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

Similar documents
Staci Biggar Criminal Defense Attorney Harris County, Texas

LEGISLATION AFFECTING

Health Education, Advocacy, Linkage Because Human Trafficking is a Public Health Issue HEALTrafficking.org PO Box Los Angeles, CA 90031

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO (Central Courthouse)

IN THE SUPERIOR COURT OF DISTRICT OF COLUMBIA CIVIL DIVISION * * * * * * * * * * * * * * * * * * * * * * *

Comparing Stress Responses to Terrorism in Residents of Two Communities Over Time

Clinical Leadership Arrangements: Leicester Multi-systemic Therapy (MST) and Children s Social Care

Homelessness and Domestic Violence

Sex Crimes: Definitions and Penalties Montana

Webinar. We will start soon TRAUMA-INFORMED CARE, PART 2: THE NUTS AND BOLTS OF IMMIGRATION STORY WRITING INTERVENTION

Guidance on making referrals to Disclosure Scotland

FISCAL YEAR 2012 VA BUDGET

ALASKA STATE LEGISLATURE HOUSE SPECIAL COMMITTEE ON MILITARY AND VETERANS' AFFAIRS March 20, :05 p.m.

Detainee/Former Detainee Assessment and Referral Form

JOB DESCRIPTION. Multi Systemic Therapy Supervisor. 37 hours per week + on call responsibilities. Cambridgeshire MST service JOB FUNCTION

Charlotte County Sheriff s Office

PROHIBITION OF HARASSMENT & DISCRIMINATION

CoC Program Participant Homelessness Verification Form

SAPR Training Supplement

STANDARD OPERATING PROCEDURES FOR VICTIM PROTECTION AND ASSITANCE OFFICE

2. "Artificially administered" means providing food or fluid through a medically invasive procedure.

F.A.O.: The All Party Parliamentary Group on Refugees and the All Party Parliamentary

Training The Next Generation Of Refugee Service Providers Melodie Kinet, M.P.H., M.B.A. Richard Mollica, M.D., M.A.R. Hawthorne Smith, Ph.d.

IL: INCIDENT COMMANDER AT LODD COURT ALLOWS CLAIM FOR PTSD EVEN IF IC HAD NO PHYSICAL INJURY

Unaccompanied Migrant Children

290 hours per year including cover for 24 hour on call rota

PRESENT: Hassell, C.J., Keenan, Koontz, Kinser, Lemons, and Agee, JJ., and Russell, S.J.

Appendix D Title IX Offense Definitions

CURRICULUM VITAE. Rupa M. Khetarpal, LCSW

The Slave Next Door: What Psychologists in New Jersey Need to Know About Human Trafficking

Immigrant Health in the US

Information for Users of Mental Health Services

THE MENTAL HEALTH OF REFUGEES LIVING IN THE US

Iden%fying & Managing The Red Flags of Opioid Misuse

Delivering Culturally Sensitive Traumainformed Services to Former Refugees

Trauma-Informed Care for Work with Refugees & Immigrants

4th Asia World Schools Debating Championship

Nurses United to End Sexual Exploitation and Trafficking of Children By Kelly Martin-Vegue, RN, MSW

STREET OUTREACH COURT A community project of the Washtenaw County criminal justice system and advocates for the homeless.

Person Completing Form: Agency Completing: Date Form Completed:

PROCEDURE ETH-151P-01 EQUAL OPPORTUNITY COMPLAINT INVESTIGATION AND RESOLUTION

10/28/2018. Human Trafficking It IS in your hospital. Elements of Human Trafficking: Force Fraud Coercion. Definition: Human Trafficking

STORIES OF ADAPTATION

WORLD SCHOOLS DEBATING CHAMPIONSHIPS Code of Conduct

ADDRESSING THE MENTAL HEALTH NEEDS OF REFUGEE CHILDREN

Are You Coming To The United States Temporarily To Work Or Study?

AMERICAN BAR ASSOCIATION ADOPTED BY THE HOUSE OF DELEGATES AUGUST 9-10, 2010 RECOMMENDATION

Are You Coming To The United States Temporarily To Work Or Study?

POLICY FOR PREVENTION, PROHIBITION AND REDRESSAL OF SEXUAL HARASSMENT AT THE WORK PLACE

The Mental Health Service Requirements in Ireland for Asylum Seekers, Refugees and Migrants from Conflict Zones.

Justice-Involved Veterans 1 : A decision map of Penal Code section

TARGETED HEALTH CARE SERVICES FOR MIGRANTS WHAT ARE THE NEEDS?

