VA Health Care
VA Has Taken Steps to Make Services Available to Women Veterans, but Needs to Revise Key Policies and Improve Oversight Processes
GAO-10-287, Mar 31, 2010
Additional Materials:
Contact:
In 2008, VA provided health care to over 281,000 women veterans, a fast growing subgroup of veterans. Women veterans seeking VA health care need access to an array of services and Congress has raised concerns about how well VA is prepared to meet the physical and mental health care needs of women. GAO was asked to examine (1) the on-site availability of health care services at VA facilities for women veterans, (2) the extent to which VA facilities are following VA policies that apply to the delivery of health care to women veterans, and (3) key challenges that VA facilities face in providing health care to women veterans and how VA is addressing these challenges. GAO reviewed applicable laws and VA policies, interviewed officials, and visited a judgmental sample of 9 VA medical centers (VAMC) and 10 community-based outpatient clinics (CBOC) chosen, in part, based on the number of women using services. GAO also visited 10 VA counseling centers (Vet Centers).
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 services for women. Seventeen of the 19 medical facilities GAO visited offered basic gender-specific services including pelvic examinations and cervical cancer screening on site, and 15 offered access to one or more female providers for gender-specific care. The availability of specialized gender-specific services--such as treatment of reproductive cancers--and mental health services for women varied by service and facility. While some VAMCs offered a broad array of specialized gender-specific care on site, smaller CBOCs referred women to other VA or non-VA facilities for many or most of these services. Nationally, 9 VAMCs have residential mental health programs that are for women only or have dedicated cohorts for women. However, information about all of these programs was not available on VA's external Web sites. In July 2009, GAO reported in VA Health Care: Preliminary Findings on VA's Provision of Health Care Services to Women Veterans (GAO-09-884T), that none of the facilities GAO visited were fully compliant with VA policy requirements related to privacy for women veterans. In response, VA has required facilities to report more information on their compliance with these policies. However, facility reporting on privacy policies has, in the past, been inaccurate, and VA's oversight process does not include a means to validate the information facilities report. The facilities GAO visited were in various stages of implementing a new VA initiative to provide comprehensive primary care--defined as complete primary care, including basic gender-specific services, and mental health care--to women veterans at all facilities. VA headquarters officials are working with Women Veterans Program Managers (WVPM) and facility leadership to help facilities implement this initiative. In locations GAO visited, VA identified a number of key challenges in providing health care services to women veterans. For example, officials at VA medical facilities reported that space constraints have raised issues affecting the provision of health care services to women veterans, particularly related to ensuring their privacy and safety. According to VA officials, most VAMCs have planned renovation, construction, or relocation projects as part of their efforts to expand services and implement comprehensive primary care for women veterans. However, VA's design and construction policies have not been updated to reflect VA's privacy policies for women veterans. Moreover, the VA memorandum which established the WVPM as a full-time position outlined broad authority for the WVPM in facilitating changes in the delivery of services to women veterans, but some facilities have not modified the WVPM position as envisioned in VA's memorandum. For example, some WVPMs reported that they did not have sufficient authority and access to leadership to implement needed changes. Furthermore, VA's WVPM handbook, which defines the roles and responsibilities of the WVPM, has not been updated since the WVPM position was made full-time.
Status Legend:
Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.
- In Process
- Open
- Closed - implemented
- Closed - not implemented
Recommendations for Executive Action
Recommendation: To better ensure that women veterans have access to health care services that meet their unique needs and to strengthen oversight of the services delivered to women veterans at VA facilities, the Secretary of Veterans Affairs should direct the Under Secretary of Health to provide complete information on VA's external Web sites on the specialized residential mental health treatment programs VA offers for women veterans who have experienced military sexual trauma (MST) or other traumas.
Agency Affected: Department of Veterans Affairs
Status: Open
Comments: VA's Office of Mental Health Services MST Support Team, which oversees MST related education and training, has begun a systematic review of VA's national web sites to identify sites with incorrect or inadequate MST-related information. The MST Support Team will follow-up with VA facilities where information is limited or inadequate to request that more appropriate MST-related information be posted on their websites. This will include information about the availability of specialized MST-related care in residential and inpatient settings. Until VA's systematic review of its national web sites is complete this recommendation will remain open.
Recommendation: To better ensure that women veterans have access to health care services that meet their unique needs and to strengthen oversight of the services delivered to women veterans at VA facilities, the Secretary of Veterans Affairs should direct the Under Secretary of Health to establish a process to independently validate self-reported information by VA medical facilities' on compliance with privacy policies that pertain to women veterans.
Agency Affected: Department of Veterans Affairs
Status: Open
Comments: Veterans Integrated Service Networks (VISN) have been directed by VA headquarters to develop and implement a plan to validate information reported by medical facilities on compliance with women veterans' privacy and security policies. All VISN plans have been received in VA headquarters and an analysis of reports was conducted. Those VISNs with plans that were deemed deficient by VA headquarters have been asked to revise their plans. In addition, VISNs are required to submit a quarterly compliance status report one week after the close of each quarter to the Deputy Under Secretary for Health for Operations and Management, Office of Environmental Programs to be used as evidence of completion of actions. The Office of Environmental Programs is planning a schedule for unannounced document reviews and site visits which will address the recommendation. Until these unannounced site visits begin this recommendation remains open.
Recommendation: To better ensure that women veterans have access to health care services that meet their unique needs and to strengthen oversight of the services delivered to women veterans at VA facilities, the Secretary of Veterans Affairs should direct the Under Secretary of Health to expedite action to ensure that VA's design and construction policies explicitly address the needs of women veterans in all health care delivery settings in VA medical facilities.
Agency Affected: Department of Veterans Affairs
Status: Open
Comments: VA plans to issue an interim document on Design and Construction Standards to specifically address women's issues. Women's issues are included within many VA Design and Construction documents which are all continuously updated in cycles the vary from three to five years.
Recommendation: To better ensure that women veterans have access to health care services that meet their unique needs and to strengthen oversight of the services delivered to women veterans at VA facilities, the Secretary of Veterans Affairs should direct the Under Secretary of Health to clarify VA's policies by describing specifically what constitutes "appropriate and necessary training" for mental health professionals who provide services to veterans who have experienced MST.
Agency Affected: Department of Veterans Affairs
Status: Open
Comments: VA has defined all VA mental health providers who are licensed in their field and have appropriate clinical privileges as qualified to work with victims of MST. VA agrees that a working knowledge of the special issues MST survivors may face in recovery can help to tailor care to each veteran's particular need. To ensure basic skills and knowledge for all healthcare professionals, VA plans to develop a training presentation designed to provide an overview of issues relevant to working with any MST survivor. VA plans to explore making this a one-time mandatory training for all professionals working with patients in a clinical role. In addition, VA is working on implementing the provisions of Pub. L. 111-163, which mandates graduate education, training, certification, and continuing medical education for VA providers delivering counseling, care and services for MST-related conditions.
Recommendation: To better ensure that women veterans have access to health care services that meet their unique needs and to strengthen oversight of the services delivered to women veterans at VA facilities, the Secretary of Veterans Affairs should direct the Under Secretary of Health to update VA's policies to clarify the roles and responsibilities of the full-time WVPM position, in particular with respect to the level of reporting authority and access to senior facility management.
Agency Affected: Department of Veterans Affairs
Status: Open
Comments: A VA workgroup has completed its review and is in the process of revising the current Women's Veteran Program Manager (WVPM) handbook to include the specific roles and duties of full time WVPMs. When the WVPM handbook is revised and issued this recommendation will be considered implemented.