Heidi J. Koehler, Ph.D., ABPP Clinical Psychologist /MST Coordinator VA North Texas Health care System

Transcription

1 Heidi J. Koehler, Ph.D., ABPP Clinical Psychologist /MST Coordinator VA North Texas Health care System Assistant Professor Department of Psychiatry UT Southwestern Medical Center

2 Outline Definition of MST Breakdown of definition Time-Line of Important Events Risk Factors Unique Features Long-Term Effects VA Mental Health Treatment for Veterans with MST Screening National Rates Rates for VA North Texas Healthcare System Eligibility of Care MH Treatment Options at Dallas VAMC Individual Therapies Group Therapies Psychiatric Care

3 Presentation Objectives 1. Define Military Sexual Trauma (MST) 2. Identify the Risk Factors Associated with MST 3. Explain the Long-Term Effects of MST 4. Describe the VA Mental Health Services Offered to Veterans with MST

4 Definition of MST psychological trauma, which in the judgment of a VA mental health professional, resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the Veteran was serving on active duty, active duty for training, or inactive duty training. Sexual harassment is further defined as "repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character. Federal law (Title 38 U.S. Code 1720D)

5 Definition of MST Breakdown MST can include the following: Physically forced into sexual activies Unable to give consent due to intoxication Pressured into engaging in sexual activities Threatened with negative consequences for refusal to cooperate Promised better treatment in exchange for cooperation

6 Definition of MST Breakdown MST can include the following: Unwanted sexual touching Grabbing Threatening and offensive remarks about one s body or sexual activities Threatening and unwelcome sexual advances

7 Definition of MST Breakdown Perpetrator does not have to be in the military The location of the MST does not matter (can be on or off base) The event may occur during both active and inactive duty to be considered MST by VA standards

8 Definition of MST Important Events First Public Outcry Senate Hearings First Recognition of Services for Women with MST Mandatory MST Screening for all Care for With MST Designated MST Coordinators Veterans Millennium Health Care and Benefits Act Expansion of Services Permanent Authorization to Continue Services at VA US Navy Tailhoo k Incident Passing of Public Law 102- Public Law Extensio n Validation letter from Jessie Brown Public Law MST Counselin g Act

9 Definition of MST Risk Factors In one sample of women studied, 50% had reported their reason for joining the military was to escape home environment Veterans with childhood sexual assault histories have been found to be more likely to be raped as an adult. Female soldiers have been found to have a higher rate of childhood sexual assault than their civilian counterparts. Cited in Suris and Lind (2008)

10 Definition of MST Risk Factors Entry into the military at a younger age Being enlisted rank Less likely to have completed college Cited in Suris and Lind (2008)

11 Definition of MST Unique Features Reside and work along side perpetrators Victims of MST must cope with conflicting messages of being safe versus assault encounters Military Stereotypes conflict with personal experiences of Victimization Holland, Rabelo and Cortina (2014)

12 Definition of MST Unique Features Perpetrator may commanding officer with significant influence on service member s career, evaluations, promotions, etc. Service member may experience alienation from military family (no support or unit cohesion) Service member may feel a report cannot be made especially if perpetrator is a higher rank

13 Definition of MST Unique Features Service member may not wish to seek support due to fears of being seen as weak Male service members may have an especially difficult time reporting due to social stigma Suris et al, 2004

14 Definition of MST Long-Term Consequences Consequence of MST vary and depend upon several factors: Prior history of sexual trauma Response from others at the time of disclosure Frequency of MST Multicultural gender, race, and sexual orientation for example)

15 Definition of MST Long-Term Consequences Strong Emotions Feelings of Numbness Trouble Sleeping Difficulties with Attention, Concentration and Memory Substance Abuse Difficulties with reminders of the MST and relationships Physical Health Problems

16 Definition of MST Long-Term Consequences Veterans who experience a Military Sexual Trauma may develop the following psychological problems : Posttraumatic Stress Disorder Major Depressive Disorder Increase Substance Use

17 VA Mental Health Treatment for Veterans with MST Screening Per Public Law , a VA Healthcare Provider is required to complete an MST screening Clinical Reminder in the Medical Record Screening has a positive effect