Refugee Health Curriculum University of Colorado School of Medicine

Fair Housing Sexual Harassment

BEGINNING ANEW: Refugees and Asylum Seekers

The Police Response to IPV Chapter 11 DR GINNA BABCOCK

First Regular Session Seventy-second General Assembly STATE OF COLORADO INTRODUCED. Bill Summary

LAW. mcadsv. Missouri Coalition Against Domestic and Sexual Violence

JOB DESCRIPTION. Multisystemic Therapy Supervisor. Newham/Tower Hamlets/Bexley. Family Action DDIR1 DDIR5. 37 hours per week + on call

WHAT S AT STAKE: IMMIGRANT MENTAL HEALTH

Human Trafficking in Scotland The Impact on Survivors Bronagh Andrew

Sexual Assault and Other Sexual Misconduct

NO TALLAHASSEE, September 11, Mental Health/Substance Abuse

Veterans Benefits: Honoring America s Veterans and Caring for Camp Lejeune Families Act of 2012 (P.L )

Policy Prohibiting Sexual Harassment. A. Statement of Policy

VAWA and Other Related Programs Appropriations for Fiscal Years 13, 14, 15 and 16

An Overview of Refugee Mental Health: A Federal Perspective

Human Trafficking (HT)

Case 1:14-cv Document 1 Filed 06/05/14 USDC Colorado Page 1 of 7 IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLORADO

Somali Refugee Women: Empowerment of Self-Sufficiency Program

Guidelines for making a Victim Impact Statement

Unaccompanied Immigrant Youth in Alameda County: Building Communities of Support

MEDICAL ASSISTANCE TO MIGRANTS AND REFUGEES IN GREECE

Addressing the Legal and Mental Health Needs of Undocumented Immigrant Children

Minnesota House of Representatives

F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB

Sample Memorandum for the Plaintiff

Overview on Children of Immigrants

Sex Crimes: Definitions and Penalties Georgia

Types of Programs Fall Conference. Dispute Resolution Center (DRC)

Providing access to Healthcare for Refugees arriving in the UK Dr Peter Gough, Doctors of the World UK

HUMAN TRAFFICKING FOR HEALTHCARE 101. Swedish Pediatric Specialty Care Jan 26,2018

Cornelius Katona ISTM Rome October 2018

THE MENTAL HEALTH OF IMMIGRANTS: RECENT FINDINGS FROM THE OSLO HEALTH STUDY

UNITED STATES DISTRICT COURT DISTRICT OF ARIZONA. Plaintiff Sharolynn L. Griffiths, by and through her undersigned counsel, by way of JURISDICTION

COURT OF APPEALS OF OHIO, EIGHTH DISTRICT

COMPLAINT. Plaintiff, DEANNA HALLIDAY, by and through her undersigned counsel, brings this

Evidence of Coercive Control: Proof of Extreme Cruelty in Immigration Cases and Power and Control Dynamics in Family Law Cases

3/22/2019. Human Trafficking: Realities and Definitions Human trafficking happens in Wisconsin. Here are the facts. Objectives.

Vulnerable groups in Immigration Detention: Mental Health

Women and Displacement

Referred to Committee on Health and Human Services. SUMMARY Revises provisions governing mental health. (BDR )

Oklahoma Statutes Citationized Title 22. Criminal Procedure

Identities, Opportunities and Challenges

FLORIDA OCCUPATIONAL THERAPY ASSOCIATION LEGISLATIVE UPDATE

IN THE COURT OF APPEALS OF THE STATE OF OREGON

Supporting Immigrants Mental Health & Wellness in these Times. Presented by: Cathi Tillman, LSW Corinne Guest, LSW

The University of Texas System. 1. Title. Criminal Background Checks. 2. Policy

Teaching the Refugee Newcomer Student

Operations. Prison Rape Elimination Act Lockup Standards

Transcription:

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

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

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

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) http://www.mentalhealth.va.gov/msthome.asp

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 http://www.mentalhealth.va.gov/msthome.asp http://www.mentalhealth.va.gov/msthome.asp

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 http://www.mentalhealth.va.gov/msthome.asp

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 http://www.mentalhealth.va.gov/msthome.asp

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 1991 1992 1994 1997 1999 2004 US Navy Tailhoo k Incident Passing of Public Law 102- Public Law 102-452 Extensio n Validation letter from Jessie Brown Public Law 106-117 MST Counselin g Act

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)

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)

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)

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

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

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) http://www.mentalhealth.va.gov/msthome.asp

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 http://www.mentalhealth.va.gov/msthome.asp

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

VA Mental Health Treatment for Veterans with MST Screening Per Public Law 103-45, a VA Healthcare Provider is required to complete an MST screening Clinical Reminder in the Medical Record Screening has a positive effect

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

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

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: http://vaww.mst.va.gov

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

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)

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

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

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

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

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.

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)

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

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

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)

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

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

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, 289-303.

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, 749-756. Suris, A., & Lind, L. (2008). A review of prevalence and associated health consequences in veterans. Trauma, Violence, & Abuse, 9, 250-269.