finlay bwjp presentation 07 28 16 … · 6 fewer women were receiving homeless services or were...

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Andrea Finlay, PhDHSR&D Career Development Awardee

Center for Innovation to Implementation (Ci2i)VA Palo Alto Health Care System

Instructor (Affiliated)Department of Medicine and Division of General Medical Disciplines

Stanford University School of MedicineAffiliated Researcher

National Center on Homelessness Among VeteransDepartment of Veterans Affairs

July 26, 20161

Disclosures Employed and funded 100% by the Department of Veterans Affairs.

No other disclosures.

Funding Sources:Health Services Research & Development (HSR&D) Career Development Award (CDA 13‐279, PI: Finlay) HSR&D Research Career Scientist (RCS 14‐132, PI: Harris)HSR&D Senior Research Career Scientist (RCS 00‐001, PI: Timko)Women’s Health Evaluation Initiative (PI: Frayne)

Role of the funding source: The views expressed in this presentation are those of the authors and do not necessarily reflect the position nor policy of the Department of Veterans Affairs (VA) or the United States government.

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Vulnerable populations have more difficulty accessing and using health care

General population Racial/ethnic minority groups

Low socioeconomic backgrounds

Disabilities

Justice‐involved adults Courts

Jail

Prison

Probation/parole

Alegria et al., 2008; Binswanger et al., 2011; Bristow et al., 2013; Guerrero et al., 2013; Krahn et al., 2015. 3

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Veterans who have difficulty accessing or using health care

Women veterans

Veterans in rural areas

Homeless veterans

Justice‐involved veterans

Photo: http://www.military.com/benefits/veteran‐benefits/incarcerated‐veterans.html

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Difficulty accessing VA services among justice‐involved veterans

5

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Any VA service Mental health Residential Medical/surgical

Jailed veterans Homeless veterans

McGuire et al., Psych Serv, 2003

Among Veterans involved in the criminal justice system are there gender differences in:

Mental health and substance use disorder condition diagnosis rates

Treatment use

Research Question

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Women in the criminal justice system more likely to be physically/sexually abused as children and as adults than men

Criminal activity may differ by gender Prostitution Drug use while committing offense

Different health treatment needs?

Lewis, 2006; Messina et al., 2006;

U.S. Department of Justice, 1999

Reasons for Expecting Gender Differences

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99% reported nonmilitary trauma

68% reported lifetime sexual assault

38% served in a combat zone Of those, 90% reported combat trauma

58% reported being sexually assaulted while in military

Stainbrook et al., 2015

Trauma experiences among female veterans in jail are common

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General incarcerated population 44% of women and 22% of men had mental health condition

59% of women and 53% of men had a drug dependence condition

37% of women and 48% of men had alcohol dependence

Veterans involved in criminal justice system Unknown gender differences 43‐54% self‐report a mental health condition 57‐61% self‐report a substance use disorder condition

Binswanger et al., 2010; Noonan & Mumola, 2007

Previous Research

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4

− Prisons

~63,000+ served

− Jails− Courts− Law enforcement

~87,000+ served

Veterans Justice Programs

Veterans Justice Outreach

Health Care for Re‐Entry Veterans

10Photo: http://www.justiceforvets.org/sites/default/files/images/Orange%20County%20200.jpg

1,621 women and 34,737 men were seen by Veterans Justice Outreach Specialists in FY2010‐2012

4%

96%

Women

Men

Finlay et al., Medical Care, 201511

Women are younger than men

4%

26%23%

34%

12%

4%

19%

13%

30%33%

< 25 25‐34 35‐44 45‐54 55+

0%

10%

20%

30%

40%

50%

60%

Age


5

Most justice-involved veterans areBlack/African American or White

1% 1%

32%

58%

6%1% 1%

32%

59%

7%

0%

10%

20%

30%

40%

50%

60%

AmericanIndian/

Alaskan Native

Asian AfricanAmerican/

Black

White Hispanic


15%

41% 42%

2%

21%

40%37%

2%

0%

10%

20%

30%

40%

50%

60%

Married Single Divorced/Separated

Widowed

Fewer women were married than men


21% of women and men live in rural areas

21% 21%

Rural

0%

10%

20%

30%

40%

50%

60%

Women

Men


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Fewer women were receiving homeless servicesor were at-risk for homelessness than men

19%

24%

Homeless services

0%

10%

20%

30%

40%

50%

60%

Women

Men


More than 20% served inIraq or Afghanistan (OEF/OIF/OND)

