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; 2/2013

4 Sources: VetPOP 2007 and VetPOP 2011 ADUSH for Policy and PlanningVetPOP 2007VetPOP /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, 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 / years’ free VA health care for OEF/OIF/OND Veterans with 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 12,15778, %26.1% 2 7,35139, %29.7% 3 8,21561, %23.2% 4 15,053104, %24.8% 5 13,020112, %19.8% 6 29,014181, %24.7% 7 34,318182, %26.4% 8 34,228156, %36.3% 9 16,26192, %29.2% 10 11,57068, %26.6% Sources: WATCH Briefing Book, VetPop 2011

VETERANS HEALTH ADMINISTRATION 8 VISN FEMALE USERS FEMALE VETERANS MKT PENETRATION (WOMEN) MKT PENETRATION (MEN) 11 14,07389, %23.0% 12 13,24780, %27.2% 15 12,75782, %28.4% 16 33,544181, %28.6% 17 25,577129, %27.1% 18 18,28496, %30.5% 19 13,38675, %26.3% 20 20,325119, %24.8% 21 16,08097, %29.6% 22 21,033126, %25.1% 23 14,88181, %33.4% TOTAL 361,8952,240, %26.2% Sources: WATCH Briefing Book, VetPop 2011

FacilityFemale UsersFemale VeteransMkt Penetration Asheville1,9497, % Beckley5462, % Durham5,21722, % Fayetteville6,41431, % Hampton6,59953, % Richmond4,65330, % Salem1,9539, % Salisbury5, 19424, %

 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 13 2/2013

Next 20 years … more intensive health care services and support as caregivers 14 √ 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 (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 (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 (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 (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 18 *2010 Annual Homeless Assessment Report (AHAR)

Are We Ready? 19 2/2013

20 2/2013

Dr. Patty Hayes Chief Consultant Dr. Sally Haskell Deputy Chief Consultant (Clinical) Dr. Laure Veet Director Women’s Health Education Dr. Maggie Czarnogorski Acting Deputy Director Women’s Comprehensive Health Dr. Laurie Zephyrin Director 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

NameFacility Phone # Shenekia Williams-JohnsonVISN Sharon x5434 Kimberly 2121, x4842 Joan 0411, x5229 Sandra 2120, x7479 Patrice x2398 Beverly Suzette 2463, x3830 Penny 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 way  Women’s health informational mobile applications under development  IT Innovations maternity tracker (care coordination) pilots selected  Many VISNs have not yet implemented WH telehealth 29 2/2013

 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 30 2/2013

Barriers to Care 31 2/2013

“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 Hickey VA Under Secretary for Benefits 9/27/ /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 33 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 34 *Not mutually exclusive Source: 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 Veterans  High-functioning women’s health committees with high-level involvement  Succession planning for WVPMs and challenge of institutional knowledge 35 2/2013

 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 36 2/2013

 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 , identifies best practices for eliminating gender gaps based on success in VA networks Gender Differences in Performance Measures, VHA /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 % VA average ( ) Vs. 77% private sector (2010) 67% Medicaid (2010) 86% VA average ( ) Vs. 71% private sector (2010) 69% Medicare 51% 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: Sponsoring grant program to develop/deliver in traditional mini-residency format with virtual components 39 2/2013

 VISN 06 Women Veterans SharePoint site menshealth/default.aspx  Women Veterans Healthcare Site