STATEMENT BY BETTY MOSELEY BROWN, ED.D.
ASSOCIATE DIRECTOR, CENTER FOR WOMEN VETERANS
DEPARTMENT OF VETERANS AFFAIRS
BEFORE THE SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS AND THE SUBCOMMITTEE ON HEALTH OF THE U.S. HOUSE OF REPRESENTATIVES COMMITTEE ON VETERANS' AFFAIRS
July 12, 2007
Chairman Hall, Chairman Michaud, and Members of the Subcommittees, I am pleased to testify today on behalf of the Department of Veterans Affairs (VA) about services in VA for women veterans. Particularly, I will address how VA serves women veterans through its current programs, how present and future strategies will address the needs of this growing population, and what outreach efforts are being conducted by VA to women veterans. The Center for Women Veterans was established by Public Law No. 103-446 in November 1994 to oversee VA programs for women veterans. The Center's mission is to ensure that women veterans receive benefits and services on par with male veterans; that VA programs are responsive to gender-specific needs of women veterans; that outreach is performed to improve women veterans' awareness of services, benefits and eligibility criteria; and that women veterans are treated with dignity and respect. The Director, Center for Women Veterans, acts as the primary advisor to the Secretary and Deputy Secretary on all matters related to policies, legislation, programs, issues, and initiatives affecting women veterans.
How is the Department of Veterans Affairs (VA) serving women through its current programs?
The Center for Women Veterans monitors changes in services through briefings by the three VA administrations and assesses the impact these changes may have on the delivery of services for the Nation's 1.75 million women veterans --from programs for homeless women veterans with children, elderly women veterans, women veterans living in rural areas, and for those women still unaware they, too, are veterans, since many do not identify themselves as such. The Center regularly monitors VA briefings during Transition Assistance Programs to ensure that active duty women are provided access to information on the benefits and services aVAilable to them as veterans prior to their release from active duty.
The Advisory Committee on Women Veterans was established by Public Law 98-160 in 1983. The Advisory Committee is charged with advising the Secretary of Veterans Affairs on VA benefits and services for women veterans, assessing the needs of women veterans, reviewing VA programs and activities designed to meet those needs, and developing recommendations addressing unmet needs. The Advisory Committee submits a biennial report to the Secretary incorporating the Committee's findings and recommendations.
As a means of obtaining information regarding the delivery of health care and services to women veterans, the Advisory Committee conducts site visits to VA facilities throughout the country. In addition, the Advisory Committee tours the facilities and meets with senior officials to discuss services and programs aVAilable to women veterans. During site visits, the Advisory Committee also hosts open forums with the women veterans' community, encouraging women veterans to discuss issues and ask questions related to VA benefits and services. The Advisory Committee meets twice a year at VA Central Office (VACO) and receives briefings from the Veterans Health Administration (VHA), Veterans Benefits Administration (VBA), National Cemetery Administration (NCA) and other staff offices. These briefings update the Committee on the status of VA programs and respond to concerns raised during the site visits. The Advisory Committee uses information from these site visits and briefings in its biennial reports to the Secretary.
In the 2006 Report of the Advisory Committee on Women Veterans, the Advisory Committee made 23 recommendations. Some of the key report issues included outreach, behavioral and mental health care, military sexual trauma, health care, research and studies, strategic planning, training, and women veterans who are homeless. The 2006 Report has been provided to Congress.
Regarding women veterans health program, the Advisory Committee, in its 2006 Report, recommended VA ensure the Center is provided an annual update on the effectiveness of the VHA Women Veterans Program Managers Program. VHA officials, including the Women Veterans Health Strategic Healthcare Group (formerly known as Women Veterans Health Program), briefed the Center and Advisory Committee members on this issue at the February - March 2007 meeting of the Advisory Committee. In addition, the Women Veterans Health Strategic Healthcare Group works closely with the Center on issues that are frequently referred to Women Veterans Program Managers in field facilities.
In addition, in 2006 WVHSHG co-sponsored Elizabeth Yano, PhD, MSPH, Deputy Director VA Greater Los Angeles HSR&D Center of Excellence and Associate Professor at UCLA, to survey VISN Leadership, facility and program directors regarding provision of care models in women's health in VHA. We expect delivery of this report in late 2007, informing VHA of the provision of primary care to women veterans through models of specialized women's health clinics and in models of mixed-gender primary care sites, including community based outpatient sites. This study will clarify which models of care for women provide the best performance outcomes and higher patient ratings of care.
Realizing the current influx of returning women veterans will increase the number of women seen by VHA in the next several years, VHA has initiated programs to identify interested primary care providers and provide them with intensive training in women's health. The needs assessment for this program will be implemented in September 2007 through VA's Employee Education Service efforts. This program will be especially important in addressing the health care needs of rural women. We also recognize that the majority of women veterans new to VHA are of child bearing age and could be at risk for birth defects from some prescription medications. This presents new challenges which we are addressing through initiatives in pharmacy management and provider education.
