Improving health care for veterans has become a matter of national attention and has gained increasing attention from the medical community. With the current surge of veterans reintegrating into civilian society it is critical to improve the training of the next cadre of providers who will provide care for our veterans. It is widely known that veterans receive care in all aspects of the health system, thus providers in veteran focused care facilities, military health serves and civilian locals must be aware of the unique needs of veterans. It is perhaps even more important to educate civilian providers who may be unfamiliar with the unique physical, mental and emotional needs related to military service. Course Audience - all health professions learners, example: - medical students, resident physicians, dental students, - nursing students, advanced practice nurses, - social work, pharmacy student as graduate level learners - as well as any and all health professionals interested in veteran-centered care What You Will Learn: This course will provide learners the opportunity to engage with material to facilitate their understanding of the origins of Academic Medical Centers and Veterans Administration affiliations, recognize and manage the influence of bias, class, and power on the clinical encounter and self-reflect on their biases that particularly affect U.S. military veterans. This course also features several video clips from the acclaimed documentary, Where Soldiers Come From, directed by Heather Courtney. The views expressed in this course are those of the authors and do not necessarily reflect the position or the policy of the Department of Veterans Affairs or the U.S. government.
05.01 - Screening for Sexual Trauma
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Из курса от партнера University of Michigan
Service Transformed: Lessons in U.S. Veteran Centered Care
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Unit 5
Unit 5 allows learners to use everything they have learned and apply those principles to improving assessment and triage skills for patients with post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) and identifying anxiety and depression.
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Monica Lypson, M.D., M.H.P.E.Associate Chief of Staff for Education, Ann Arbor Veterans Affairs Healthcare System and Professor of Internal Medicine and Learning Health Sciences
University of Michigan Medical School
Paula Ross, Ph.D.Director, Advancing Scholarship and Medical Sociologist
Office of Medical Student Education
Welcome back as always to Service Transforms Lessons and
Veterans Center Care.
We're here for unit five, and in unit five we're gonna focus on screening for
sexual trauma and the issues related to reintegration for military service people.
We really wanna understand how trauma or
reintegration really affects those who come back, and
how that might impact veteran-centered care in the future.
Segment one, Military Sexual Trauma.
Military sexual trauma is something that's been in the news quite a bit, and
it's really defined as a sexual assault that's been repeated, threatening, or any
type of sexual harassment that occurred during a veteran's military service.
It can occur on or off base, on or
off duty, and who the perpetrator is does not matter.
It's an experience and not a diagnosis.
The important thing to really understand about military sexual
trauma is one would assume that this affects women mostly.
And it's true that over 6% of women report unwanted sexual
contact from the Department of Defense surveys,
but that also includes 1% of men who are in the military.
And one must understand that of those who screen positive for
military sexual trauma within the VA, 54% of those people are men.
And military sexual assault reporting because there's been a real
emphasis on it from the Department of Defense, also by civilian resources,
reporting has increased 50% between say, fiscal year 12 and fiscal year 13.
So when we hear about military sexual trauma,
there are really compelling stories regarding its impact.
You'll watch two very short videos, about and
from veterans as they talk about their experience with that type of trauma.
So when one wants to think about how do you go about screening for these issues,
there's two questions that you can ask on any introductory visit and those could be.
And this is for any patient, whether they have experienced military service or not.
You really wanna ask everyone,
has anyone ever touched you in a sexual way that made you uncomfortable?
And have you had an unwanted sexual experience?
Those are two questions that are screening for everyone.
The way that you actually might make that more specific as to addressing a veteran
or someone who's active duty, you will then ask, and the way you change that is,
when you were in the military did you ever receive unwanted, threatening,
or repeated sexual attention, and when you were in the military,
did you have sexual contact against your will or when you ere unable to say no?
And again, we know that for you as a health professional or
a health professional trainee, issues around unwanted sexual assault and
sexual contact are in the news, and
these are good screening questions that you should be asking all of your patients.
Here is a sample questionnaire that the military and
the Department of Defense use either at intake or in various ways in order to
get more details about how an experience or an assault might have occurred.
And you can read the questions here on the slide.
Again, there's more specific issues, but the two questions we
talked about before allow you to see, do you need to do a deeper dive, and
one of interesting, if you look at question seven here is, sometimes you'll
actually find a history of abuse that actually predates military service.
But you also want to know about childhood sexual trauma.
Again, these are questions that you wanna ask everyone and
you add a slight different twist in terms of trying to understand the experience or
where it might happen if you're dealing with a veteran or
someone who's active duty military.
The thing you wanna be very clear about is not to use jargon.
Once you add words like rape, sexual assault or abuse, incest,
you're patient, or the person that you're screening actually might shut down.
So that's why I ask you about sexual contact that you might not have wanted,
sometimes is actually a quite useful way to start to do a deep dive on some of
these issues, and also you wanna avoid non-judgmental questionings,
like shaking your head.
You haven't had any sexual assault related, do you?
When I shake my head like that I'm actually conveying to you a clear message
that the answer is no, and that's the answer I want to hear.
And if I phrase it from a negative point of view, I'm also conveying a judgment.
So again, these are things that we ask for my perspective medical students
to practice prior to engaging in real life clinical experiences.
But those are things you wanna get used to asking in a very non-judgmental way,
being very aware of your non verbal communication as well as your
verbal communication.
The issue is when you ask these questions,
you have to really be able and ready to expect to hear an answer.
And those answers actually vary across the spectrum.
You actually might hear from perpetrators who actually feel guilty,
who have been holding in a lot of issues over time, and
you have to be prepared to hear what a patient or
a person that you might be screening is willing to tell you.
You're gonna hear circumstances around the assault, the nature, and the response.
And so, you need to be just as prepared to what the answer is you might
get as to asking the question with the sensitivity that expect.
These things take time in the clinical encounter.
If a patient does disclose to you a history of military sexual trauma,
there's some things that you wanna be able to deliver to the patient,
or to the veteran, right away.
And those are things such as validation and empathy.
Things that all patients deserve.
An example, I'm sorry you experienced trauma.
You wanna educate, you wanna tell people that actually those experiences do happen.
You wanna understand how the current state, how these experiences might be
affecting them now in their current health care situation or in their life situation.
And you wanna asses what level of support is available to them once
they might leave your office or the interaction with you.
Sometimes and I can speak from my own experience,
that you are actually the first person that the veteran or the individual
has ever told this to because you've actually asked the question directly.
And so you wanna understand what type of support system is available.
The key here is there's things that you can do in your own care pathway,
but you also wanna prepare to refer appropriately to mental health.
We've talked about and we'll talk about in unit seven about
the team-based approach that actually is quite robust within
the Veteran's Healthcare Administration, but also in mechanisms about
how you can really refer patients an veterans to get the help that they need.
How your own clinical practice is able to handle those type of treatment issues,
or any health related issues as it might relate to trauma.
And again, as we've been hearing in the news, either it be on college campuses, or
be it within the military, issues around unwanted sexual contact are real robust,
and we need to address those as future health care professionals or
current health care professionals.
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