Health Services Research & Development

Veterans Crisis Line Badge
Go to the ORD website
Go to the QUERI website

IAE 05-291 – HSR&D Study

New | Current | Completed | DRA | DRE | Portfolios/Projects | Centers | Career Development Projects

IAE 05-291
Evaluation of Military Sexual Trauma Screening and Treatment
Rachel Kimerling PhD BA
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, CA
Funding Period: February 2006 - July 2009

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 modeled screening, detection, and treatment as a function of MST practices and facility-level variables. We identified variations in MST prevalence and treatment among special populations of women by including patient factors in all models. The specific objectives of this project were 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 utilized the first National Survey of MST Practices, which assessed AHRQ recommended best practices for screening for violence against women. These data were merged with existing VA data sources. We first determined the demographic, clinical, and military service characteristics associated with MST screening, detection, and access to treatment. We then modeled these relationships nested within facility characteristics.

FINDINGS/RESULTS:
Both male and female Veterans with positive MST screens are more likely to be diagnosed with a number of physical and mental health conditions, as compared to veterans with negative screens. The most frequently diagnosed mental health conditions were PTSD, depression, anxiety disorders and substance use disorders. Positive screens were also associated with increased use of mental health services, relative to pre-screen utilization. Preliminary examination of organizational factors and practices that promote screening and treatment for MST suggest that a number of MST-related policies can promote screening and detection, though treatment was determined primarily by patient-level factors. In separate analyses examining OEF/OIF veterans, MST was also associated with an increased prevalence of mental health conditions, even after adjustment for military service characteristics.

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 helped to established monitoring methods for MST screening and treatment in VA. We identified key issues in the health and mental health treatment of MST-exposed women. These data are relevant to facility MST coordinators who are implementing the mandate to detect and treat MST in the absence of empirical data or feedback such as performance indicators. Long-term results will be refined methods for research into 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 address these issues in future research.

PUBLICATIONS:

Journal Articles

  1. Kimerling R, Makin-Byrd K, Louzon S, Ignacio RV, McCarthy JF. Military Sexual Trauma and Suicide Mortality. American journal of preventive medicine. 2016 Jun 1; 50(6):684-691.
  2. Hyun JK, Kimerling R, Cronkite RC, McCutcheon S, Frayne SM. Organizational factors associated with screening for military sexual trauma. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2012 Mar 1; 22(2):e209-15.
  3. Kimerling R, Pavao J, Valdez C, Mark H, Hyun JK, Saweikis M. Military sexual trauma and patient perceptions of Veteran Health Administration health care quality. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2011 Jul 1; 21(4 Suppl):S145-51.
  4. Frayne SM, Chiu VY, Iqbal S, Berg EA, Laungani KJ, Cronkite RC, Pavao J, Kimerling R. Medical care needs of returning veterans with PTSD: their other burden. Journal of general internal medicine. 2011 Jan 1; 26(1):33-9.
  5. Valdez C, Kimerling R, Hyun JK, Mark HF, Saweikis M, Pavao J. Veterans Health Administration mental health treatment settings of patients who report military sexual trauma. Journal of trauma & dissociation : the official journal of the International Society for the Study of Dissociation (ISSD). 2011 Jan 1; 12(3):232-43.
  6. Smith MW, Chow A, Kimerling R. Estimating lost revenue from a free-care mandate in the U.S. Department of Veterans Affairs. Psychiatric services (Washington, D.C.). 2010 Nov 1; 61(11):1150-2.
  7. Kimerling R, Street AE, Pavao J, Smith MW, Cronkite RC, Holmes TH, Frayne SM. Military-related sexual trauma among Veterans Health Administration patients returning from Afghanistan and Iraq. American journal of public health. 2010 Aug 1; 100(8):1409-12.
  8. Kimerling R, Street AE, Gima K, Smith MW. Evaluation of universal screening for military-related sexual trauma. Psychiatric services (Washington, D.C.). 2008 Jun 1; 59(6):635-40.
  9. Kimerling R, Gima K, Smith MW, Street A, Frayne S. The Veterans Health Administration and military sexual trauma. American journal of public health. 2007 Dec 1; 97(12):2160-6.
VA Cyberseminars

