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Organizational Factors Associated with Screening for Military Sexual Trauma

  • Jenny K. Hyun
    Correspondence
    Correspondence to: Jenny K. Hyun, PhD, MPH, VA Palo Alto Health Care System National Center for PTSD 795 Willow Road (334-PTSD) Menlo Park, CA 94025. Phone: (650) 493-5000 x23495; fax: (650) 617-2701.
    Affiliations
    Office of Mental Health Services, Military Sexual Trauma Support Team, Department of Veterans Affairs, Washington, DC

    National Center for Posttraumatic Stress Disorder, VA Palo Alto Health Care System, Palo Alto, California
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  • Rachel Kimerling
    Affiliations
    Office of Mental Health Services, Military Sexual Trauma Support Team, Department of Veterans Affairs, Washington, DC

    National Center for Posttraumatic Stress Disorder, VA Palo Alto Health Care System, Palo Alto, California

    Center for Health Care Evaluation, VA Palo Alto Health Care System, Palo Alto, California
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  • Ruth C. Cronkite
    Affiliations
    Center for Health Care Evaluation, VA Palo Alto Health Care System, Palo Alto, California

    Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California

    Department of Sociology, Stanford University, Stanford, California
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  • Susan McCutcheon
    Affiliations
    Office of Mental Health Services, Military Sexual Trauma Support Team, Department of Veterans Affairs, Washington, DC

    Office of Mental Health Services, Department of Veterans Affairs, Washington, DC
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  • Susan M. Frayne
    Affiliations
    Center for Health Care Evaluation, VA Palo Alto Health Care System, Palo Alto, California

    Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California

    Division of General Medical Disciplines, Department of Medicine, Stanford University, Stanford, California
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Published:November 04, 2011DOI:https://doi.org/10.1016/j.whi.2011.09.001

      Abstract

      Purpose

      This exploratory study investigated organizational factors associated with receipt of military sexual trauma (MST) screening during an early timeframe of the Veterans Health Administration’s (VHA) implementation of the universal MST screening policy.

      Methods

      The sample consisted of all VHA patients eligible for MST screening in fiscal year 2005 at 119 VHA facilities. Analyses were conducted separately by gender and by user status (i.e., new patients to the VHA health care system in FY 2005 and continuing users who had previously used the VHA health care system in the past year). Multivariate generalized estimating equations were used to assess the effects of facility-level characteristics and adjusted for person-level covariates.

      Results

      Facility-level mandatory universal MST screening policies were associated with increased odds of receiving MST screening among new female patients and both continuing and new male patients: Odds ratio (OR), 2.87 (95% confidence interval [CI], 1.39–5.89) for new female patients; OR, 8.15 (95% CI, 2.93–22.69) for continuing male patients; and OR, 4.48 (95% CI, 1.79–11.20) for new male patients. Facility-level audit and feedback practices was associated with increased odds of receiving MST screening among new patients: OR, 1.91 (95% CI, 1.26–2.91) for females and OR, 1.86 (95% CI, 1.22–2.84) for males. Although the facility-level effect for women’s health clinic (WHC) did not emerge as significant, patient-level effects indicated that among these facilities, women who used a WHC had greater odds of being screened for MST compared with women who had not used a WHC: OR, 1.79 (95% CI, 1.18–2.71) for continuing patients and OR, 2.20 (95% CI, 1.59–3.04) for new patients.

      Conclusion

      This study showed that facility policies that promote universal MST screening, as well as audit and feedback practices at the facility, significantly improved the odds of patients receiving MST screening. Women veterans’ utilization of a WHC was associated with higher odds of receiving MST screening. This study provides empirical support for the use of policies and audit and feedback practices which the VHA has used since the implementation of the MST screening directive to encourage compliance with VHA’s MST screening policy and is likely associated with the present-day success in MST screening across all VHA facilities.
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      Biography

      Jenny Hyun is a Health Science Specialist at the National Center for Posttraumatic Stress Disorder, Dissemination and Training Division at VA Palo Alto Health Care System. Her research interests are in organizational research, women veterans, and military sexual trauma.

      Biography

      Rachel Kimerling is Clinical Psychologist at the National Center for Posttraumatic Stress Disorder, Dissemination and Training Division and an Investigator at the Center for Health Care Evaluation, VA Palo Alto Health Care System. She specializes in sexual trauma research.

      Biography

      Ruth Cronkite is a Research Health Science Specialist, Center for Health Care Evaluation, VA Palo Alto, and a Consulting Professor, Department of Sociology, Stanford University. She focuses on program evaluation, long-term course of psychiatric disorders, and continuity of care.

      Biography

      Susan McCutcheon is the National Mental Health Director for Family Services, Women’s Mental Health & Military Sexual Trauma. She focuses on policy and program development for her areas of responsibility. Her areas of research expertise include women’s issues and trauma.

      Biography

      Susan Frayne, at the Center for Health Care Evaluation, VA Palo Alto, directs the Women’s Health Practice-Based Research Network and Women’s Health Evaluation Initiative. She is Associate Director, VA Palo Alto Women’s Health Center, and Associate Professor of Medicine, Stanford University.