VHA is committed to expanding the focus of women veterans' health care beyond the issues of gender specific screening for breast and cervical cancer. In the United States, heart disease is the number one cause of death in women, and WVHSHG has proposed initiatives in improved management and prevention for heart disease risk including cholesterol, weight management and smoking cessation. On June 22, 2007, VHA's Office of Public Health and Environmental Hazards awarded two clinical demonstration grants specific to smoking cessation programs for women veterans.
Another focus area for women veterans' health is prevention and detection of cancers, particularly colorectal cancers, through improved screening of women veterans. We are eVAluating factors related to the fact that fewer women than men receive colorectal cancer screening, both within VA and in community samples.
There are specialized women's mental health services in VHA:
Currently, the VHA Office of Research and Development (ORD) is supporting a broad portfolio focused on women's health issues, including studies on diseases preVAlent solely or predominantly in women [e.g., certain types of cancer (breast, cervical, oVArian), lupus, human papillomavirus (HPV) and hormonal effects on diseases in post-menopausal women], research focusing on women subjects (e.g., PTSD in women, osteoporosis in women, multiple sclerosis in women) and research on the health care of women veterans.
ORD's efforts to support research that will improve the health care of the growing number of women veterans can be categorized in three areas:
Veterans Benefits Administration
What are the present and future needs of these growing populations and what strategies does VA have for meeting them?
The last national survey of female veterans was conducted in 1985, leaving VHA policy makers and managers with limited information with which to adequately plan for future health care services for women veterans. To address this knowledge gap, the WVHSHG commissioned Donna Washington, MD, MPH, VA Greater Los Angeles HSR&D Center of Excellence, to conduct a National Survey of Women Veterans. The objectives of the National Survey of Women Veterans are: (1) identify the current demographics, health care needs, and VA experiences of women veterans; (2) determine how health care needs and barriers to VA health care use differ among women veterans of different periods of military service, e.g., OEF/OIF versus earlier periods; and (3) assess women veterans preference for and perceived VAlue of different types of VA interventions to improve access and quality. VA will survey between 2,500 and 3,200 women veterans across the nation, including equal numbers of VA users and nonusers. The survey began in April of 2007 and the final report will be submitted by December 31, 2008.
The recent eleVAtion of the Women Veterans Health Program to the Women Veterans Health Strategic Healthcare Group has positioned the office to gain expertise in the population of women veterans, strategically plan for health care delivery and provide leadership in clinical knowledge of this unique group of women and to catalyze optimal integration of women veterans health issues across all VHA programs and offices. We aim to be a world leader in innoVAtive and high quality care to women veterans.
What outreach efforts are being conducted by VA to women veterans?
We continue to outreach to the women veterans' community with increased emphasis on our partnerships with federal, state, and county agencies, national Veterans Service Organizations and community organizations. To enhance collaboration and better serve our women veterans, representatives from the Department of Health and Human Services, the Department of Labor, the Department of Defense, and VA Administrations (VHA, VBA and NCA) serve on the Advisory Committee on Women Veterans as appointed ex officio members. The Center's Director serves as an ex officio member on the Defense Advisory Committee on Women in the Services. In this role, she ensures that DoD and VA collaboratively address military and women veterans' health and benefits issues.
The Center published the 25 most Frequently Asked Questions from women veterans in English and Spanish based on thousands of inquiries from women veterans. These questions are posted on the Center's website and the VA website.
The next National Summit on Women Veterans Issues will be June 20-22, 2008. We are planning to outreach to the military services, particularly the Reserves and National Guard. We are planning VArious workshops, including "Readjustment Counseling Service: Outreach and Transition Services for Veterans Families," "Gender Differences: What the Data Shows," and "Mental Health Issues." Our previous summit was attended by over 300 women veterans, federal, state and veteran advocates and developed recommendations for how to better serve women veterans.
Since October 2001, the Center staff has completed nearly 100 media interviews and hundreds of keynote speeches, participated in veterans forums, and monitored Transition Assistance sessions and veterans briefings. To ensure veterans' issues are addressed quickly during forums, VA has assigned local women veterans program managers from VA Medical Centers and women veteran coordinators from Regional Offices to accompany Center staff to answer general questions and see that health care and benefit issues raised regarding individual cases receive immediate attention. In addition, Center staff works closely with numerous other VA advisory committees and councils, Department of Defense, Department of Labor, Department of Health and Human Services, Women's Policy, Inc., state and local agencies, and VSO's to address and resolve women veterans issues.
VA is grateful for the work of the Advisory Committee because its activities and reports play a vital role in helping VA assess and address the needs of women veterans.
This concludes my formal testimony. I will be pleased to answer any questions.