addressing military sexual trauma in a community setting
DESCRIPTION
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. Introduction. - PowerPoint PPT PresentationTRANSCRIPT
Addressing Military Sexual Trauma in a Community Setting
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.”
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 - IScreening - 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 IIScreening 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 DistressWatching 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 MSTHealth 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 EncounterManaging 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 TreatmentsEffective 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 ModelVA 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 MSTScreening 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.
ConclusionConclusion 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