The VA & Military Sexual Trauma Presentation to RVAP Advocates January 20, 2016 Dr. Lauren Welter (MST Coordinator) Barb Duder (Advocate) Range of behaviors

Objectives Understand definition of MST Awareness of VA services available for trauma survivors Know how to make referrals for Veterans Increased awareness of military culture & how it might impact trauma experience and healing

What is Military Sexual Trauma (MST)? VA’s definition of MST comes from Federal law but in general is sexual assault or repeated, threatening sexual harassment that occurred during a Veteran’s military service Can occur on or off base, while a Veteran was on or off duty Perpetrator identity does not matter MST is an experience, not a diagnosis

How Prevalent Is MST? Very difficult to get accurate data DOD Data (2002) – annual prevalence for active duty military personnel Sexual Harassment: 54% among women; 23% among men Sexual Assault: 3% among women; 1% among men VA data (Skinner at al., 2000) (any time during military service) Sexual Harassment: 55% of female veterans Sexual Assault: 23% of female veterans When asked directly, about 1 in 5 women and 1 in 100 men tell their VHA health care provider that they experienced MST Much higher rates of MST in women, but many male Veterans are MST survivors These data speak only to the rate among Veterans who have chosen to seek VA health care Because MST is an experience, not a diagnosis, these data cannot address what percent of those who screened positive need or want treatment

Evolution of DOD Response 1992 definition: Events occurred while on active duty Veterans required to seek counseling within two years of discharge Treatment was limited to one year in duration Current definition: Events occurred while on active duty, active duty for training, or inactive duty for training No “statute of limitations” on seeking of treatment No treatment limitations No requirements to “prove” that MST occurred

VA Response to MST Universal MST screening Free MST-related health care MST Coordinators at every VA medical center National MST Support Team Education and training of staff Outreach to Veterans

Iowa City VA Services for MST Individual therapy Evidence-based treatment, including EMDR (Eye Movement Desensitization Retraining), CPT (Cognitive Processing Therapy), PE (Prolonged Exposure), as well as supportive therapy services Substance abuse treatment – individual, group, partial hospitalization Group Therapy Historically have had an MST survivors group (Not currently offered) Dialectic Behavioral Therapy – Borderline Personality Disorder very common in individuals with trauma history Psychiatric Treatment Inpatient hospitalization for acute suicidality/ substance abuse/psychosis MST Coordinator/point of contact Can help to explore treatment options and the VA system, including intensive/residential treatment State of the Art trauma treatment – FREE FOR MST SURVIVORS

VA Service Connection Process Distinct from MST-related treatment Payments for disabilities related to time in the military Mental & physical health conditions E.g., Hearing/vision loss, care related to blast exposures, PTSD, depression, etc. -Has anyone heard about the VA service connection process? What do you know?

Referrals for MST-related care Dr. Lauren Welter, ICVAHCS Military Sexual Trauma Coordinator (319) 631- 1099

How is MST different? Sexual assault in the military may be more strongly associated with PTSD and other health consequences than is civilian sexual trauma Service members often interdependent Frequently a friend, intimate partner, or other trusted individual Involves a profound violation of boundaries and personal integrity Sends confusing messages about what is acceptable and expected behavior from a trusted other, what rights/needs the victim has, and what is “theirs” versus publicly available

MST May Be Ongoing Over Time In military, fewer boundaries between work and home life Survivors may continue to have interactions with their perpetrator May be ongoing potential for re-victimization Can increase feelings of helplessness and of being trapped Parallels with childhood abuse

Social Support May Be Limited During trauma, may be far from friends and family (i.e., in training, combat, or duty station) Problematic: social support as the most consistent and best predictor of recovery after trauma Negative reactions to disclosure are particularly harmful

Military values strength & self-sufficiency May idealize being strong, tough, and physically powerful or have these as components of their self-identity Victimization may be extremely difficult to accept or understand

Impact of Other Experiences of Trauma Rates of childhood and pre-military trauma are high among MST survivors and military personnel more generally Current Veterans in particular often exposed to combat trauma and constant threat given modern warfare (i.e., terrorism) **Exposure to multiple types/repeated trauma increases the risk of negative mental health outcomes

Referrals for MST-related care Dr. Lauren Welter, ICVAHCS Military Sexual Trauma Coordinator (319) 631- 1099