VA Facilities Provided Basic and Specialized Gender-Specific Services and Mental Health Services to Women Veterans, though Not All Services Were Provided On Site at Each VA Facility

The VA facilities we visited provided basic gender-specific and outpatient  mental health services to women veterans on site, and some facilities also  provided specialized gender-specific or mental health services specifically  designed for women on site. Among CBOCs, other than the two largest facilities  we visited, most offered limited specialized gender-specific care on site. Regarding mental health care, we found that outpatient services for  women were widely available at the VAMCs and most Vet Centers we  visited, but were more limited at some CBOCs. Basic Gender-Specific Care Services Were Generally Available On site at VA Medical Facilities

Basic gender-specific care services were available on site at all nine of the  VAMCs and 8 of the 10 CBOCs that we visited. In general,  women veterans had access to female providers for their gender-specific  care: of the 19 medical facilities we visited, all but 4 had one or more  female providers available to deliver basic gender-specific care. While All VAMCs Offered at Least Some Specialized Gender-Specific Services On site, CBOCs Typically Referred Patients Needing These Services to Other VA or Non-VA Medical Facilities

The provision of specialized gender-specific services for women, including  treatment after abnormal cervical cancer screenings and breast cancer  treatment, varied by service and by facility. All VA medical  facilities referred female patients to outside providers for obstetric care. Some of the VAMCs we visited offered a broad array of other specialized  gender-specific services on site, but all contracted or fee-based at least  some services. Vet Centers generally offered  some counseling services in the evenings. The smaller CBOCs, however, tended to  rely on staff from the affiliated VAMC, often through telehealth, to provide  mental health services. Medical Facilities Had Not Fully Implemented VA Policies Pertaining to the Delivery of Health Care Services for Women Veterans

The extent to which VA medical facilities we visited were following VA  policies that apply to the delivery of health care services for women  veterans varied, but none of the facilities had fully implemented VA  policies pertaining to women veterans’ health care. In particular, none of  the VAMCs or CBOCs we visited were fully compliant with VA policy  requirements related to privacy for women veterans. Officials at some VA  facilities reported that they were unclear about the specific steps they  would need to take to meet VA’s definition of comprehensive primary care  for women veterans. None of the VAMCs or CBOCs  we visited ensured adequate visual and auditory privacy at check-in in all  clinical settings that are accessed by women veterans. Medical Facilities Were in Various Stages of Implementing VA’s Initiative on Comprehensive Primary Care for Women Veterans, but Officials at Some Facilities Were Unclear about the Steps Needed to Implement VA’s New Initiative

VA has not set a deadline by which all VAMCs and CBOCs are required to  implement VA’s new comprehensive primary care initiative for women  veterans, which would allow women veterans to obtain both primary care  and basic gender-specific services from one provider at one site. VA Officials Identified Key Challenges Related to Space, Hiring Staff with Specific Experience and Training, and Establishing the WVPM as a Full-time Position

VA officials at medical facilities we visited identified a number of key  challenges in providing health care services to women veterans. In particular, officials at 7 of 9 VAMCs and 5 of 10 CBOCs we  visited said that space issues, such as the number, size, or configuration of  exam rooms or bathrooms at their facilities sometimes made it difficult for  them to comply with some VA requirements related to privacy for women  veterans. VA facility officials also told us they have struggled with space constraints  as they work to comply with VA’s new policy on comprehensive primary  care for women and the requirements in the September 2008 Uniform  Mental Health Services in VA Medical Centers and Clinics, as well as the  increasing numbers of women veterans requesting these services. We also considered whether VAMCs had programs specifically for women  veterans, particularly treatment programs for post-traumatic stress  disorder (PTSD) and for women who have experienced military sexual  trauma (MST). For each of the factors listed below, we examined available  facility- or market-level data to identify facilities of interest:  total number of unique women veteran patients using the VAMC;   total number of unique OEF/OIF women veteran patients using the VAMC;    proportion of unique women veterans using the VAMC who are OEF/OIF    proportion of unique OEF/OIF women veterans using the VAMC who were  discharged from the National Guard or Reserves;    within the VA-defined market area for the VAMC, the proportion of women  veterans who use VA health care and live in rural or highly rural areas; and    availability of on-site programs specific to women veterans, such as  inpatient or residential treatment programs that offer specialized  treatment for women veterans with PTSD or who have experienced MST,  including programs that are for women only or have an admission cycle  that includes only women; and outpatient treatment teams with a  specialized focus on MST.
Why GAO Did This Study

