Kenya Graham, Women Veterans Outreach Coordinator VA Mid-Atlantic Network (VISN 6) April 2013.

Kenya Graham, Women Veterans Outreach Coordinator VA Mid-Atlantic Network (VISN 6)April 2013

Since the Revolutionary War, America’s women have earned America’s gratitude and respect for their contributions to the military and to the Nation. VA will continue to improve our benefits and services for women Veterans as we transform into a 21st century organization.

Secretary of Veterans Affairs Eric K. Shinseki March 10, 2010

3

Source: America’s Women Veterans: Military Service History and VA Benefits Utilization Statistics, Department of Veterans Affairs, National Center for Veterans Analysis and Statistics, Nov. 23, 2011; http://www.va.gov/VETDATA/docs/SpecialReports/Final_Womens_Report_3_2_12_v_7.pdf

2/2013

4

Sources: VetPOP 2007 and VetPOP 2011 ADUSH for Policy and Planning

2/2013

5

Sources: Women’s Health Evaluation Initiative (WHEI) and the Women Veterans Health Strategic Health Care Group. Sourcebook: Women Veterans in the Veterans Health Administration V1: Sociodemographic Characteristics and Use of VHA Care, 2011. VHA Office of Finance Allocation Resource Center (ARC).

2/2013

12% of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn(OEF/OIF/OND) Veterans

18% of National Guard/Reserves 6% of VA health care users

Women Veteran enrollment outpacing that of men—21% increase since 2009

62/2013

5 years’ free VA health care for OEF/OIF/OND Veteranswith service-related issues

57% of OEF/OIF/OND women Veterans have used VA care

VETERANS HEALTH ADMINISTRATION

7

VISN

FEMALE USERS

FEMALE VETERANS

MKT PENETRATION

(WOMEN)

MKT PENETRATION

(MEN)

1 12,157 78,921 15.4% 26.1%

2 7,351 39,982 18.4% 29.7%

3 8,215 61,222 13.4% 23.2%

4 15,053 104,434 14.4% 24.8%

5 13,020 112,168 11.6% 19.8%

6 29,014 181,054 16.0% 24.7%

7 34,318 182,241 18.8% 26.4%

8 34,228 156,655 21.8% 36.3%

9 16,261 92,875 17.5% 29.2%

10 11,570 68,834 16.8% 26.6%

Sources: WATCH Briefing Book, VetPop 2011

VETERANS HEALTH ADMINISTRATION

8

VISN FEMALE USERS

FEMALE VETERANS

MKT PENETRATION

(WOMEN)

MKT PENETRATION

(MEN)

11 14,073 89,917 15.7% 23.0%

12 13,247 80,909 16.4% 27.2%

15 12,757 82,308 15.5% 28.4%

16 33,544 181,737 18.5% 28.6%

17 25,577 129,790 19.7% 27.1%

18 18,284 96,722 18.9% 30.5%

19 13,386 75,858 17.6% 26.3%

20 20,325 119,361 17.0% 24.8%

21 16,080 97,079 16.6% 29.6%

22 21,033 126,839 16.6% 25.1%

23 14,881 81,622 18.2% 33.4%

TOTAL 361,895 2,240,529 16.2% 26.2%

Sources: WATCH Briefing Book, VetPop 2011

Facility Female Users Female Veterans

Mkt Penetration

Asheville 1,949 7,449 26.2%

Beckley 546 2,387 22.9%

Durham 5,217 22,355 23.3 %

Fayetteville 6,414 31,608 20.3%

Hampton 6,599 53,634 12.3%

Richmond 4,653 30,289 15.4 %

Salem 1,953 9,004 21.7%

Salisbury 5, 194 24, 329 21.3%

1 year after separating from service, 62% of female OEF/OIF/OND Veterans and 56% of male Veterans remain in VA care

5 years after separating from service, 52% of female OEF/OIF/OND Veterans and 47% of male Veterans remain in VA care

Research-funded CREATE Attrition Study—examines factors related to staying in or leaving VA care

12

Source: Leslie, Douglas. Women Veterans Cohort Study (2012 unpublished data).