  1. Frayne S, Lipson L, Phibbs C, Yano EM. Improving Care for Women Veterans: How to Move from Observational to Interventional and Implementation Research. [Cyberseminar]. 2011 Nov 2.
Conference Presentations

  1. Hyun J, Kimerling R, Cronkite RC, McCutcheon S, Frayne SM. Organizational Factors Related to Military Sexual Trauma Screening. Paper presented at: AcademyHealth Annual Research Meeting; 2012 Jun 24; Orlando, FL.
  2. Yee EF, DiLeone B, Yano EM, Frayne SM, Bean-Mayberry B, Sadler A, Bastian L, Carney DV, Klap R, Pomernacki A, Blakeney J, Erschens H, Barrett T, Vogt D. Use of Implementation Science Principles to Implement a Gender Sensitivity Curriculum in a VA Practice Based Research Network. Poster session presented at: Agency for Healthcare Research and Quality Practice-Based Research Network Annual Meeting; 2012 Jun 22; Bethesda, MD.
  3. Turchik JA, Pavao JR, Hyun J, Mark H, Kimerling R. Sexual trauma related Veteran Health Administration outpatient health care: Which Veterans utilize this free care? Poster session presented at: International Society for Traumatic Stress Studies Annual Meeting; 2011 Oct 3; Baltimore, MD.
  4. Kimerling R, Pavao JR, Valdez C, Mark H. Military sexual trauma history and patient perceptions of healthcare quality in the Veteran's Health Administration. Poster session presented at: American Public Health Association Annual Meeting and Exposition; 2010 Nov 8; Denver, CO.
  5. Kimerling R, Street J, Pavao JR, Smith MW, Cronkite RC, Holmes TH, Frayne SM. Military Sexual Trauma Among OEF/OIF Patients. Poster session presented at: VA Implementing a Public Health Model for Meeting the Mental Health Needs of Veterans Annual Mental Health Conference; 2010 Jul 28; Baltimore, MD.
  6. Kimerling R, Hyun J, Saweikis M, Cronkite RC, Frayne SM. Organizational factors associated with military sexual trauma screening: The role of specialty clinics. Presented at: VA HSR&D Field-Based Women's Health Meeting; 2010 Jul 1; Arlington, VA.
  7. Nazarian D, Kimerling R, Frayne SM. PTSD, Substance Use Disorders, and Medical Comorbidity among OEF/OIF Veterans in Primary Care: Prevalence and Implications for Behavioral Medicine Interventions. Paper presented at: VA HSR&D Field-Based Mental Health and Substance Use Disorders Meeting; 2010 Apr 28; Little Rock, AR.
  8. Kimerling R. Military Sexual Trauma among OEF/OIF Veterans. Presented at: VA / DoD Evolving Paradigms II OEF / OIF National Conference; 2009 Sep 21; Las Vegas, NV.
  9. Frayne SM. Addressing the health care needs of women veterans in VA. Paper presented at: Disabled American Veterans Annual Convention; 2009 Aug 24; Denver, CO.
  10. Kimerling R, Hyun J, Pavao J, Saweikis M, Mark H. Implementing MST-related mental health care. Presented at: VA Psychology Training Council (VAPTC) Annual Meeting; 2009 Jul 20; Baltimore, MD.
  11. Kimerling R, Street AE, Pavao JR, Smith MW, Cronkite RC, Holmes TH, Frayne SM. Military-related sexual trauma among VHA patients returning from Iraq and Afghanistan. Poster session presented at: VA Psychology Training Council (VAPTC) Annual Meeting; 2009 Jul 20; Baltimore, MD.
  12. Ouimette P, Tirone V, Kimerling R, Laffaye C, Vogt D, Greenbaum M, Fitt J, Rosen CS. Facilitators and barriers to health care among male and female veterans with PTSD. Presented at: VA HSR&D National Meeting; 2009 Feb 11; Baltimore, MD.
