Addressing the Health Concerns of VA Women With Sexual Trauma
Addressing the Health Concerns of VA Women With Sexual Trauma
Lifetime sexual trauma (ST) (i.e., behaviors that range from unwanted sexual touching to
 attempted or completed rape) is a significant social and public health problem among women
 Veterans. For women Veterans, lifetime ST can occur prior to, during or after military
 service. ST is associated with multiple difficulties and risks, including posttraumatic
 stress disorder (PTSD), intimate partner violence (IPV), and alcohol misuse. Providing an
 effective, integrated, and low-cost intervention that targets ST-related risks for women
 Veterans with lifetime ST would advance clinical care for these vulnerable women.

 This research will develop and assess a computer-delivered intervention (Safety and Health
 Experiences Program; SHE) that will provide a screening and brief behavior intervention for
 women Veterans with any lifetime ST. More specifically, the intervention, SHE, will address
 interrelated health concerns for women Veterans with ST (i.e. alcohol misuse, IPV, and PTSD).
 SHE will be designed to provide individualized assessment, feedback, and referrals for women
 Veterans with any lifetime ST. SHE will take place within a primary care setting. Primary
 care visits are frequent points of health care contact for women Veterans making the visit
 itself the ideal, and possibly only, opportunity to provide behavioral interventions.

 This study will lay the groundwork for a larger clinical trial of the SHE program in multiple
 VA primary care settings. If effective, the intervention, SHE, represents an innovative and
 low cost service for early identification and intervention that could be implemented
 nationwide with ease and speed to address the needs of women Veterans with lifetime ST. The
 long-term goal of the project is to make a significant impact on advancing health services
 research by introducing and testing a novel and potentially powerful service tool that may
 improve service delivery to address the co-occurring health concerns for women Veterans with
 any lifetime ST.
The VA Women's Health Research Agenda underscores the importance of improving the safety and
 health outcomes of returning Veteran women. With greater numbers of women joining the
 military, the need for gender-specific VA-based interventions is increasingly important.
 Posttraumatic stress disorder (PTSD), intimate partner violence (IPV), and alcohol use are
 closely interrelated and significant concerns for women Veterans with a history of sexual
 trauma (ST). Given that screening for military sexual trauma (MST) is mandated within VAs, a
 computer delivered intervention has the potential to be easily integrated into the standard
 of care for women who screen positive for MST and/or other lifetime STs, increasing the
 identification of high-risk women Veterans. This intervention will provide a computer-based
 intervention on a VA issued laptop that could improve delivery service and fill a healthcare
 gap for a vulnerable Veteran population.

 The long-term goal of the project is to make a significant impact on advancing health
 services research by introducing and testing a novel and potentially powerful service tool
 that may improve service delivery to address the co-occurring health concerns for VA women
 with lifetime ST. The intervention, Safe and Healthy Experiences (SHE), a brief modular,
 computer-based intervention, will target interrelated health risks for women Veterans with
 lifetime ST (i.e. alcohol misuse, IPV, and PTSD). SHE will provide individualized assessment,
 feedback, and referrals for women Veterans with lifetime ST. The intervention is based on
 motivational interviewing (MI), a well-defined intervention strategy that has yielded
 particularly promising results in a range of clinical issues, including interpersonal
 violence, and a range of patient populations, including male and female Veterans. MI is a
 collaborative and non-confrontational approach that emphasizes increasing a participant's
 awareness of successful steps towards well-being. MI is consistent with an empowerment model,
 which is a highly recommended intervention model for victimized women and both MI and an
 empowerment model converge on important principles for intervening with victimized women.

 Findings from the study will provide the necessary groundwork to examine the efficacy of SHE
 in a future, large clinical trial. If the SHE intervention is found to be feasible,
 acceptable and efficacious in improving outcomes for women Veterans with lifetime ST, the
 ultimate goal would be for the program to be integrated into clinical care and widely
 disseminated. There are two phases of research directed toward these aims: 1) develop and
 refine an integrated screening and behavior intervention for VA women with lifetime ST in a
 brief modular computer-based format that can be administered in a VA primary care setting,
 and 2) collect data on the feasibility, acceptability, and initial efficacy of the
 intervention in improving the health of VA women, and increasing utilization of treatment and
 resources.

 The study aims are to:

 1. Develop the preliminary computer-based intervention, incorporating information gained in
 informant interviews.

 2. Perform a small open trial (n = 20) of SHE to assess feasibility of recruitment of
 target population and acceptability of intervention and study procedures.

 3. Conduct an initial randomized control trial in a sample of 150 women Veterans who screen
 positive for lifetime sexual trauma (ST) and have at least one risk factor (i.e., screen
 positive for intimate partner violence (IPV), posttraumatic stress disorder (PTSD),
 and/or heavy drinking) to demonstrate the feasibility of SHE and the acceptability of
 SHE via participant report of ease of use, helpfulness, and overall satisfaction.

 4. Examine preliminary evidence for the hypotheses that, relative to the control condition,
 screening and referral only (SR), SHE will result in:

 -  Decreases in the number of risks (i.e., heavy drinking (4+ drinks on one occasion),
 screen positive for PTSD, screen positive for IPV) at the 2- and 4-month follow-up
 (primary).

 -  Increases in resource and treatment utilization over the 2- and 4-month follow-up
 period (secondary).

 The data will be used to demonstrate whether the effects of the intervention look promising
 to support a future large-scale randomized control trial and to suggest, in concert with
 results from clinical trials in related fields, the range of effect sizes that would be
 reasonable to expect in a future trial.

 This is a multi-site study. At the Providence, RI based site (Women and Infants Hospital and
 Brown University), the specialized computer-based assessment and interactive intervention
 sessions will be developed and designed and staff members will also assist with data
 management. The Central Texas VA Healthcare System site will be the data collection site and
 the main site for participant recruiting, consenting, enrollment, intervention and follow-up.
 Staff at the two sites will work collaboratively throughout the project to supervise study
 staff, for reporting to the DOD and IRB's and in designing the assessment and intervention
 sessions, however, only the study staff at the Central Texas site will have access to
 participant PHI.
Inclusion Criteria:

 Female Veterans

 -  Lifetime history of ST with at least one risk factor: heavy drinking within the past 3
 months, screen positive for current PTSD or for IPV within last 12 months

 -  Age 18-65

 -  Seeking treatment through the Women's Primary Care Clinics at the Central Texas VA
 Healthcare System.

 -  Ability to understand study procedures in English

 -  Not actively in suicidal or homicidal crisis warranting imminent hospitalization