18 VA Mental Health Treatment for Veterans with MST Screening The MST Screen consists of two questions While you were in the military, did you ever receive uninvited or unwanted sexual attention? (i.e., touching, cornering, pressure for sexual favors or inappropriate verbal remarks, etc.)? While you were in the military, did anyone ever use force or threat of force to have sex against your will? Yes to either question is a positive Screen The patient can decline the screen and can further decline follow-up to a positive screen

19 VA Mental Health Treatment for Veterans with MST National Rates 1 in 4 Female Veterans seeking care at VA facility 1 in 100 Male Veterans seeking care at a VA facility

20 MST Prevalence North Texas Healthcare System FY2013 Total Screened 97,677 (99.0%) Total Screened Positive 2,889 (3.0%) Total Women Screened 7,554 Total Men Screened 90,123 Number of Women 1830 (24.2 %) Men 1,059 (1.2%) Source:

21 VA Mental Health Treatment for Veterans with MST Eligibility No Service Connection required No required reporting while on active duty A Veteran may be able to receive MST services even if he or she is not eligible for other VA care

22 VA Mental Health Treatment for Veterans with MST Eligibility Any VA Medical Facility Readjustment Counseling Service Vet Center Veterans Benefit Office If MST services are not available at site, federal law requires VA to pay for service in community Treatment is FREE (counseling, medication, related procedures)

23 WSD/MST: Programmatic Overview Established in February 22, 2006 Founding member Alina Surís, Ph.D, ABPP Comprehensive Team Psychiatrists, Psychologists, Master s level Social Worker NEPEC monitored as a specialty PTSD program Mission Clinical, Research, and Education

24 VA Mental Health Treatment for Veterans with MST MH Treatment of MST at the Dallas VAMC Women s Stress Disorder and MST Program

25 Women s Stress Disorders and MST Program MH Access MH Copper MH Platinum MH Gold MH Silver MHTS WSD/MST OEF/OIF PCT

26 Referrals to the Program Access clinic when the veteran is enrolled for MH services at the Dallas VA MH Treatment Teams other MH treatment teams may refer their patients to the program for specific treatment of MST (male and female veterans) or war zone exposure, non-combat related traumas, non-military sexual assaults (female veterans only) Other providers within the VA North Texas Health Care System may also refer veterans for MST treatment

27 Military Sexual Trauma Evaluation The patient is given an appointment to meet with the assigned provider. The patient is sent an Intake packet and asked to complete it prior to the appointment.

28 Intake Form MH Trauma Services Program Intake Form Standard Intake questions are included in the intake Military History Detail Account of Sexual Trauma History (includes trauma accounts from childhood, MST and adult civilian)

29 Military Sexual Trauma Evaluation The evaluation will result in the following: Diagnoses DSM 5 Treatment Recommendations Patient s treatment recommendations based on the results of the clinical interview, testing and goals for treatment Written Report within the patient s VA medical file

30 Treatment Options There are several treatment options offered through the Women s Stress Disorder and Military Sexual Trauma program Group Therapy Individual Therapy Medication Management

31 Treatment Options Individual Therapy Individual therapy is available and included the following types: Cognitive Processing Therapy Prolonged Exposure Dialectical Behavior Therapy Acceptance Commitment Therapy Supportive Therapy (Time-Limited)

32 Treatment Options Group Therapy Group therapy is available and included the following types: Structured MST Education DBT Pre-Treatment Skills Gateway Group Managing Mood

33 Treatment Options GroupTherapy - Process Women s MST Support Group Men s MST Support Group Women s Support Group

34 References Holland, K. J., Rabelo, V. C. & Cortina, L. M. (2014). Sexual Assault Training in the Military : Evaluating Efforts to End the Invisible War. American Journal of Community Psychology, 54,

35 References Suris, A., Lind, L., Kashner, T. M., Borman, P., & Petty, F. (2004). Sexual assault in women veterans: An examination of PTSD risk, health care utilization, and cost of care. Psychosomatic Medicine, 66, Suris, A., & Lind, L. (2008). A review of prevalence and associated health consequences in veterans. Trauma, Violence, & Abuse, 9,