21%23%

0%

10%

20%

30%

40%

50%

60%

Iraq or Afghanistan veterans

Women

Men


42%

22%

36%

53%

21%

27%

0%

10%

20%

30%

40%

50%

60%

None < 50% service‐connected

≥ 50% service‐connected

Women

Men

More women havea service-connected disability than men


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7

Outreach efforts are effectiveat connecting veterans with VA health care


95%88%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

VA contact after outreach

Women

Men

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Mental health disorders are more common among womenand substance use disorder are less common than among men

88%

58%

76%72%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Mental health disorders Substance use disorders

Women

Men


67%

51%

33%

21%

8%

20%

55%

36%

22%

10% 8% 9%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Women Men

Mental Health Disorders are Common


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41%

12%

20%

7%

17%

32%

58%

13%

26%

6%

20%

36%

0%

10%

20%

30%

40%

50%

60%

70%Women Men

Substance Use Disorders are Common


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Most women and men entered primary care,mental health care, and substance use disorder care

89%98%

71%

85%

97%

70%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Primary care Mental health outpatient Substance use disorderoutpatient

Women Men

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Most women and men hada similar number of outpatient visits

5

36

31

5

30 31

0

5

10

15

20

25

30

35

40

Primary care Mental healthoutpatient

Substance use disorderoutpatient

Average number of visits

Women Men

24

9

Women had lower odds of enteringmental health residential care than men

10%12%13%

11%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Mental health residential Substance use disorderresidential

Women Men

25

Most women and men hada similar number of days in residential care

84

42

86

36

0

10

20

30

40

50

60

70

80

90

100

Mental healthresidential days

Substance use disorderresidential days

Average number of days

Women Men

26

Women had higher odds of receivingpharmacotherapy for alcohol use disorder than men

22%

18%

10%

20%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Pharmacotherapy foralcohol use disorder

Pharmacotherapy foropioid use disorder

Women Men

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10

Substantial burden of mental health and substance use disorder conditions in both women and men

Tailoring available services to women

Outreach to women Veterans involved with the justice system

Improve receipt of pharmacotherapy for alcohol and opioid use disorders

Summary/Implications

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Questions?

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Contact information:

Andrea Finlay

[email protected]

Center for Innovation to Implementation (Ci2i): http://www.hsrd.research.va.gov/centers/ci2i.cfm

Center for Innovation to Implementation Veterans Justice ProgramsSusan Frayne Joel Rosenthal Alex Sox‐Harris Jessica Blue‐Howells Christine Timko Sean Clark Steve Asch Jim McGuire Tom Bowe

Kaiser Permanente CHOIRIngrid Binswanger David Smelson

Acknowledgements

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References CitedAlegria, M., Chatterji, P., Wells, K., Cao, Z., Chen, C., Takeuchi, D., Jackson, J., & Meng, X.‐L. (2008). Disparity in depression

treatment among racial and ethnic minority populations in the United States. Psychiatric Services, 59, 1264‐1272.

Binswanger, I. A., Merrill, J. O., Krueger, P. M., White, M. C., Booth, R. E., & Elmore, J. G. (2010). Gender differences in chronic medical, psychiatric, and substance‐dependence disorders among jail inmates. American Journal of Public Health, 100, 476‐482.

Binswanger, I. A., Redmond, N., Steiner, J. F., & Hicks, L. S. (2011). Health disparities and the criminal justice system: An agenda for further research and action. Journal of Urban Health, 89, 98‐107.

Blue‐Howells, J. H., Clark, S. C., van den Berk‐Clark, C., & McGuire, J. F. (2013). The US Department of Veterans Affairs Veterans Justice Programs and the sequential intercept model: case examples in national dissemination of intervention for justice‐involved veterans. Psychological Services, 10(1), 48‐53. doi: 10.1037/a0029652

Bristow, R. E., Powell, M. A., Al‐Hammadi, N., Chen, L., Miller, J. P., Roland, P. Y., Mutch, D. G., & Cliby, W. A. (2013). Disparities in ovarian cancer care quality and survival according to race and socioeconomic status. Journal of the National Cancer Institute, 105, 823‐832.

Bronson, J., Carson, A., & Berzofsky, M. (2015). Veterans in prisons and jail, 2011‐12. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics.

Elbogen, E. B., Johnson, S. C., Newton, V. M., Straits‐Troster, K., Vasterling, J. J., Wagner, H. R., & Beckham, J. C. (2012). Criminal justice involvement, trauma, and negative affect in Iraq and Afghanistan war era veterans. Journal of Consulting and Clinical Psychology, 80(6), 1097‐1102.

