December 2021

In This Issue: HSR&D Advances Research in Providing Healthcare for Veterans in Rural Settings
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Home-Based Psychotherapy for Women with MST Living in Rural Areas

Feature Article

Takeaway: This program has the potential to offer in-home delivery of gender-sensitive, evidence-based coping skills that will improve social functioning and PTSD associated with military sexual trauma (MST). Further, in reducing barriers to care, it will provide a tremendous benefit to women Veterans with MST, particularly those residing in rural areas.

Military Sexual Trauma (MST) among women Veterans is a problem of epidemic proportion associated with significant mental health and functional impairment, as well as substantial access to care barriers. When screened, surveillance data indicate that one in four women Veterans reports MST. Compared to women Veterans with other service-related stressors, those experiencing MST have greater mental health problems, are more likely to report difficulty in functioning in social, family, and intimate relationships, and are more likely to be unemployed and to report difficulties in finding a job. Nevertheless, women with MST engage less frequently in VA healthcare than other women Veterans. Barriers to care include distance from specialty services, financial difficulties, childcare and family responsibilities, and gender-related discomfort in male-dominated VA facilities. Research over the past decade has clearly identified the problems and concerns of women Veterans with MST, but programs addressing their mental health needs and that are responsive to identified barriers are lacking.

The objectives of this ongoing study (April 2018 – March 2022) are to evaluate the effectiveness of a skills training treatment, and then assess facilitators and barriers to implementing this treatment. Specifically, investigators will compare Skills Training in Affective and Interpersonal Regulation (STAIR) to an active non-specific treatment—Present Centered Therapy (PCT), both delivered via home-based video. STAIR is a short-term, evidence-based cognitive-behavioral therapy for individuals suffering from PTSD, while PCT is a time-limited treatment for PTSD that focuses on increasing adaptive responses to current life stressors and difficulties that are directly or indirectly related to trauma or PTSD symptoms.

Methodology

This study has dedicated resources to ensure engagement of those living in rural areas. Investigators will evaluate remote delivery of the treatment to the Veteran’s home rather than a VA clinic. Qualitative assessment will be conducted via a multi-stakeholder mixed-methods evaluation of the delivery of STAIR via HBVT (home-based video technology). Assessments will occur five times: baseline (week 0), mid-treatment (week 5), post-treatment (week 10), 2-month follow-up (week 18), and 4-month follow-up (week 26). Investigators will contextualize the quantitative findings of the clinical trial to enhance  understanding of both treatment processes and their effectiveness. It is hypothesized that STAIR will be superior to PCT in reducing PTSD and related symptoms – and in improving perceived social support, community engagement, and social functioning.

Findings

Nothing to report at this time.

Anticipated Impact

This program has the potential to provide in-home delivery of gender-sensitive, evidence-based coping skills that will improve social functioning and PTSD – and reduce barriers to care. This will provide a tremendous benefit to women Veterans with MST, particularly those in rural areas.

Principal Investigator

Marylene Cloitre, PhD, is a core investigator with HSR&D’s Center for Innovation to Implementation (Ci2i): Fostering High-Value Care in Palo Alto, CA.

Publications

Weiss B, Azevedo K, Webb K, Gimeno J, and Cloitre M. Telemental health delivery of Skills Training in Affective and Interpersonal Regulation (STAIR) for rural women Veterans who have experienced military sexual trauma. Trauma Stress. August 2018;31(4):620-625.

View study abstract