Survey: Women Veterans Dissatisfied with VA Care, Especially Sexual Trauma Screening for New Enrollees

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WASHINGTON—Women veterans are dissatisfied with many of the services provided through the VA health-care system, including screening processes for military sexual trauma (MST) that new enrollees receive, according to a survey conducted by the American Legion.

While VA mandates that all veterans coming to their facilities for the first time be screened for MST, fewer than half of women veterans responded that they were satisfied with the screening process, though the details of that dissatisfaction will not be investigated until later phases of the survey.

Dissatisfaction With Screening

The survey, taken by 3,012 U.S. military women veterans worldwide, was conducted January 5 to 31, 2011, with the findings released last month. American Legion officials said they felt compelled to conduct the survey after receiving numerous calls from women veterans voicing complaints about VA health care.

“[We understood] that this may be a segment of our veterans that are under-researched,” explained Verna Jones, director of the Legion’s Veterans Affairs and Rehabilitation Division. “A lot of women will call and not know they have benefits or have complaints about how they were treated when they went to VA.”

The 67-question survey focused on the specialized services that women receive and was designed to measure 10 attributes of service quality regarding VA: reliability, responsiveness, competence, access, courtesy, communication, credibility, security, tangibles and understanding the customer.

The survey showed that women veterans perceived VA care as being deficient in a number of areas, including MST. Approximately 36% of women veterans said they were “dissatisfied” with that screening process, with 26% saying they were “very dissatisfied.” Only 42% responded that they were satisfied, with the remainder being neither satisfied or dissatisfied.

“That’s a very low number of respondents satisfied with the process,” Jones said. “That is certainly one area where we believe there’s room for considerable improvement.”

Problems in the MST screening process affects VA’s ability to care for veterans with PTSD, Jones noted. Nearly 39% of respondents said they suffered from PTSD, with 15% of those affected saying their symptoms resulted from military sexual trauma.

The initial survey did not dig deeply into any specific area, including MST, so exactly where the dissatisfaction is coming from has not been quantified. However, previous surveys and congressional testimony from women veterans and veteran’s advocates have zeroed in on several perceived deficiencies in VA.

Repeatedly having to tell their story to multiple clinicians can be re-traumatizing. There is also a lack of women-only MST and PTSD treatment programs, and the co-ed nature of most VA clinics can be difficult for women having recently suffered MST.

Perception of Poor Care

One of the survey results that surprised Legion officials was how many women veterans were dissatisfied with the overall care they received from VA. The majority of complaints attributed to VA care usually involve delays in receiving care, with veterans praising the quality of care once they receive it.

The survey suggests that, for many women veterans, the VA system comes up short in other ways when compared to private providers.

“More than 40% were very dissatisfied with the competence level of VA doctors for women-specific or gender-specific issues,” Jones said. “That was surprising for me. That’s a lot of women who seem to not have the confidence in their health-care providers. And for a woman, that’s huge. You have to make sure that women, who are dying at record rates of breast and ovarian cancer, are being properly treated for gender-specific conditions.”

Nearly half of respondents rated VA’s space and the equipment provided for treatment as “moderate” or “poor”; only 60% of respondents believed their treatments were clearly explained to them; and nearly 40% would “seldom” or “almost never” go to VA for a second opinion over a private practitioner.

A quarter of respondees ranked convenience in location of VA facilities as “poor,” with 29% ranking it only slightly better at “moderate.”

“What we got out of this survey is that VA does some things quite well. But there are problem areas that need to be attended to, including this particular segment of veterans. There is research lacking. VA needs to spend more time and research on this specific population of veterans,” Jones said.

VA is making efforts to bridge the gap in research on women veterans. In July 2010, the agency held a VA Women’s Health Services Research Conference, the theme of which was “building the evidence base” for women veterans. There is also a Women’s Health Sciences Division of VA’s National Center for PTSD, which has resulted in numerous discoveries, including indication that men and women present with PTSD in different ways.

Digging Deeper

The survey is only Phase I of the American Legion’s information-gathering effort on women veterans. In Phase II of the survey, the Legion will post an online question each week that will focus on specific areas from the survey, including MST and how it is related to PTSD care.

“We’ll start in [mid-April] looking at Question of the Week—taking one question from this survey per week and digging down into it a little deeper,” Jones said. “We identified women who did not use the VA health-care system. Now we want to know why. We’ve got a little bit of the answer from [focus groups we’ve conducted]. Some of the women talked about child care, but we want to know exactly how many women those affect. Is it because VA doesn’t have child care? Or is it because you don’t think VA provides a good service? Why? Did you have a bad experience?”

While veteran’s service organizations like the American Legion frequently work closely with VA officials, the VA has not yet chimed in on the survey’s results. However, Jones stressed that the goal of the survey is not to tear VA down or bash the organization’s reputation.

“We appreciate our relationship with the VA. We want to foster that relationship. We have the same client,” Jones pointed out.

The survey, she said, is the tip of the iceberg—the first step in a larger effort to improve the Legion’s own outreach efforts to women veterans and, in the end, improve VA care. “We want to know exactly why women feel the VA health-care system isn’t the best in the world, because that’s what we want the system to be.”

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