2/2013

Maternity Care Mental Health Service-Connected

Disabilities Privacy, safety,

convenience

132/2013

Next 20 years … more intensive health care services and support as caregivers

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√ Menopausal Needs

√ Geriatric Care

√ Inpatient/Extended Stays

58% of women VA users are 45+

Source: Women’s Health Evaluation Initiative and VHA Women’s Health Services. Sourcebook: Women Veterans in the Veterans Health Administration. Volume 2. Sociodemographics and Use of VHA and Non-VA Care Fee. 2012 (in press).

Age distribution of women Veteran patients, FY01 and FY10

2/2013

15

Source: Women’s Health Evaluation Initiative and VHA Women’s Health Services. Sourcebook: Women Veterans in the Veterans Health Administration. Volume 2. Sociodemographics and Use of VHA and Non-VA Care Fee. 2012 (in press).

Proportion of women and men Veteran outpatients by total primary care encounters, FY10

2/2013

16

Source: Women’s Health Evaluation Initiative and VHA Women’s Health Services. Sourcebook: Women Veterans in the Veterans Health Administration. Volume 2. Sociodemographics and Use of VHA and Non-VA Care Fee. 2012 (in press).

Proportion of women and men Veteran outpatients by mental health/SUD encounters, FY10

2/2013

17

Source: Women’s Health Evaluation Initiative and VHA Women’s Health Services. Sourcebook: Women Veterans in the Veterans Health Administration. Volume 2. Sociodemographics and Use of VHA and Non-VA Care Fee. 2012 (in press).

Service-connected disability status among Veteran patients, by gender, FY10

2/2013

Women Veterans: ~8% of homeless Veteran population; 2X more likely to be homeless than non-Veteran women*

FY 2011: VA served ~198,908 homeless, at-risk, or formerly homeless Veterans (7.7% or 15,303 women)

VA homeless programs include:◦ HUD-VASH Program (permanent housing): 13% of recipients are women;

14% of HUD-VASH vouchers go to homeless Veterans with children; among women housed in HUD-VASH in FY12, 38.4% are housed with children

◦ Grant Per Diem Program (GPD): In 2012, 7% of Veteran recipients were women

◦ Supportive Services for Veterans Families (SSVF) Program:  First year assisted ~21,000 Veteran households comprising over 35,000 adults and children; 15% were women

◦ Homeless Veterans Support Employment Program (HVSEP): Approximately 25% of hires are women Veterans

◦ Veterans Homeless Prevention Demonstration Program (VHPD): 3-year pilot to prevent homelessness among recently discharged through early intervention; 22% served were women

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*2010 Annual Homeless Assessment Report (AHAR)

Are We Ready?

192/2013

202/2013

Dr. Patty Hayes Chief Consultant

Dr. Sally Haskell Deputy Chief Consultant (Clinical)

Dr. Laure VeetDirector

Women’s Health Education

Dr. Maggie Czarnogorski

Acting Deputy Director Women’s

Comprehensive Health

Dr. Laurie ZephyrinDirector

Reproductive Health

Melissa Lanzendorfer Assoc. Chief Consultant

(Operations)

Women’s Health Education TEAM

Reproductive Health TEAM

Comprehensive Health TEAM

Operations Support TEAM

Meri Mallard, Peggy Mikelonis

Deputy Field Directors

WVPMs, WHMDs

2/2013

Name Facility Email Phone # Shenekia Williams-Johnson VISN 06 [email protected] 919-956-5541

Sharon West Asheville [email protected] 828-298-7911 x5434

Kimberly Nugen Beckley [email protected] 304-255-2121, x4842

Joan Galbraith Durham [email protected] 919-286-0411, x5229

Sandra Smith Fayetteville [email protected] 910-488-2120, x7479

Patrice Malena Hampton [email protected] 757-722-9961. x2398

Beverly Ross Richmond [email protected] 804-675-5389

Suzette Hile Salem [email protected] 540-982-2463, x3830

Penny Greer-Link Salisbury [email protected] 704-638-9000, x4949

Women Veteran Program Manager at all Medical Centers

Women’s Clinic at every NC Facility ◦ Women have the option of being seen in the WH

clinic, but may be seen in other clinics Interested and proficient women health

providers at each site *WH services offered at most Community

Based Outpatient Clinics (CBOCs)

Required full-time in every health care system; must report to Facility Director or Chief of Staff

Linchpin for improved women's health services Leader of facility women's program Resource for women Veterans in the community

