • Lack of affordable housing • Limited child care support VA offers an extensive, specialized continuum of care to address the unique needs of homeless women Veterans.

20. Patient-Centered Medical Home Patient-driven, team-based approach that delivers efficient, comprehensive, and continuous care through active communication and coordination of resources Key principles Veteran-Centric Access Continuity Comprehensive team-based care Improved coordination for all transitions

21. WOMEN VETERAN PROGRAM SPRING 2010 OUTREACH-OUTREACH-OUTREACH • Women Veteran Focus Groups • VA NWIHCS Site and Other Locations • Veterans of Armed Forces Outreach • Regional Rural Areas • Visibility & Communications • Environment and Service Enhancement

22. BECAUSE THEY SERVED THEY DESERVE THE BEST CARE

23. QUESTIONS • My goal is to improve and address the needs of women veterans for NWIHCS • Together we can make a difference • THANK YOU for you interest in serving veterans.