1. Overview of Women Veterans in
the VA Greater Los Angeles
Healthcare System
Callie Wight MA, RN
GLAHS Women Veterans Program Manager
March 8, 2012
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3. 3
•Women comprise approximately:
•14% of active duty military
•18% of National Guard and Reserves
•6% of VA health care users
•Operation Enduring Freedom/Operation Iraqi
Freedom
•48% of female OEF/OIF veterans have
enrolled with VA health care, 44% of whom have
used VA health care 2-10 times
•Increasing recognition of Women Veterans’
unique and complex health needs—influx of
younger Women Veterans of childbearing age
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4. Need increasing capacity
Cohort: Women and men Veteran VHA users in year. Women in FY09: N=292,921; Men in FY09: N=4,846,869.
Source: WHEI analysis of ADUSH Monthly Enrollment Files, FY00–FY09.
.
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5. • Influx of younger women
• Maternity care
• Mental health
• Service-connected disabilities
• Privacy, safety, convenience
• Older women (largest sub-population of female VA
users)
• Menopausal needs
• Geriatric care
• Inpatient/extended stays
Increasing Demand
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6. VA women users have heavier health
burdens
• VA cares for a sicker women Veteran
population compared to healthcare settings
outside of the VA.
• Women Veterans have higher rates of chronic
diseases, including cardiovascular diseases.
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7. Age distribution among women Veteran VHA patients, FY09
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Cohort: Women Veteran VHA users who have non-missing ages between 18 and 110 years old (inclusive) in year. N=159.548
in FY00, N=292,878 in FY09. Source: WHEI analysis of ADUSH Monthly Enrollment File, FY09.March 7, 2012 cw.cg.eb2012

8. Age group of Veteran patients, by gender, FY09
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Cohort: Women and men Veteran VHA users who have non-missing ages between 18 and 110 years old (inclusive) in FY09.
Women: N=292,894; Men: N=4,846,792. Source: WHEI analysis of ADUSH Monthly Enrollment Files, FY09.
.
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9. Service-Connected Status, FY00 vs FY09
Women Veteran VHA patients
Cohort: Women Veteran VHA users with non-missing SC values in year. N=158,160 in FY00, N=292,108 in FY09.
Source: WHEI analysis of ADUSH Monthly Enrollment Files, FY00 and FY09.
Majority have SC rating
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10. Service-Connected Status: Women vs. Men
Veteran VHA patients
Cohort: Women and men Veteran VHA users with non-missing SC values in FY09. Women: N=292,108; Men: N=4,838,232.
Source: WHEI analysis of ADUSH Monthly Enrollment File, FY09.
More women eligible for VHA care
for SC conditions.
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12. Based on 1+ instance of an ICD-9 code in FY08
Top 8 Conditions in Women Veterans
-Common medical conditions amenable to intervention include
cardiovascular risk factors and painful conditions
-Health services delivery systems must take varying needs of
different age groups into account
Frayne SM. VA Women’s Health Evaluation Initiative. VA HSR&D Women’s Health Services Research Conference in Washington DC July, 2010.
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13. # of Mental Health Visits,
by Age Group, Women vs. Men (FY09)
Cohort: Women and men Veteran VHA outpatients who have non-missing ages between 18 and 110 years old (inclusive)
in FY09. Women: N=287,436; Men: N=4,747,995. Sources: WHEI analysis of ADUSH Monthly Enrollment File, FY09; VA
outpatient utilization file (SE), FY09.
Heavy use of mental
health services
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14. Privacy, Safety, Dignity
• A chaperone must be present at all gender
specific exams, procedures, or treatments and
when requested by a female Veteran for any visit,
regardless of the gender of the provider. Whenever
a woman is disrobed.
• The health care environment directly and indirectly
affects the quality of care provided to women
Veterans. It affects their comfort and sense of
security, as well as their perceptions of care
received. Measures must be taken to maintain and
adjust care environments to support their dignity,
privacy, and security.
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15. Homelessness & Women Veterans
GAO Report (GAO 12-182)
• number of women veterans identified as homeless more than
doubled,
• from 1,380 in fiscal year 2006 to 3,328 in fiscal year 2010.
• almost two-thirds were between 40 and 59 years old and
over one-third had disabilities.
• many of these women resided with their minor children.
