VA Health Care:

VA Has Taken Steps to Make Services Available to Women Veterans, but Needs to Revise Key Policies and Improve Oversight Processes

GAO-10-287: Published: Mar 31, 2010. Publicly Released: Mar 31, 2010.

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In 2008, VA provided health care to over 281,000 women veterans, a fast growing subgroup of veterans. Women veterans seeking VA health care need access to an array of services and Congress has raised concerns about how well VA is prepared to meet the physical and mental health care needs of women. GAO was asked to examine (1) the on-site availability of health care services at VA facilities for women veterans, (2) the extent to which VA facilities are following VA policies that apply to the delivery of health care to women veterans, and (3) key challenges that VA facilities face in providing health care to women veterans and how VA is addressing these challenges. GAO reviewed applicable laws and VA policies, interviewed officials, and visited a judgmental sample of 9 VA medical centers (VAMC) and 10 community-based outpatient clinics (CBOC) chosen, in part, based on the number of women using services. GAO also visited 10 VA counseling centers (Vet Centers).

The VA facilities GAO visited provided basic gender-specific and outpatient mental health services to women veterans on site, and some facilities also provided specialized services for women. Seventeen of the 19 medical facilities GAO visited offered basic gender-specific services including pelvic examinations and cervical cancer screening on site, and 15 offered access to one or more female providers for gender-specific care. The availability of specialized gender-specific services--such as treatment of reproductive cancers--and mental health services for women varied by service and facility. While some VAMCs offered a broad array of specialized gender-specific care on site, smaller CBOCs referred women to other VA or non-VA facilities for many or most of these services. Nationally, 9 VAMCs have residential mental health programs that are for women only or have dedicated cohorts for women. However, information about all of these programs was not available on VA's external Web sites. In July 2009, GAO reported in VA Health Care: Preliminary Findings on VA's Provision of Health Care Services to Women Veterans (GAO-09-884T), that none of the facilities GAO visited were fully compliant with VA policy requirements related to privacy for women veterans. In response, VA has required facilities to report more information on their compliance with these policies. However, facility reporting on privacy policies has, in the past, been inaccurate, and VA's oversight process does not include a means to validate the information facilities report. The facilities GAO visited were in various stages of implementing a new VA initiative to provide comprehensive primary care--defined as complete primary care, including basic gender-specific services, and mental health care--to women veterans at all facilities. VA headquarters officials are working with Women Veterans Program Managers (WVPM) and facility leadership to help facilities implement this initiative. In locations GAO visited, VA identified a number of key challenges in providing health care services to women veterans. For example, officials at VA medical facilities reported that space constraints have raised issues affecting the provision of health care services to women veterans, particularly related to ensuring their privacy and safety. According to VA officials, most VAMCs have planned renovation, construction, or relocation projects as part of their efforts to expand services and implement comprehensive primary care for women veterans. However, VA's design and construction policies have not been updated to reflect VA's privacy policies for women veterans. Moreover, the VA memorandum which established the WVPM as a full-time position outlined broad authority for the WVPM in facilitating changes in the delivery of services to women veterans, but some facilities have not modified the WVPM position as envisioned in VA's memorandum. For example, some WVPMs reported that they did not have sufficient authority and access to leadership to implement needed changes. Furthermore, VA's WVPM handbook, which defines the roles and responsibilities of the WVPM, has not been updated since the WVPM position was made full-time.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: VA's Office of Mental Health Services MST Support Team's review of national VA websites for MST-related information is ongoing. In 2010 they conducted a systematic search for inaccurate MST-related information using the va.gov search engine. In addition the the primary NCPTSD page on MST was updated to include more expansive content, including information about the availability of specialized residential and inpatient care, and links to additional resources. Also, the NCPTSD's "PTSD Program Locator" site now has a "VA Cares About MST" icon that links to MST-specific information. Additionally, the OMHS now has an MST-specific page on the OMHS Internet website. This page has information about the range of MST-related services available through VA, including the availability of specialized residential and inpatient care. Most recently, the campaign has particularly focused on identifying and updating national VA websites that Veterans seeking MST-related information might be likely to visit, but which do not currently have information about MST services posted. According to VA, the review has not revealed any additional VA websites with major errors or misleading information about MST. The most common correction is to redirect out-of-date web links to the current OMHS Internet site. OMHS has now completed its review and has undertaken several other initiatives to ensure that information about programs available to women veterans was readily available to veterans

    Recommendation: To better ensure that women veterans have access to health care services that meet their unique needs and to strengthen oversight of the services delivered to women veterans at VA facilities, the Secretary of Veterans Affairs should direct the Under Secretary of Health to provide complete information on VA's external Web sites on the specialized residential mental health treatment programs VA offers for women veterans who have experienced military sexual trauma (MST) or other traumas.

