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
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Over 1 million active military are
returning to the US
Many will not seek help at the VA
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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
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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
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“If you ask, they will answer”
Create comfortable climate for
disclosure
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Private setting
Minimize interruptions
Nonjudgmental posture
Use unhurried speech
Maintain good eye contact
Screening II
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Often done by nurse or PCP
Ask specific questions
Heightened issues for women in maledominated setting such as the VA
Manage/limit the disclosure process
Assess current status and safety
Watching for MST–Related
Distress
Power 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:
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Anxiety
Angry outbursts
Irritability
Avoidant behavior
Re–experiencing
Dissociation
Health Problems and MST
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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
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Make the medical encounter as safe as
possible:
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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
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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
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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
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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
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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
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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
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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
www.ebcrp.org