Funded by the VA HSR&D (Project# SDR 10-012)

Spotlight on Women Cyberseminar Series
Conducting Research with 

Data on Military Sexual Tra

Rachel Kimerling, PhD

Director for Monitoring

Jenny Hyun, MPH, PhD

Manager for Monitoring, Data, and Analytics

MST Support Team

VA Office of Mental Health Services

Presented for Women’s Health HSR&D Cyberseminar Janu
Poll Question

• What best describes your position in t

– Researcher– Clinician– MST Coordinator– Administrator/Policy maker– Other
Poll Question

• How much familiarity do you have wit

administrative data on military sexual 

(MST)?

– Very familiar– Moderately familiar– Somewhat familiar

– A little bit familiar

– Not familiar at all
Topics

• Military Sexual Trauma (MST) Support 

• Overview Overview of MST Screening Screening and Treat

Treat

the VA

• MST Data Issues

• VA Administrative Data on MST

• Examples of Recent MST Research• Future Directions for MST Research
The MST Support Tea

The MST Support Team was established by 

Office of Mental Health Services to:

1. Conduct legally mandated monitoring of M

screening and treatment within VHA

2. Oversee legally mandated MST‐related edu

training within VHA

3. Promote best practices for MST screening a

treatment within VHA

4. Offer policy recommendations related to M

consideration by OMHS
Monitoring

Division:

Monitor

MST screening

&

treatment

Division:

Monitor

MST screening

&

treatment

MST Support Team

Promote best

practices for MS

screening

&

pp

Promote best

practices for MS

screening

&

Ed ti

&

screening

&

treatment; offer po

recommendation

related to MST

screening

&

treatment; offer po

recommendation

related to MST

Education

&

Training Division:

Oversee MST‐

related education

Education

&

Training Division:

Oversee MST‐

related education

& training
MST Support Support Team Annual R

R

1. MST S i creen ng R t epor2. Summary of MST‐Related Outpatient Ca3. MST Screening in Community Based Out

Clinics (CBOCs)

4. Summary of MST‐Related Outpatient Ca

CBOCs

5. MST Screening and Summary of MST‐Re

Outpatient Outpatient Care: Special Special Report of OEF/O

OEF/O

Veterans
https://vaww.mst.va.go
MST Resources Homepag

• Archived Teleconference Training Serie

• Public laws and regulations regulations related related to 

• Training handouts

– “Top 10 Things All VA Staff Should Know 

MST”

• Monitoring/documentation handouts• Sample presentations
What is Military Military Sexual Trauma 

VA’s definition of MST comes from Public Law

“Psychological trauma, which in the judgme

mental health professional employed by the

Dtt epar ment, result de from a phil ys ca assaul

nature, battery of a sexual nature, or sexual 

[ repeated “repeated, unsolicited unsolicited verbal or physical physical co

co

sexual nature which is threatening in charac

occurred while a Veteran was serving on act

active duty for training.”

Title 3
MST Screening

• Universal screening for MST began in 

• All Veterans are screened for MST onc

clinical reminder

• Although Although the screen is only given once, M

can be changed by a provider at any time

• VHA Directive Directive 2010‐033 states that sc

sc

must be conducted in appropriate clin

settings by providers

• Completed using Clinical Reminder in 
MST Screening

Questions: “When you were in the military...

3⁄4 Did you ever receive uninvited or unwante

attention (i.e. touching, cornering, pressu

sexual favors, favors, or inappropriate inappropriate verbal rem

rem

etc?)”

3⁄4 Did anyone ever use force or the threat of 

have sex with you against your will?”

Veterans who respond positively to either item 

considered to have a positive screen for M
MST Screening

• Responses to MST Screening

NO‐Denies prior MST (answered “No” to b

questions)

YES‐Reports MST in the past (answered “Ye

or b h ot questi ) ons

DECLINED TO ANSWER‐Patient declined to 

questions regarding MST
MST Screening

• Determining those eligible for MST sc

– Patient must be a Veteran– At least one outpatient encounter at a n

clinic, as defined defined by the Office of Quality Quality 

Performance (OQP)

