“Do you expect me to receive PTSD care in a setting where most of the other patients remind me of the perpetrator?”: Home-based telemedicine to address barriers to care unique to military sexual trauma and veterans affairs hospitals

Abstract

Home-based telemedicine (HBT) is a validated method of evidence-based treatment delivery for posttraumatic stress disorder (PTSD), and justification for its use has centered on closing gaps related to provider availability and distance to treatment centers. However, another potential use of HBT may be to overcome barriers to care that are inherent to the treatment environment, such as with female veterans who have experienced military sexual trauma (MST) and who must present to VA Medical Centers where the majority of patients share features with perpetrator (e.g. gender, clothing) and may function as reminders of the trauma. Delivering evidence-based therapies to female veterans with MST-related PTSD via HBT can provide needed treatment to this population. This manuscript describes an ongoing federally funded randomized controlled trial comparing Prolonged Exposure (PE) delivered in-person to PE delivered via HBT. Outcomes include session attendance, satisfaction with services, and clinical and quality of life indices. It is hypothesized that based on intent-to-treat analyses, HBT delivery of PE will be more effective than SD at improving both clinical and quality of life outcomes at post, 3-, and 6-month follow-up. This is because ‘dose received’, that is fewer sessions missed, and lower attrition, will be observed in the HBT group. Although the current manuscript focuses on female veterans with MST-related PTSD, implications for other populations facing systemic barriers are discussed.

Military Sexual Trauma and Co-occurring Posttraumatic Stress Disorder, Depressive Disorders, and Substance Use Disorders among Returning Afghanistan and Iraq Veterans

“…Nonetheless, this finding highlights the continued need to dedicate women-specific services for Veterans. This could include offering telemedicine for women with positive MST status (Gilmore et al, 2016) if there are not separate waiting rooms available for women within VA while larger anti-harassment policies are developed and implemented in the military.…”

Gender Differences in Veterans’ Perceptions of Harassment on Veterans Health Administration Grounds

“…Women veterans who feel unwelcome at the VA are more likely to report delaying or forgoing needed health care in the prior year (Washington, Bean-Mayberry, Riopelle, & Yano, 2011) or to drop out of VA care entirely (Hamilton, Frayne, Cordasco, & Washington, 2013). The VA may be particularly uncomfortable for women with a history of military sexual trauma, for whom the male-dominated environment may cue trauma-related distress and symptoms (Gilmore et al, 2016;Miles-McLean et al, 2015). This finding is particularly concerning given that 49% of women veteran VA users who served during Operations Enduring Freedom and Iraqi Freedom report a military sexual trauma history (Barth et al, 2016).…”

Developing an Occupation-Centred Framework for Trauma Intervention

“…Trained across conditions, occupational therapists capably adapt and grade their interventions accordingly, and can extend their service delivery into the home and community. This can be incredibly helpful, as service for trauma within a hospital-or clinic-based model can create triggers for those living with the effects of PTSD (Gilmore et al, 2016). Occupational therapists are ideally positioned to provide trauma-informed inclusive interventions in the community environments preferred by their clients, and the OTTIF is a clinical reasoning framework that can enable the provision of this evidence-based care.…”