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2015 HSR&D/QUERI National Conference Abstract

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3198 — Trauma and Health Risks among Women Veterans in their Communities: Fog, Detours, and Crashes on Pathways to Treatment

Glover DL, VA Greater Los Angeles COIN; Broadus C, Women Alive Coalition; Hamilton AB, VA Greater Los Angeles COIN;

Objectives:
With recent changes in VA policy accommodating more community-based care for Veterans, it is critical to learn more about Veterans' experiences with this care. Our objective was to explore women Veterans' (WVs) pathways to care, community-based healthcare experiences, and health risk behaviors.

Methods:
Partnering with a community-based women's health advocate, we recruited WVs from community-based organizations (CBOs). Eligibility criteria included use of at least some non-VA health/social services. Consented participants completed in-depth interviews and background surveys. Multiple case study analysis was employed.

Results:
Women (n = 22) averaged 44 years (range, 29-57). Most (80%) were minority women, had some college education (60%), were unmarried (90%), and 50% had children. Half had experienced homelessness in the prior five years. Most participants had a regular healthcare provider (VA or otherwise), had seen a mental health (MH) provider within the past year, and had insurance in addition to VA. Most participants had complex trauma histories that they did not disclose during the average 10-year period from military discharge to VA or other source of care. They were typically "in a fog," unaware of their eligibility for or not seeking care. They faced many health and life detours after military service, describing trying to "fit in" to civilian life and ignoring or minimizing health problems. Their Veteran status was not identified in CBOs. Many continued to experience trauma and stressors after military service, and reported "crashing," e.g., engaging in risk behaviors to cope with stressors. Several reported health risk behaviors in the past six months, e.g., substance abuse, unprotected sex. Those currently in MH treatment felt that their trauma was being adequately addressed.

Implications:
This diverse community-based sample of WVs had extensive trauma histories and took circuitous, often risky, protracted routes to regular health care.

Impacts:
Considering that most WVs do not use VA care, and that more VA users may soon be using community-based care, it is incumbent upon the system to coordinate with CBOs in order to ensure that WVs' complex histories and needs are thoroughly addressed. Improved screening for health risk behaviors will be an important component of getting women to the care they need, in a timely fashion.