Finlay, A. K., Binswanger, I. A., Smelson, D., Sawh, L., McGuire, J., Rosenthal, J., Blue‐Howells, J., Timko, C., Blodgett, J. C., Harris, A. H. S., Asch, S. M., & Frayne, S. (2015). Sex differences in mental health and substance use disorders and treatment entry among justice‐involved veterans in the Veterans Health Administration.Medical Care, 53, S105‐S111.

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References CitedGuerrero, E. G., Marsh, J. C., Duan, L., Oh, C., Perron, B., & Lee, B. (2013). Disparities in completion of substance

abuse treatment between and within racial and ethnic groups. Health Research and Educational Trust, 1450‐1467.

Krahn, G. L., Walker, D. K., & Correa‐De‐Araujo, R. (2015). Persons with disabilities as an unrecognized health disparity population. American Journal of Public Health, 5, S198‐S206.

Lewis, C. (2006). Treating incarcerated women: Gender matters. Psychiatric Clinics of North America, 29, 773‐789.

McGuire, J., Rosenheck, R. A., & Kasprow, W. J. (2003). Health status, service use, and costs among veterans receiving outreach services in jail or community settings. Psychological Services, 54 (2), 201‐207.

Messina, N., Burdon, W., Hagopian, J. D., & Prendergast, M. (2006). Predictors of prison‐based treatment outcomes: A comparison of men and women participants. The American Journal of Drug and Alcohol Abuse, 32, 7‐28.

Noonan, M. E., & Mumola, C. J. (2007). Veterans in state and federal prison, 2004. Retrieved from the Bureau of Justice Statistics website: http://bjs.gov/content/pub/pdf/vsfp04.pdf

Rieckhoff, P., Schliefer, J., & McCarthy, M. (2012). IAVA 2012 member survey. New York: Iraq and Afghanistan Veterans of America. Retrieved April 5th, 2013 from http://iava.org/iavas‐2012‐member‐survey

Stainbrook, K., Hartwell, S., James, A. (2015). Female veterans in jail diversion programs: Differences from and similarities to their male peers. Psychiatric Services.

Tsai, J., Rosenheck, R. A., W, J. K., & McGuire, J. F. (2013). Risk of incarceration and other characteristics of Iraq and Afghanistan era veterans in state and federal prisons. Psychiatr Serv, 64(1), 36‐43. doi: 10.1176/appi.ps.201200188

U.S. Department of Justice (1999). Women offenders. Bureau of Justice Statistics Special Report (NCJ 175688). Washington DC: Author.

Wortzel, H. S., Blatchford, P., Conner, L., Adler, L. E., & Binswanger, I. A. (2012). Risk of death for veterans on release from prison. Journal of the American Academy of Psychiatry and Law, 40(3), 348‐354.

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Women Veterans Involved in the Justice System: The need for gender‐specific

considerations

Matthew Stimmel, PhD

Clinical Psychologist

Veterans Justice Outreach Specialist

Veterans Justice Programs

VA Palo Alto Health Care System

VETERANS HEALTH ADMINISTRATION

Disclosures

• Employed by VA Palo Alto Health Care System

• Information in this slides does not reflect endorsement of VHA or VAPAHCS

• No other disclosures or conflicts of interest

• No financial compensation or funding


Veterans in custody

• 9% of population

• 8% of prison population

• 7% of jail population

• BUT, greater number of violent offenses

• 48‐55% have mental illness (more common in combat veterans)

• Women Veterans– 1% ‐3.2% of incarcerated Veteran population

– 7.3% 13.4% of general incarcerated population

(Berzofsky, et al., 2015)

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Women in jails/prison

• 14 % of total jail population, but from 1999‐2013 population of women in local jails increased 48% (68,100‐ 100,940) compared to 17% increase for males (Brumbaugh et al., 2015).

• Reasons?– Relabeling of offenses

– Changes in tolerance of antisocial behavior among women

– Changes in approach to IPV/DV arrest policies

• Recent research suggest rates of IPV equal among genders (e.g., Magdol, et al., 1997; Nicholls, Brink, et al., 2009)


Gendered pathway?

• Pathway through juvenile offending

• Disproportionate increases in all arrest categories of female adolescent offending ‐ e.g. 187% for drug offenses (Tracy, Kempf‐Leonard, &

Abramoske‐James, 2009) from 1985‐2005

• Harsher sentences for female juvenile offenders (Carr, Hudson, Hanks, & Hunt, 2008)

• Same for women veterans?