• Consistent Consistent with performance performance measure measure mon

mon

• See OQP Technical Manual Q4, FY2010

– Addition Addition of Women’s Women’s Stress Disorder Disorder Tre

Tre

Team clinic as “nexus”
MST Screening Screening Rates Over Ti

MSTned for Screen%
VHA MST Screening Screening Data FY 20

Women 

% of All Veteran VHA users with a positive

screen for MST 22.4% 

% of OEF/OIF/OND Veteran VHA users with a

iti f MST 18.5% 

pos ve screen for MST

% of Homeless Homeless Veteran Veteran VHA users with a

positive screen for MST 38.7% 
Data Issue: Variations in M

Screening Questions

• Facilities are required to use the natio

version of MST Clinical Reminder [VHA Dir

• Recent efforts to standardize the MST

screening questions

– Initiative identified a small number of fa

using non‐standard MST screening quest

– All non‐standard MST screening question

been corrected as of FY 2012
Data Issue: Facilities with De

Responses

• Problems with MST Clinical Reminder

implementation have resulted in data 

issues

– For example example, MST CR defaults defaults to “yes” o

“decline” for all patients during a period 

• These f ili i facilities have been grayed out 

annual MST reports

• Consult annual MST reports produced 

Support Support Team for facilities facilities with known 

reminder implementation problems 
Data Issue: Incomplete Incomplete MST 

• Implementation problems have led to

incomplete transmission of MST data 

local facility to national data warehou

– Facilities Facilities have incorrect incorrect health factor ma

ma

not using the national MST CR

• One f ili ac ty has been grayed out of ou

annual MST reports (FY 2010)

• Consult annual MST reports produced 

Support Support Team for facilities facilities with known 

reminder implementation problems 
Data Issue: Low MST Scree

Scree

• Implementation problems related to the M

Reminder activation settings have led to low 

screening data at some facilities

• Facilities may have an MST CR that is incorrectly 

only to mental health clinics

• Consult annual MST reports produced by M

Support Team for facilities for facilities that 

MST screening rates
MST‐Related Related Care is Fre

• Inpatient, outpatient outpatient, and pharmaceutic

pharmaceutic

for physical and mental health condition

to a Veteran’s experiences of MST is pro

free of charge

• Providers of services make the determin

whether the care provided in a session i

related

• B d ase on cli i l n ca jd t u gment• Providers indicate that care is MST‐related by check

encounter form checkbox

• The encounter checkbox ensures that Ve

are not billed for the visit
Mental Health Diagnoses Commonly As

with MST

• VHA’s national monitoring data reveals th

diagnoses most commonly associated wit

among users of VA healthcare are:

– PTSD– Major Depression– Schizophrenia and Psychoses Psychoses– Substance Abuse– Mania/Bipolar Disorders

Data provided by the Office of Mental Health Services’ Military Sexual TSupport Team
Medical Issues Common

Associated with MST

• Behaviorally linked conditions, includi

disease, p y ulmonary disease, obesity, a

hypertension are associated with MST VHA patients patients (Frayne (Frayne et al., 1999; Kim

Kim

al., 2007)

• Sexually transmitted infection and sex

dysfunction disorders (Turchik et al, in 
MST‐Related Care

• MST is an experience, not a diagnosis• Although Although VHA clinicians clinicians offer services services 

Veterans with positive screens, not all 

who report MST will require care in an

year

• The amount of MST‐related care requi

each Veteran Veteran will vary due to the wide 

associated clinical conditions and their 
Proportion of MST+ Veterans with an 

Related MH Encounter by Year

52 3% 54 4%

60.0%

44.8% 45.2%

49.8% 52.3% 54.4%

37 6% 40.0%

50.0%

23.8% 24.9%

31.8%

35.3% 37.6%

30.0% 

23.8% 

10.0%20.0%

0.0%

2006 2007 2008 2009 20 01
MST‐Related Related Mental Health Care F

% of Veterans Veterans with at l

MST‐related MH Enco

Women 

All Veterans 54.4% 3

OEF/OIF/OND Veterans 58.4% 4

Homeless Veterans 87.2% 7
MST‐Related Encounter

• There were 696,250 MST‐related enco

of any type in FY 2010

• The majority (81%) of MST‐related en

are for mental health care

– Equal to 562,986 MST‐related mental he

encounters
Why not Clinic Stop 524

• Clinic Stop 524 (Active Duty Sexual Tr

cannot capture the breadth of treatm

which Veterans with experiences of Meligible

• Providers are asked to use the MST en

checkbox to indicate care that, in theijudgment, was delivered for the treatconditions related to MST
VA Ad i i i m n strative Data

MST Screening Data

• DSS National Outpatient Extract

– Variable Name: MST– De to : finition: MST status– Data available: FY 2002 Q2 to date– Responses are

• Y, N, D• “ ” D is counted as “ d” screened” for annual MST 
MST Encounter Data

• NPCD/Medical SAS Outpatient Events (SE) F

– Variable Name: MST

– Definition: Indicates whether encounter 

Military Sexual Trauma

– Data Available: FY 2006 to date

• DSS N ti l a ona O t ti t Outpatient Et t x rac

– Variable Name: MST_ENC– Definition: Encounter MST– Data Available: Available: FY 2006 Q3 to date
Other Considerations wh

