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Using Novel Strategies to Connect with Women Veterans

 Almost half (48%) of women Veterans have at least one mental health condition, with depression being the most common among women Veteran VA healthcare users (24% in FY14), followed by PTSD (14%) and anxiety (8%). Depression and anxiety are substantially more prevalent among women Veterans than men. Women Veterans also are more likely than men to have comorbid mental health conditions, and they are more likely to have experienced military sexual trauma and intimate partner violence.¹

The core goal of the Enhancing Mental and Physical health of Women through Engagement and Retention (EMPOWER) national QUERI program is to improve women Veterans' engagement and retention in evidence-based care models for high-priority health conditions, including mental health. The Collaborative Care for Women Veterans (CCWV) study is designed to provide women Veterans with access to patient-centered, gender-tailored mental healthcare for anxiety, depression, and/or PTSD in the context of primary care. The MISSION Act specifically calls for development of strategic plans to meet healthcare demand (Section 106). The EMPOWER QUERI’s CCWV care model allows women to have increased choice regarding the type(s) of care in which they would prefer to engage, thus heightening access to services, and emphasizing women’s experiences of their care. QUERI investigators posit that, with support, women will actively engage in mental healthcare that meets their needs and circumstances, which will help to restore their trust and confidence in VA.

The CCWV care model draws on well-established Primary Care-Mental Health Integration (PC-MHI) and care management principles, while offering a new-to-VA intervention, Coordinated Anxiety Learning and Management (CALM), which has a strong evidence base and a flexible approach to provider-supported patient self-management, including computer-assisted delivery of psychotherapy. EMPOWER QUERI investigators have introduced several adaptations to date, including:

• Gender-tailoring of CCWV to meet the needs of women Veterans;
• Planning for flexible referral pathways to allow implementation in women-only and mixed gender primary care clinics;
• Addressing site-specific resource challenges (i.e., space sharing, computer access);
• Ensuring the CALM package is culturally competent for use among female Veterans in collaboration with the HSR&D funded CALM study (CRE 12-314); and
• Developing refinements to the plan for provider training and educational materials based on stakeholder feedback.

The MISSION Act also authorizes VA healthcare providers to use telemedicine to serve patients regardless of their location (Section 151). In alignment with the MISSION Act, EMPOWER QUERI investigators are piloting CCWV using telemedicine to support gender-tailored primary care mental health integration via a women’s care manager. They also are exploring the MISSION priority of peer specialists in PACTs (Section 506), investigating ways in which these specialists might meet some of the needs of women Veterans seeking mental healthcare. Moreover, throughout all these projects, QUERI investigators are prioritizing educating women Veterans about their healthcare options (Section 121), with the goal of engaging and retaining them in high-quality, evidence-based care that meets their needs.

For more information about EMPOWER QUERI and/or the CCWV study, please contact Alison Hamilton, PhD, MPH, at Alison.Hamilton@va.gov.

1. Implementation of Tailored Collaborative Care for Women Veterans. QUERI eNews. January, 2018.