• Childhood victimization, dysfunctional intimate relationship, adult victimization, and lack of psychosocial support contributing to PTSD, mental health disorders and substance use. (Salisbury & Van Voorhis, 2009).

• Relational in nature


Trauma

• As many as 55% of incarcerated women have experienced physical or sexual abuse in their lifetime and 41% have been diagnosed with

lifetime post‐traumatic stress disorder (PTSD; Osher & Steadman, 2007)

• Estimated 30% of incarcerated women experience trauma within correctional settings (Wolff & Shi, 2010)

• As with trauma exposure in the general and Veteran population, justice‐involved men experience higher rates of physical assault, while justice‐involved women experience higher rates of sexual victimization (Beck & Harrison, 2008; Wolff, Blitz, Shi, Bachman, & Siegel, 2006; Wolff & Shi, 2010).

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Outcomes of Trauma• Female inmates have higher levels of maltreatment as adults than male

counter parts

• Negative outcomes more frequent than males (e.g., PTSD, depression, SUD) (Drapalsky, Youman, Stuewig, & Tangney, 2009 )

• Greater incidence of relapse post‐ release (McClellan, Farabee, & Crouch, 1997).

• Physical health outcomes: – head injury

– pelvic inflammatory disease

– general physical symptoms (e.g., chest pain, heart palpitations, shortness of breath, muscle/joint pain) (Harner et al., 2013)

• Affect dysregulation


Relevance of Affect Dysregulation

• Outcomes:

– Juvenile Offenders: Violence and risk taking (Miller, Vachon, &

Aalsma, 2012 )

– Adults: Poor health, co‐morbidity and substance abuse, recidivism (Black, Gunter, Allen, et al., 2007)

– High drop out rates in treatment

– Safety risks in treatment settings

– Impairments increase after incarceration, including behavioral dysregulation (Cole et al., 2007; Islam‐Zwart, Vik, & Rawlins, 2007)

– Key feature of personality disorders


Veteran Women in jails/prisons

• Similar profile of general population with additional risk factors:– MST

– Combat exposure

– Childhood trauma (83‐91% at least one traumatic exposure in their life) (Zinzow, Grubaugh, Monnier, Suffoletta‐Maierle, & Frueh, 2007

– PTSD 27%‐60% depending on type of trauma (Yaeger, Himmelfarb, Cammack, &

Mintz, 2006)

• Limited data on incarcerated women Veterans (thank you Andrea!)– High rates of Mental health disorders (88% total)

– PTSD: 51% (Finlay et al., in press)

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Gender-specific risk factors• Assessment is key!

• Past history:

– Prostitution

– Parenting difficulties

– Pregnancy at a young age

– Suicide attempt/self harm (internalizing)

• Future risk concerns:

– Problematic child care responsibilities

– Problematic intimate relationships

• Clinical:

– Covert or manipulative/relational behavior

– Low self‐esteem (internalizing)(FAM; Vogel, et al., 2012)


Gender Responsive Treatment

• Consider criminogenic needs but from gender‐responsive perspective:

– Trauma informed care:

• “a strengths‐based framework that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and empowerment” (Hopper, Bassuk, & Olivet, 2010, p.133)

– Address gender‐specific factors

– Address intersection with Veteran specific factors (e.g., MST)


Treatment examples

• Helping Women Recover (Covington, 1999)

• VOICES (ages 12‐24; Covington, 2012)

• DBT (Berzins & Trestman, 2004)

• Seeking Safety (Najavits, 1998)

• TARGET (Ford et al., 2013)

(Please note these are not specific recommendations or endorsements, just examples that treatment is beginning to shift towards gender informed models, with mixed amounts of research supporting their efficacy)

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Clinical experience

• Relevant issues:– CSA

– Disrupted families of origin

– Childcare

– MST

– Combat exposure

– Custody

– Prostituion

– IPV


Conclusions

• Continued emphasis on gender‐informed risk assessment and treatment planning.

• Continued emphasis on gender‐informed care focusing on prevalence of victimization, co‐morbidity and the impact of affect regulation on behavioral outcomes and interpersonal functioning.

• Expanding research base on women Veterans within criminal justice system.

• For women in Veteran Treatment Courts importance of women mentors


References Cited

Beck, A. J., & Harrison, P. M. (2008). Sexual victimization in state and federal prisons reported by inmates, 2007: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics.

