Addressing Military Sexual Trauma in a Community Setting

Joan E. Zweben, Ph.D.Executive Director, East Bay Community Recovery

ProjectClinical Professor of Psychiatry, UCSF

Staff Psychologist, VA Medical Center, San Francisco

ASAM Med Sci – Chicago - 2013

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

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.”

Total Victim Reports

Gender Breakdown

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

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

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

Watching for MST–Related DistressPower 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 Re–experiencing Dissociation

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

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

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)

Addressing Military Sexual Trauma in an Integrated Care Setting

Learn about your nearby VA resources

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

VA Care Electronic records since mid

1980’s, used to track outcomes (user-made system)

No incentive to overtreat Must plan for long term; can’t

churn pts

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)

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.

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

Slides

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