  13. Pavao JR, Kimerling R, Street A, Gima K, Smith MW, Cronkite RC, Frayne SM. Burden of mental illness associated with military sexual trauma among veterans deployed to Iraq and Afghanistan. Poster session presented at: American Public Health Association Annual Meeting and Exposition; 2008 Oct 28; San Diego, CA.
  14. Kimerling R, Pavao J, Gima K, Street A, Bell M, McCutcheon S. Military Sexual Trauma: What every mental health provider should know. Poster session presented at: VA MIRECC Annual Best Practices in Mental Health Conference; 2008 Jul 18; Arlington, VA.
  15. Kimerling R, McCutcheon S. Military Sexual Trauma in VA. Paper presented at: VA National Summit on Women Veteran's Issues; 2008 Jun 20; Washington, DC.
  16. Kimerling R, Pavao J, Gima K. Developing Gender-Specific Indicators of Care of Military-Related Sexual Trauma in VHA. Paper presented at: AcademyHealth Annual Research Meeting; 2008 Jun 9; Washington, DC.
  17. Kimerling R, Street A, Pavao J, Gima K, Smith MW, Cronkite R, Frayne S. Burden of Illness Associated with Military Sexual Trauma Among Veterans Deployed to Iraq and Afghanistan. Paper presented at: AcademyHealth Annual Research Meeting; 2008 Jun 9; Washington, DC.
  18. Kimerling, Pavao, Gima, Street, Smith, Cronkite, Frayne. MST in Veterans Returning from Iraq and Afghanistan: The "Other" Deployment Stressor. Presented at: VA HSR&D National Meeting; 2008 Feb 13; Baltimore, MD.
  19. Kimerling R, Street A, Smith MW, Gima K. Military sexual trauma screening and treatment. Paper presented at: International Society for Traumatic Stress Studies Annual Meeting; 2007 Nov 15; Baltimore, MD.
  20. Street AE, Galbreath N, Kimerling R. Sexual assault during military service: Preventing the trauma and mental health consequences. Paper presented at: International Society for Traumatic Stress Studies Annual Meeting; 2007 Nov 15; Baltimore, MD.
  21. Kimerling R, Street A, Smith M, Frayne SM. Does universal screening for military sexual trauma increase access to mental health treatment? Poster session presented at: American Psychological Association Annual Convention; 2007 Aug 19; San Francisco, CA.
  22. Kimerling R, Alvarez J, Gima K, Street A, Bell M, Pavao J, McCutcheon S. The military sexual trauma support team. Poster session presented at: VA MIRECC Annual Best Practices in Mental Health Conference; 2007 Jul 18; Alexandria, VA.
  23. McCutcheon SJ, Kimerling R. Military sexual trauma. Paper presented at: VA Primary Care Mental Health Integration Conference; 2007 Jun 1; Denver, CO.
  24. Kimerling R. Screening and treatment for MST in VA. Presented at: VA National Pain Management Conference; 2007 Apr 10; Las Vegas, NV.
  25. Kimerling R, Gima K, Smith M, Street A, Frayne S. MST screening and associated medical and mental health conditions. Poster session presented at: VA HSR&D National Meeting; 2007 Feb 22; Arlington, VA.
  26. Kimerling R, Gima K, Smith MW, Street A, King S, Frayne S. MST screening and access to mental health treatment. Poster session presented at: VA HSR&D National Meeting; 2007 Feb 22; Arlington, VA.
  27. Kimerling R, Gima K, Smith MW, Street A, King S, Frayne S. MST screening and access to mental health treatment. Poster session presented at: Association of Military Surgeons of the United States Annual Meeting; 2006 Nov 5; San Antonio, TX.


DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders, Health Systems
DRE: Treatment - Observational, Prevention
Keywords: Practice patterns, Screening, Women - or gender differences
MeSH Terms: none