2/2013

• Serves as clinical leader for facility women’s health program

• Works with WVPM to form the foundation of the WH team

• Establishes priority and direction for clinical quality improvement

• Oversees WH educational initiatives for providers and trainees

2/2013

Comprehensive Primary Care

Expanded Tele-health Cancer Screenings Mental Health

◦ Depression ◦ Post Traumatic Stress

Disorder ◦ Military Sexual Trauma

Heart Disease Diabetes Nutrition Counseling

Mammograms Pap Smears Maternity Care Reproductive Health

◦ Infertility Services (excluding in vitro fertilization)

◦ Tubal Ligation ◦ Menopause

New Born Care – up to 7 days Postpartum care

Substance Abuse treatment

Seeing more pregnant female veterans Must be enrolled for healthcare to receive

benefits Maternity care is not performed at the

Medical Center ◦ Veteran can choose local provider and VA will pay

as long as provider accepts VA insurance Women can receive breast pumps through

VA

On site mammography offered at following VISN 6 sites: Durham, Fayetteville, Hampton, Richmond, Salisbury

Mobile Mammography ◦ Will provide care to new Health Center Complex

(HCC) initially and will spread to CBOCs – van available late summer 2014; implementation TBD

FY13: 11 Women’s Health/Rural Health telehealth projects funded after 8 launched in FY12; FY14 grant applications under wayWomen’s health informational mobile applications under developmentIT Innovations maternity tracker (care coordination) pilots selectedMany VISNs have not yet implemented WH telehealth

292/2013

High-quality, equitable care on par with that of men

Care delivered in a safe and healing environment

Seamless coordination of services Recognition as Veterans

302/2013

Barriers to Care

312/2013

“We don’t know if it’s because they had different roles, because they felt like they didn’t do the same thing as some of our male Veterans … whatever it is, they are still not self-identifying.”

General Allison HickeyVA Under Secretary for Benefits 9/27/12

322/2013

39% have zero or almost no knowledge of needed information about VA

Misperceptions in all cohorts about who is eligible for VA care

OEF/OIF/OND more knowledgeable than other cohorts about available women’s health and readjustment services

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Source: 2010 National Survey of Women Veterans, (D. Washington)

2/2013

31% didn’t think they were eligible 21% didn’t know how to apply for benefits 20% said closest VA is too far from home Other challenges:

◦ Difficulty getting time off for appointments◦ Child/eldercare responsibilities

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*Not mutually exclusiveSource: 2010 National Survey of Women Veterans, (D. Washington)

2/2013

Major gaps prevent delivery of equitable health care to all women Veterans (e.g., privacy, PACT, GYN, etc.)Needs:Leadership support essential to enhancing VA health care for women VeteransHigh-functioning women’s health committees with high-level involvementSuccession planning for WVPMs and challenge of institutional knowledge

352/2013

Free, drop-in childcare pilots at three VA medical centers◦ Northport, NY (Opened 4/2012)◦ Buffalo, NY (Opened 10/2011)◦ Tacoma, WA (Opened 12/2012)

Open to eligible Veterans during appointments

Pilots will run until September 30, 2013; evaluation under way

No legal authority beyond this pilot

362/2013

VA has significantly reduced gender gaps and exceeds private sector on most performance measures for both men and women

Gender Differences in Performance Measures, VHA 2008-2011, identifies best practices for eliminating gender gaps based on success in VA networks

372/2013

Gender-specific care to women Veterans in VHA facilities substantially exceeds that in other systems

Cervical Cancer screening

Breast Cancer screening

38

Source: VA Office of Analytics and Business Intelligence 12-19-2011

93.5% VA average (2010-11)

Vs.77% private sector (2010)67% Medicaid (2010)

86% VA average (2010-11)

Vs.71% private sector (2010)69% Medicare51% Medicaid (2010)

2/2013

• Trained 1,500 VA providers in basic and advanced women’s health care to enhance access

• Expanding large-scale provider/nursing education programs

• Developing online training for core topics in emergency women’s health, with virtual patient platform, videos, traditional e-learning My VeHU Women’s Health Special Focus Topics

February through April: http://myvehu.com/ • Sponsoring grant program to develop/deliver in

traditional mini-residency format with virtual components

392/2013

VISN 06 Women Veterans SharePoint sitehttps://v6infoshare.v06.med.va.gov/programs/womenshealth/default.aspx

Women Veterans Healthcare Site http://www.womenshealth.va.gov