Working with MST Data

• Veterans can change their response to 

MST screen at any time

– Generally, last MST status is appropriate 

analyses

• MST screening data cannot be separat

between sexual assault and sexual ha

• Inconsistent gender data

• May consider excluding facilities outsi

U S. . (e g. ., Manila) Manila)
Examples Examples of MST Data in Res

Res

• Kimerling, R., Pavao, J., Valdez, C., Ma

Hy , un J.K., Saweikis, M. ( ) 2011 . Milita

Trauma and Patient Perceptions of VeHealth Administration Administration Health Care Qu

Qu

Women’s Health Issues. 21(4S): S145‐

• Hyun, J.K., Kimerling, R., Cronkite, R.C

McCutcheon, S., Frayne, S.M. (in press

Organizational Factors Associated withScreening for Military Military Sexual Trauma. Trauma.

Women’s Health Issues. 
MST and Satisfaction with 

Care

• Purpose: To investigate patient satisfa

between women and men who do an

report experiences of MST
MST and Satisfaction with 

Care

• Data Sources:

– FY 2007 data– Office of Quality and Performance’s Surv

Healthcare Experiences Experiences of Patients Patients (SHEP

– MST Data Archive
MST and Satisfaction with 

Care

• 10 satisfaction measures were analyz

standard OQP satisfaction measures

– Overall Overall Satisfaction Satisfaction with Education & 

VHA care in the last two

months

– Education & – Emotional Su

Patient Prefe

– Overall Coordination– Continuity

– Patient Prefe– Visit Coordin

S i li t C Continuity

– Access– Courtesy

– Specialist Car

Courtesy
MST and Satisfaction with 

Care

• Key Findings:• MST status was not associated associated with ov

ov

satisfaction ratings of VHA health care

adjusting for patient patient characteristics characteristics

• Among male Veterans, there was no

association between MST status andsubdomains of health care satisfaction satisfaction
MST and Satisfaction with 

Care

• Female Veterans with a history of MST 

satisfaction lower in these subdomain

– Overall Coordination– Education & Information Information

• Findings may reflect generally on the

experiences of Veterans with complex 

and mental health disorders
MST and Satisfaction with 

Care

Adj t d Adjusted Mean Scores for O ll vera S ti f ti Satisfaction and Di i mens ons of S ti f 

Satisf

by MST Status, Women (n=5,758)

MST+ MSTMST+ MST‐ Diff

Diff

Overall Satisfaction 82.5 82.2 Overall Coordination 73.8 80.4 Continuity 80.3 82.2 Access 84.2 86.7 Courtesy 94.5 95.9 Education and

Information 69.7 76.1 

Emotional Support 81.8 85.8 Patient Preferences 82.1 85 Visit Coordination 84 84.9 

Specialist Care 78.4 82.5 
Adjusted Mean Scores for Overall Satisfaction and Dimensions 

Stratified by MST Status, Women (n=5,758)

* *
Organizational Factors and 

Screening

• Purpose: To investigate organizational 

related to MST screening and the diffe

influence of these organizational factonew, as well as continuing continuing, VHA users
Organizational Factors and 

Screening

• Data Sources: This study merged 5 facility‐

datasets with patient‐level data from the V

Outpatient Events File, FY 2005

– Facility data from VHA’s Outpatient Events File– Decision Support System Account Level Budget 

Centers (ALBCC)

– New England PTSD Evaluation Center (NEPEC) r

specialized PTSD programs

– Plan of C /Cli i l Care/Clinical Inventory Survey by the W

Veterans Health Strategic Healthcare Group

– National National Survey of MST Practice Practice
Organizational Factors and 

Screening

• Key Findings:

– Facility policies that promote universal M

screening, as well as audit and feedback 

at the facility, sig y nificantly improved the 

patients receiving MST screening.

– Women (both new and continuing) continuing) who 

Women’s Health Clinic were more likely 

been screened for MST
Organizational Factors and 

Screening

• However, women in facilities with a Women

Clinic, but who did not receive their care at 

clinics were no more likely to have been scr

MST than women in facilities without a Wo

Health Clinic

– Suggesting either no or equal diffusion of speci

knowledge across all VHA facilities
Future Directions in MST He

Services Research

• Access to MST‐related care

– Patient level and system level

• MST and men• Processes of care and organizational f• MST and clinical clinical outcomes outcomes...to name only a few
Questions?

THANK YOU

Rachel Kimerling

rachel.kimerling@va.gov

Jenny Hyun

jenny.hyun@va.gov