Berzins, L. G., & Trestman, R. L. (2004). The development and implementation of dialectical behavior therapy in forensic settings. International Journal of Forensic Mental Health, 3(1), 93‐103.

Berzofsky, M., Bronson, J., Carson, E.A., & Noonan, M (2015). Veterans in prison and jail, 2011‐2012. Retrieved

from the Bureau of Justice Statistics website: http://www.bjs.gov/index.cfm?ty=pbdetail&iid=5479

Black, D.W., Gunter, T., Allen, J…& Sieleni, B. (2007). Borderline personality disorder in male and female offenders newly committed to prison. Comprehensive Psychiatry, 48(5), 400‐405. doi: 10.1016/j.comppsych.2007.04.006

Brumbaugh, S.M., Ginder, S., Minton, T.D., Rohloff, H., & Smiley‐McDonald, H., (2015). Census of jails:

Population changes, 1999‐2013. Retrieved from the Bureau of Justice Statistics website: http://www.bjs.gov/index.cfm?ty=pbdetail&iid=5480

Carr, N. T., Hudson, K., Hanks, R. S., & Hunt, A. N. (2008). Gender effects along the juvenile justice system

evidence of a gendered organization. Feminist Criminology, 3(1), 25‐43.

Cole, K.L., Sarlund‐Heinrich, P., & Brown, L. (2007). Developing and assessing

effectiveness of a time‐limited therapy group for incarcerated women survivors of childhood sexual abuse. Journal of Trauma and Dissociation, 8(2), 97–121. doi: 10.1300/J229v08n02_07

Covington, S. S. (1999). Helping women recover: A program for treating substance abuse, special edition for use in the criminal justice system. San Francisco: CA: Jossey‐Bass.

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References Cited

Covington, S. (2012). Curricula to support trauma‐informed practice with women. In N. Poole, & L. Greaves (Eds). Becoming trauma informed. Toronto, Ontario, Canada: Centre for Addiction and Mental Health (CAMH).

De Vogel, V., de Vries Robbé, M., Van Kalmthout, W., & Place, C. (2012). Female Additional Manual (FAM).

Additional guidelines to the HCR‐20 for assessing risk for violence in women. English version. Utrecht

Drapalski, A.L., Youman, K., Stuewig, J., & Tangney, J. (2009). Gender differences in

jail inmates’ symptoms of mental illness, treatment history and treatment seeking. Criminal Behaviour and Mental Health, 19(3), 193‐206. doi: 10.1002/cbm.733

Finlay, A. K., Binswanger, I. A., Smelson, D., Sawh, L., McGuire, J., Rosenthal, J., Blue‐Howells, J., Timko, C.,

Blodgett, J. C., Harris, A. H. S., Asch, S. M., & Frayne, S. (in press). Gender differences in mental health and substance use disorders and treatment entry among justice‐involved veterans in the Veterans Health Administration.Medical Care.

Harner, H.M., Budescu, M., Gillihan, S.J., Riley, S., & Foa, E.B. (2013). Posttraumatic

Stress Disorder in Incarcerated Women: A Call for Evidence‐Based Treatment. Psychological Trauma: Theory, Research, Practice, and Policy. doi: 10.1037/a0032508

Ford, J.D., Chang, R., Levine, J., & Zhang, W. (2013). Randomized clinical trial

comparing affect regulation and supportive group therapies for victimization‐related PTSD with incarcerated women. Behavior Therapy, 44, 262‐276.


References Cited

Hopper, E. K., Bassuk, E. L., & Olivet, J. (2010). Shelter from the storm: Trauma‐informed care in homelessness services settings. The Open Health Services and Policy Journal, 3, 80‐100.

Islam‐Zwart, K.A., Vik, P.W., & Rawlins, K. (2007).Short‐term psychological

adjustment of female prison inmates on a minimum security unit. Women's Health Issues, 17, 237–243. doi: 10.1016/j.whi.2007.02.007

McClellan, Farabee, & Crouch, 1997. Early victimization, drug use, and criminality: A comparison of male and female prisoners. Criminal Justice and Behavior, 24(4), 455‐476. doi: 10.1177/0093854897024004004

(NL): Van der Hoeven Kliniek.