• Female Veterans are the fastest growing segment of the
homeless population
• Women who are Veterans are at much higher risk of
homelessness than male counterparts
• Source: Vasquez, S. Homelessness Among Women Veterans PowerPoint presentation;
July 2011 National Summit on Women Veterans. http://www.va.gov/WOMENVET/2011Summit/
VasquezFINAL.pdf
• VA Homeless Programs Serve Women Veterans
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16. MST Among Homeless, Female VHA
Users FY10
• 38.7 % of homeless women VHA users screen
positive for MST
• 87.2% of homeless women VHA users had
at least one MST-related Mental Health
Encounter
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Source: Vasquez, S. Homelessness Among Women Veterans PowerPoint presentation; July 2011 National
Summit on Women Veterans. http://www.va.gov/WOMENVET/2011Summit/VasquezFINAL.pdf
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17. Military Sexual Trauma (MST)
Defined by the Department of Veterans Affairs as:
• Sexual harassment that is threatening in character or
• Physical assault of a sexual nature
• Which occurred while the victim was in the military,
• Regardless of geographic location of the trauma,
gender of victim, or the relationship to the perpetrator.
• And as interpreted by the veteran
• VACO policy is that VA clinicians address the substantial
physical and mental illness that can follow MST.
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18. How Does Military Sexual Trauma (MST)
Affect Veterans?
• Across a range of studies, Veterans with
histories of MST report:
• More mental health problems (e.g., anxiety, depression and
substance abuse disorders)
• More physical health symptoms and conditions
• More problems readjusting after discharge
• Mental and physical health conditions that can contribute
to difficulties with employment (e.g., problems with
concentration, difficulty sleeping, physical pain)
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Source: Vasquez, S. Homelessness Among Women Veterans PowerPoint presentation; July 2011 National
Summit on Women Veterans. http://www.va.gov/WOMENVET/2011Summit/VasquezFINAL.pdf
3/7/12
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19. Trauma-informed Care
« Trauma-informed care can include
• family education on how trauma impacts behavior, cognitions,
and mood
• development of family skills to deal with memories of trauma
and traumatic symptoms
• families are provided with tools for bonding when presented
with traumatic reminders
*National Task Force on Children Exposed to Violence
Resources: National Child Traumatic Stress Network nctsn.org, https://
www.childwelfare.gov/responding/trauma.cfm, SAMHSA National Center
for Trauma Informed Care http://www.samhsa.gov/nctic/default.asp
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20. MST Among OEF/OIF Veterans
• No good prevalence data, but we know MST is
occurring
• Particular issues to consider:
• Trauma is recent, reactions are acute
• Interaction between combat exposure and MST is
unclear
• How TBI may affect treatment is unclear
• Issue of compounded stressors, particularly while
away from home and support network
• DoD’s new policies and programs are an
improvement, but are still new/untestedMarch 7, 2012 20cw.cg.eb2012

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22. Childbearing age veterans
• Optimize control of chronic health conditions
• Safe prescribing education for all providers
• Pre-pregnancy care/screening by primary care
providers for all women of childbearing age
• Address contraceptive options for women of
childbearing age
• Counsel women regarding use of potential
teratogenic medications
• Assessment of lifestyle habits such as smoking,
alcohol or drug use, and sexual history
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23. Pregnancy
• In a study of women Veterans of OEF/OIF, who
were less than 50 years old, and used VA, from
2001-2008:
• 43,078 women returned from deployment
• 2,966 (7%) had a pregnancy during the time period
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Source: Mattocks, 2011, Journal of Women's Health.
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24. Increasing VHA utilization by women Veterans
Growing demand for PC
and MH services
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Berg E, Laungani K, Friedman SA, Phibbs CS, Herrera L, Hayes PM, Frayne SM. The Decade in Review: Trends in Outpatient Utilization among
Women Veterans. Poster Presentation at the VA HSR&D Research Conference in Washington DC Feb, 2011
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25. Thanks to
« Laurie C. Zephyrin MD, MPH, MBA, FACOG
« Director, Reproductive Health,Women Veterans Health Strategic
Health Care Group
« Susan Frayne MD, MPH
Center for Health Care Evaluation, VA Palo Alto Health Care
System, Associate Professor of Medicine, Stanford University
« Sally Haskell, MD
« Associate Professor of Medicine, Yale University School of
Medicine, Acting Director, Comprehensive Women’s Health
« Women Veteran’s Health Strategic Healthcare Group
« Patricia M. Hayes, Ph.D
« Chief Consultant, Women Veterans Health Strategic Health Care
Group
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26. Sources include
« Sourcebook: Women Veterans in the Veterans Health Administration - Volume 1 (December 2010)
« Frayne SM. VA Women’s Health Evaluation Initiative. VA HSR&D Women’s Health Services Research Conference in
Washington DC July, 2010
« Berg E, Laungani K, Friedman SA, Phibbs CS, Herrera L, Hayes PM, Frayne SM. The Decade in Review: Trends
in Outpatient Utilization among Women Veterans. Poster Presentation at the VA HSR&D Research Conference in
Washington DC Feb, 2011
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