The Psychological Health Center of Excellence commissioned RAND researchers to conduct supplemental analysis to support its response to Congress of the use of intensive outpatient programs to treat active-duty service members affected by the mental health consequences of sexual harassment and sexual assault while in the military. The goal was to better understand different program components available to these affected service members.
Considerations Around the Use of Intensive Outpatient Programs for Service Members Who Experienced Sexual Trauma in the U.S. Military
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Research Questions
- Among service members with mental health conditions, what proportion have experienced sexual harassment or sexual assault while serving in the military?
- What program components are available to active-duty service members who have suffered sexual trauma and other trauma?
- What is the key driver of decisions about how, when, and where to implement an IOP model of care?
- What potential barriers might prohibit the use of IOPs to care for this military population?
Section 702 of the fiscal year 2019 National Defense Authorization Act directed the U.S. Department of Defense (DoD) to conduct a pilot study to assess the feasibility and advisability of using intensive outpatient treatment programs to address posttraumatic stress disorder (PTSD) and associated mental health problems among service members who have experienced sexual harassment or sexual assault while in the military. RAND researchers conducted a programmatic review of four intensive outpatient programs (IOPs) — two in the private sector and two in DoD — to understand different program components available to active-duty service members who have suffered sexual trauma and other trauma. A review of policies to understand TRICARE authorization procedures and other regulations governing IOPs and an analysis of data from the 2014 RAND Military Workplace Study survey on the prevalence of sexual trauma among personnel with mental health conditions helped obtain contextual information to inform the Psychological Health Center of Excellence's response to Congress. The review identified evidence-based approaches that IOPs have successfully used in programs designed for military service members and barriers to using this type of care to treat members of the military community. While examining the IOP model of care, the research team identified knowledge gaps surrounding the experiences, treatment needs, and effectiveness of different treatment components and models of care for active-duty service members affected by the mental health consequences of sexual harassment and sexual assault in the military.
Key Findings
- The secondary data analysis revealed that, in a hypothetical group of 100 servicewomen with probable PTSD, researchers would expect that 40 had been sexually assaulted in their lifetimes. For 15 of the 40, they would have been sexually assaulted within the previous year.
- The demand for services is a key driver of decisions about how, when, and where to implement an IOP model of care. If a clinic or hospital serves a large enough group of service members with PTSD, it might be able to support specialized, sexual trauma–informed care.
- Based on a limited number of programmatic reviews, private-sector and direct-care IOP programs use evidence-based treatment approaches and have established processes for treating active-duty service members.
- The policy review and discussions with program officials indicated that the TRICARE application process, accreditation, state licensing, and credentialing were not identified as barriers to private-sector IOP authorization and practice. Other policies, related to reimbursement, referral, leave, and privacy, were identified as potential barriers.
- The reviews revealed many knowledge gaps surrounding the experiences, treatment needs, and effectiveness of different treatment components and models of care for active-duty victims of sexual harassment and sexual assault experiencing PTSD and related mental health problems.
Recommendations
- The policy review highlights the need to collect data on the preferences of active-duty victims of sexual harassment and sexual assault with psychological health problems for seeking care in the private sector versus direct care at a military treatment facility.
- More research would be important to understand whether the benefits of IOP care relative to traditional outpatient level of care are enough to warrant the increased cost of implementing and relying on IOPs for the targeted patient population.
- The Defense Health Agency (DHA) should assess the ability of DoD to meet the demand for IOP care among active-duty service members who have experienced sexual trauma and the availability of private-sector or U.S. Department of Veterans Affairs IOPs should DoD's capacity fall short.
- DHA might consider establishing a research roadmap for how best to address these and other knowledge gaps about the optimal treatment for active-duty service members with problems stemming from a sexual assault that occurred while serving in the military.
- Some key topics for future research on this issue would be treatment effectiveness, patient preferences, and military health system and TRICARE capacity.
- Additional research to assess the availability of clear policies and procedures for behavioral health providers is needed.
Table of Contents
Chapter One
Introduction
Chapter Two
Sexual Harassment, Sexual Assault, and Mental Health in the Military
Chapter Three
A Review of DoD and Private-Sector Programs
Chapter Four
Policies Governing IOPs
Chapter Five
Knowledge Gaps and Additional Areas of Study
Appendix A
Program Staff Discussion Guide
Appendix B
Methods for Program Identification and Selection
Appendix C
Treatment Approaches for Posttraumatic Stress Disorder
Appendix D
Psychological Assessments Administered by the Intensive Outpatient Programs
Research conducted by
This research was sponsored by the Defense Health Agency Psychological Health Center of Excellence and conducted within the Forces and Resources Policy Center of the RAND National Security Research Division (NSRD).
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