Nationally, over one in five women Veterans who use the VA have histories of military sexual trauma (MST), which is associated with increased risk of depression, anxiety and PTSD and adverse impacts on medical management of chronic conditions and discomfort with routine preventive exams. Rates of MST exposures among regular VA primary care (PC) users are even higher. Ensuring delivery of PACT (VA's medical home) care that is sensitive to these exposures is therefore critical, and VA web-based trainings have been developed to promote trauma-sensitive care. Recent qualitative evidence, however, suggests that some PACT providers and staff would benefit from additional tools that complement existing educational efforts, e.g., clinical and environment-of-care tools that would support their delivery of trauma-sensitive primary care to women Veterans with MST and other sexual trauma histories.
The aims of this pilot were to: (1) integrate women Veterans' experiences and preferences into the refinement of draft trauma-sensitive tools for enhancing the delivery of and environment for trauma-sensitive care; (2) better understand best practices and existing tools through interviews of subject matter experts; and (3) disseminate and evaluate draft tools through novel and rapid engagement of VA frontline PC providers and staff in the 60-site Women's Health Practice-Based Research Network (WH-PBRN).
For Aim 1, we conducted three focus groups with WVs to explore critical aspects of trauma-sensitive care from a patient perspective and obtain feedback on two draft tools: a trauma-sensitive pocket card and environmental checklist. For Aim 2, in partnership with VA PACT, WHS, and MHS national leadership, we conducted semi-structured interviews with subject matter experts (SMEs; n=30). SMEs comprised WH Medical Directors, MST Coordinators, and Women's Mental Health Champions from around the country. For Aim 3, we conducted three national WH-PBRN webinars during which we engaged Site Leads/local providers/staff through interactive polling and evaluation forms on acceptability, content quality, feasibility, and optimal deployment of the draft tools. Based on preliminary findings, we further refined the tools and shared our findings with our program partners.
Focus group participants explained that some of the most important aspects of trauma-sensitive primary care to WV participants included experiencing good etiquette and bedside manners from staff and PCPs, having female-only providers/staff or option to choose, having separate female-only waiting rooms, not feeling rushed, and experiencing a homey and safe PC environment. SMEs shared unique trauma-sensitive care strategies that are being developed/practiced at specific sites. However, SMEs overall described individual challenges (e.g., provider burnout) and system-level challenges (e.g., lack of protected time for trainings) faced by both PC providers and staff with providing trauma-sensitive care in mixed gender clinics. They highly recommended in-person role playing and educational sessions to enhance comfort and proficiency, but many agreed that point-of-care tools such as a trauma-sensitive environmental checklist and pocket card would be helpful adjuncts. WH-PBRN members reacted favorably to the draft environmental checklist and pocket card for use in all roles in general PC clinics. Additional SME feedback specific to the environmental checklist emphasized the importance of users perceiving control over the ability to make changes in the listed/recommended content areas. Suggestions related to the pocket card included the potential usefulness of exploring other/more updated mediums (e.g., phone app).
The findings suggest that PCPs delivering care to women in VA facilities without comprehensive women's health clinics may benefit from tools to facilitate trauma-sensitive communication with WVs with histories of sexual trauma. It will be important for future research to pilot such tools in order to encourage implementation of trauma-sensitive care best practices more widely within VA PC.
- Yano EM, Hamilton AB. Accelerating delivery of trauma-sensitive care: Using multilevel stakeholder engagement to improve care for women veterans. Families, systems & health : the journal of collaborative family healthcare. 2017 Sep 1; 35(3):373-375.
- Bergman AA, Hamilton AB. Improving Trauma-Sensitive Primary Care for Women Veterans with Histories of Sexual Trauma: Findings from an HSR&D Pilot Project. Spotlight on Women's Health [Cyberseminar]. HSR&D. 2018 May 9.