    Agency Affected: Department of Veterans Affairs

  2. Status: Open

    Comments: Veterans Integrated Service Networks (VISN) were directed by VA headquarters to develop and implement a plan to validate information reported by medical facilities on compliance with women veterans' privacy and security policies. VA headquarters reviewed and analyzed all VISN plans, and required any plans that were deemed to be deficient to be revised. VISN Environment of Care teams have begun conducting unannounced site visits to validate information reported by medical facilities on compliance with women veterans' privacy and security policies. VHA Central Office is conducting record checks to verify compliance with these policies. This recommendation will be closed when VA provides documentation of the unannounced site visits that have been conducted or a policy requiring that these site visits be conducted.

    Recommendation: To better ensure that women veterans have access to health care services that meet their unique needs and to strengthen oversight of the services delivered to women veterans at VA facilities, the Secretary of Veterans Affairs should direct the Under Secretary of Health to establish a process to independently validate self-reported information by VA medical facilities' on compliance with privacy policies that pertain to women veterans.

    Agency Affected: Department of Veterans Affairs

  3. Status: Open

    Comments: VA reported that the needs and concerns of women Veterans are being addressed within VA Construction and Facilities Management (CFM) Design and Planning documents as current documents are being updated and new documents are developed. VA is planning to issue a Space Planning Criteria Chapter (#258) document for Women Veterans Clinical Services for inclusion in the planning documents. This document will be published to the CFM Technical Information Library during the 4th quarter of FY12. This recommendation will be closed when chapter 258 is published, and when VA provides an example of how the needs and concerns of female Veterans are being addressed by VA within CFM Design and Planning documents as current documents are being updated and new documents are developed.

    Recommendation: To better ensure that women veterans have access to health care services that meet their unique needs and to strengthen oversight of the services delivered to women veterans at VA facilities, the Secretary of Veterans Affairs should direct the Under Secretary of Health to expedite action to ensure that VA's design and construction policies explicitly address the needs of women veterans in all health care delivery settings in VA medical facilities.

    Agency Affected: Department of Veterans Affairs

  4. Status: Closed - Implemented

    Comments: VA issued in January 2012 VHA Directive 2012-004, Mandatory Training of VHA Mental Health and Primary Care Providers on Provision of Care to Veterans who Experienced Military Sexual Trauma (MST), which requires all mental health and primary care providers to complete two one-time mandatory trainings?a Veteran?s Health Initiative study training on MST and a 30 minute training presentation targeting the specific information needs of primary care providers.

    Recommendation: To better ensure that women veterans have access to health care services that meet their unique needs and to strengthen oversight of the services delivered to women veterans at VA facilities, the Secretary of Veterans Affairs should direct the Under Secretary of Health to clarify VA's policies by describing specifically what constitutes "appropriate and necessary training" for mental health professionals who provide services to veterans who have experienced MST.

    Agency Affected: Department of Veterans Affairs

  5. Status: Closed - Implemented

    Comments: A VA workgroup has completed its review and is in the process of revising the current Women's Veteran Program Manager (WVPM) handbook to include the specific roles and duties of full time WVPMs. When the WVPM handbook is revised and issued this recommendation will be considered implemented.

    Recommendation: To better ensure that women veterans have access to health care services that meet their unique needs and to strengthen oversight of the services delivered to women veterans at VA facilities, the Secretary of Veterans Affairs should direct the Under Secretary of Health to update VA's policies to clarify the roles and responsibilities of the full-time WVPM position, in particular with respect to the level of reporting authority and access to senior facility management.

    Agency Affected: Department of Veterans Affairs

 

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