Addressing Military Sexual Trauma in a Community Setting

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Addressing Military Sexual Trauma in a Community
Setting

• Joan E. Zweben, Ph.D.
• Executive Director, East Bay Community Recovery
  Project
• Clinical Professor of Psychiatry, UCSF
• Staff Psychologist, VA Medical Center, San
  Francisco
• ASAM Med Sci Chicago - 2013

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Introduction

• Over 1 million active military are returning to
  the US
• Many will not seek help at the VA
• Are not aware of benefits
• Obstacles accessing benefits
• Negative feelings towards the VA
• Essential that community providers understand
  military culture and pt needs

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Definition

• Military sexual trauma (MST) is sexual
  harassment and/or sexual assault experienced by a
  military service member regardless of the
  geographic location, the gender of the victim, or
  the relationship to the perpetrator. Both men and
  women can experience military sexual trauma and
  the perpetrator can be of the same or of the
  opposite gender. Perpetrators may or may not be
  service members themselves.

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Total Victim Reports
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Gender Breakdown
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Barriers to Reporting

• Minimize seriousness, too embarrassed to report
• Fear of not being believed, being blamed, having
  reputation suffer
• Fear of harm or retribution if they report fear
  for their career
• Concern their AOD use will undermine efforts to
  hold perpetrator accountable

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Screening - I

• If you ask, they will answer
• Create comfortable climate for disclosure
• Private setting
• Minimize interruptions
• Nonjudgmental posture
• Use unhurried speech
• Maintain good eye contact

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Screening II

• Often done by nurse or PCP
• Ask specific questions
• Heightened issues for women in male-dominated
  setting such as the VA
• Manage/limit the disclosure process
• Assess current status and safety

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Watching for MSTRelated Distress

• Power differential between patient and provider
  has parallels with the power differential between
  victim and perpetrator, triggering memories.
• How MST-related distress might present in a
  clinical (medical) setting
• Anxiety
• Angry outbursts
• Irritability
• Avoidant behavior
• Reexperiencing
• Dissociation

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Health Problems and MST

• Chronic pain back, pelvic, headaches
• Gynecologic sexual dysfunction, menstrual
  abnormalities, menopausal sx, reproductive
  difficulties
• Gastrointestinal diarrhea, indigestion, nausea,
  swallowing
• Other chronic fatigue, sudden weight changes,
  palpitations

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Managing the Medical Encounter

• Make the medical encounter as safe as possible
• Explain what to expect provide private, calm
  setting
• Stop doing whatever triggered reaction (stop
  touching pt, discontinue procedure)
• Reorient and soothe pt
• Ground pt with concrete tasks
• Refer pt to mental health services

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Effective Treatments

• Recognize common psychological sx, including sx
  of complex trauma
• Be aware of commonly used medications
• Be aware of specific trauma treatments (SIT,
  Exposure, CPT, EMDR)
• Identify facilities with special resources for
  MST (specific staff or programs)

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Addressing Military Sexual Trauma in an
Integrated Care Setting

• Learn about your nearby VA resources

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VA Care A National Model

• Recent media coverage is about access, not
  quality of care
• Better quality outcomes superior to Medicaid and
  private insurance
• Better safety lowest rate of medical errors
• High rates of pt satisfaction

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VA Care

• Electronic records since mid 1980s, used to
  track outcomes (user-made system)
• No incentive to overtreat
• Must plan for long term cant churn pts

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VA Care II

• Systematically looks for and reports its
  mistakes errors more likely to come to public
  attention
• Leader in quality improvement and information
  technology
• Good model for delivery system changes
• (Phillip Longman, Best Care Anywhere Why VA
  Health Care Would be Better for Everyone, 3rd
  Edition, 2012)

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Screening and Structure for Addressing MST

• All vets seen in VA healthcare are asked if they
  experienced MST
• All treatment for physical or mental health
  conditions related to MST is free
• Every VA health care facility has a designated
  MST coordinator who serves as a contact person
  for MST-related issues.

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Conclusion

• Community providers will see many of these pts
• Screening is essential
• Physicians benefit from highly focused training
  modules
• Aggregated resources are not the same as an
  integrated system of care
• Large systems need care managers to guide pt

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• Slides
• www.ebcrp.org