Magdol, L., Moffitt, T. E., Caspi, A., Newman, D. L., Fagan, J., & Silva, P. A. (1997). Gender differences in partner

violence in a birth cohort of 21 years olds: Bridging the gap between clinical and epidemiological approaches. Journal of Consulting and Clinical Psychology, 65, 68–78. doi: 10.1037/0022‐006X.65.1.68

Miller, D.J., Vachon, D.D., & Aalsma, M.C. (2012). Negative affect and emotion dysregulation: Conditional relations with violence and risky sexual behavior in a sample of justice‐involved adolescents. Criminal Justice and Behavior, 39(10), 1316‐1327. doi: 10.1177/0093854812448784

Nicholls, T. L., Brink, J., Greaves, C., Lussier, P., & Verdun‐Jones, S. (2009). Forensic psychiatric inpatients and

aggression: An exploration of incidence, prevalence, severity, and interventions by gender. International Journal of Law and Psychiatry, 32, 23–30. doi.org/10.1016/j.ijlp.2008.11.007


References Cited

Najavits, L. M., Weiss, R. D., Shaw, S. R., & Muenz, L. R. (1998). “Seeking safety”: Outcome of a new

cognitive‐behavioral psychotherapy for women with posttraumatic stress disorder and substance dependence. Journal of Traumatic Stress, 11(3), 437‐456.

Osher, F. C., & Steadman, H. J. (2007). Adapting evidence‐based practices for persons with mental illness

involved with the criminal justice system. Psychiatr Serv, 58(11), 1472‐1478. doi: 10.1176/appi.ps.58.11.1472

Salisbury, E.J., & Van Voorhis, P. (2009). Gendered pathways: A quantitative investigation of women probationers’ paths to incarceration. Criminal Justice and Behavior, 36(6), 541‐566. doi: 10.1177/0093854809334076

Tracy, P. E., Kempf‐Leonard, K., & Abramoske‐James, S. (2009). Gender differences in delinquency and juvenile

justice processing evidence from national data. Crime & Delinquency, 55(2), 171‐215.

Wolff, N., Blitz, C. L., Shi, J., Bachman, R., & Siegel, J. A. (2006). Sexual violence inside prisons: rates of

victimization. J Urban Health, 83(5), 835‐848. doi: 10.1007/s11524‐006‐9065‐2

Wolff, N., & Shi, J. (2010). Trauma and incarcerated persons. In C. L. Scott (Ed.), Handbook of Correctional

Mental Health (2nd ed., pp. 277‐320). Arlington, VA: American Psychiatric.

Yaeger, D., Himmelfarb, N., Cammack, A., & Mintz, J. (2006). DSM‐IV diagnosed posttraumatic stress disorder in

women veterans with and without military sexual trauma. J Gen Intern Med, 21 Suppl 3, S65‐69. doi: 10.1111/j.1525‐1497.2006.00377.x

Zinzow, H. M., Grubaugh, A. L., Monnier, J., Suffoletta‐Maierle, S., & Frueh, B. C. (2007). Trauma among female

veterans: a critical review. Trauma Violence Abuse, 8(4), 384‐400. doi: 10.1177/1524838007307295

1

Justice Eileen MooreAssociate Justice

California’s 4th District Court of Appeal

California Judicial MST GuideWhat judges should know about MST

• Definition of MST comes from 38 USC § 1720D, but in general it is sexual assault or repeated threatening, sexual harassment that occurred during a veteran’s military service

• MST is an experience, not a diagnosis

• Both men & women experience MST

• Among some Veterans, MST is associated with: Suicide Both mental & physical health problems, even decades later Drinking & drug use Aggressive outbursts Confusing, sometimes reckless, behaviors Decrease in normal coping strategies Male victims questioning their sexual identity

• An MST history can affect response to court-ordered programs

• MST victims suffer with power & control issues

• MST is frequently underreported; victims are often reluctant to disclose

California Judicial MST GuideEvery VA healthcare facility provides treatment for mental and physical health conditions related to MST, even if not reported at the time of occurrence; Veterans do not need documentation of their experiences or to have a VA disability rating to receive treatment

The Veterans Health Administration [VHA]1outpatient, inpatient and residential services for treatment related to MST

• A vet just asks for treatment for MST & it will be given

• All treatment for MST is provided free of charge

• Every VA facility has an MST Coordinator to assist in accessing care. Veterans with questions about eligibility or other issues that might interfere with accessing services should contact the facility MST Coordinator to discuss possibilities

• VHA Vet Centers4may be a good option for active duty personnel who wish to keep treatment confidential from the Department of Defense [DOD]

• Most VHA Vet Centers are staffed by veterans; treatment is provided in a non hospital environment

• Vet Centers DO NOT share their treatment records with the DOD

finlay bwjp presentation 07 28 16 … · 6 fewer women were receiving homeless services or were...

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