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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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?

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

10. 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

11. 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

12. 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

13. 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

14. 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

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