Historically, the vast majority of VA patients have been men, but that is changing. VA provided health care to over 281,000 women veterans in 2008--an increase of about 12 percent since 2006--and the number of women veterans in the United States is projected to increase by 17 percent between 2008 and 2033. Women veterans seeking care at VA medical facilities need access to a full range of health care services, including basic gender-specific services--such as cervical cancer screening--and specialized gender-specific services--such as treatment of reproductive cancers. This testimony, based on ongoing work, discusses GAO's preliminary findings on (1) the on-site availability of health care services for women veterans at VA facilities, (2) the extent to which VA facilities are following VA policies that apply to the delivery of health care services for women veterans, and (3) some key challenges that VA facilities are experiencing in providing health care services for women veterans. GAO reviewed applicable VA policies, interviewed officials, and visited 19 medical facilities--9 VA medical centers (VAMC) and 10 community-based outpatient clinics (CBOC)--and 10 Vet Centers. These facilities were chosen based in part on the number of women using services and whether facilities offered specific programs for women. The results from these site visits cannot be generalized to all VA facilities. GAO shared this statement with VA officials, and they generally agreed with the information presented.

What GAO Found

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 gender-specific or mental health services specifically designed for women on-site. Basic gender-specific services, including pelvic examinations, were available on-site at all nine VAMCs and 8 of the 10 CBOCs GAO visited. Almost all of the medical facilities GAO visited offered women veterans access to one or more female providers for their gender-specific care. The availability of specialized gender-specific services for women, including treatments after abnormal cervical cancer screenings and breast cancer, varied by service and facility. All VA medical facilities refer female patients to non-VA providers for obstetric care. Some of the VAMCs GAO visited offered a broad array of other specialized gender-specific services on site, but all contracted or fee-based at least some services. Among CBOCs, the two largest facilities GAO visited offered an array of specialized gender-specific care on-site; the other eight referred women to other VA or non-VA facilities for most of these services. Outpatient mental health services for women were widely available at the VAMCs and most Vet Centers GAO visited, but were more limited at some CBOCs. While the two larger CBOCs offered group counseling for women and services specifically for women who have experienced sexual trauma in the military, the smaller CBOCs tended to rely on VAMC staff,often through videoconferencing, to provide mental health services. The extent to which the VA medical facilities GAO visited were following VA policies that apply to the delivery of health care services for women veterans varied, but none of the facilities had fully implemented these policies. None of the VAMCs and CBOCs GAO visited were fully compliant with VA policy requirements related to privacy for women veterans in all clinical settings where those requirements applied. For example, many of the medical facilities GAO visited did not have adequate visual and auditory privacy in their check-in areas. Further, the facilities GAO visited were in various stages of implementing VA's new initiative to provide comprehensive primary care for women veterans, but officials at some VAMCs and CBOCs reported that they were unclear about the specific steps they would need to take to meet the goals of the new policy. Officials at facilities that GAO visited identified a number of challenges they face in providing health care services to the increasing numbers of women veterans seeking VA health care. One challenge was that space constraints have raised issues affecting the provision of health care services. For example, the number, size, or configuration of exam rooms or bathrooms sometimes made it difficult for facilities to comply with VA requirements related to privacy for women veterans. Officials also reported challenges hiring providers with specific training and experience in women's health care and in mental health care, such as treatment for women veterans with post-traumatic stress disorder or who had experienced military sexual trauma.