STAIR (Skills Training in Affective and Interpersonal Regulation)
- Need: To increase access to telemental health services for rural veterans, especially women, with a history of trauma.
- Intervention: STAIR (Skills Training in Affective and Interpersonal Regulation) is a 10-week program designed to reduce PTSD and depression symptoms and increase emotional regulation and social functioning in clients.
- Results: Therapists reported that clients attended more sessions when offered via teleconferencing, and clients reported satisfaction with the program.
Evidence-levelEffective (About evidence-level criteria)
According to the VA Office of Rural Health, out of the 18.2 million veterans in the United States, 4.7 million live in rural areas. Of these rural veterans, 6% are women. According to a 2014 Journal of Rural Health article, rural women veterans were less likely than their urban counterparts to seek mental healthcare from Veterans Affairs (VA) facilities. The VA Palo Alto Health Care System (VAPAHCS) in California is working to increase access for these women through telemental health.
STAIR (Skills Training in Affective and Interpersonal Regulation) targets rural women veterans, especially those with military sexual trauma (MST) and other military-related trauma. According to the VA, one in five women veterans seeking VA services reported having experienced MST. Although women are a specific target population, the program is open to all genders and has similar effectiveness across populations.
Clients can choose to receive individual or group treatment via teleconferencing either in the nearest community-based outpatient clinic (CBOC) or in the clients' own homes. They can also use webSTAIR, a web-based version of STAIR paired with expert coaching through telemental health, at select VA systems across the country.
STAIR works to reduce PTSD and increase participants' social functioning. The 10-week program helps veterans build skills such as:
- Mood management
- Relationship building
- Social functioning
Forty veterans were enrolled in the STAIR program. VAPAHCS therapists reported that more clients felt safer and attended more sessions when they could do so in their homes or in a clinic familiar to them. Clients reported that the facility and staff provided a positive environment, and many clients would recommend the STAIR program to others.
In addition, webSTAIR was launched in 2017 as an Enterprise Wide Initiative supported by the VA Office of Rural Health. The initiative is being offered to rural veterans with therapist guidance at the VAPAHCS; Michael E. DeBakey VA Medical Center in Houston, Texas; and the Edward Hines, Jr. VA Hospital in Hines, Illinois. From 2017 to 2022, webSTAIR will continue to expand and be implemented within 15 different healthcare systems across the country. In 2018, new sites were added in California, Montana, North Carolina, Washington, and Wisconsin.
For more information about STAIR for telemental health:
Weiss, B.J., Azevedo, K.J., Webb, K., Gimeno, J., & Cloitre, M. (2018). Telemental Health Delivery of Skills Training in Affective and Interpersonal Regulation (STAIR) for Rural Women Veterans Who Have Experienced Military Sexual Trauma. Journal of Traumatic Stress, 31(4), 620-625. Article Abstract
Azevedo, K.J., Weiss, B.J., Webb, K., Gimeno, J., & Cloitre, M. (2016). Piloting Specialized Mental Health Care for Rural Women Veterans Using STAIR Delivered via Telehealth: Implications for Reducing Health Disparities. Journal of Health Care for the Poor and Underserved 27(4), 1-7. Article Abstract
It can be difficult enrolling people into the program, as participants may not want to talk about trauma, especially sexual trauma. To encourage enrollment, program coordinators made sure to educate healthcare staff and their community partners about STAIR by giving presentations and a one-day workshop. Coordinators also mailed brochures to 300 veterans who had been diagnosed with PTSD and/or screened positively for MST.
The clinic-to-home program requires participants to have strong internet connection, webcam, and a newer computer model or device. Participants without these means were offered tablets. Program coordinators also often rely on Telemental Health Technicians (THTs) to help clients schedule appointments and use their equipment.
Program coordinators learned that other veteran populations were interested in the STAIR program. A number of male veterans, especially those who had experienced MST, had requested participating in the STAIR program, so all current STAIR programs are available to people regardless of gender identity. The coordinators believe that STAIR and webSTAIR could also be useful for veterans who identify as lesbian, gay, bisexual, transgender, and/or queer (LGBTQ), as they might experience stigma or violence targeting their sexual or gender identity and face additional barriers to accessing culturally competent care.
Contact InformationAdam Jacobs, MA, webSTAIR Program Manager
VA Palo Alto Health Care System
Abuse and violence
Stress and stress disorders
December 19, 2016
Date updated or reviewed
January 10, 2020
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.