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What Can Providers Do?
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Ask all Veterans whether they experienced MST.
- Screen for suicide risk and if necessary refer patient to the VA's 24 hour Veterans Crisis Line at 1-800-273-8255 and press "1" to talk with someone immediately.
- Screening for MST is important because many patients do not spontaneously disclose a trauma history.
Asking Veterans about MST can be the first step in getting them the help they need. Also, understanding
that a Veteran has a history of MST may provide context for her presenting problems and help the provider
adapt care appropriately.
- In screening for MST, use the same principles you would to screen sensitively for intimate partner
violence or other forms of interpersonal trauma.
- VA providers use the following questions to screen for MST:
- While you were in the military, did you receive uninvited or unwanted sexual attention,
(i.e., touching, cornering, pressure for sexual favors, or inappropriate verbal remarks, etc)?
- While you were in the military, did someone ever use force or the threat of force to have
sex with you against your will?
- If a Veteran reports that she experienced MST, be sure to ask additional questions about how
those experiences might be impacting her current life, any implications they have for her medical
care, and her interest in mental health treatment.
- Consider a referral to VA. VA provides free treatment for all mental and physical health conditions
related to MST. Veterans do not need to have a VA disability rating or documentation of their experiences
and may be able to receive this care even if they are not eligible for other VA care.
Every VA Medical Center provides outpatient treatment for MST-related difficulties and many have specialized outpatient
treatment teams focusing explicitly on sexual trauma. For Veterans who need more intense treatment and support,
VHA offers specialized sexual trauma treatment in residential or inpatient settings. Many programs offer
treatment in women-only settings. To learn more about local treatment options, contact your local VA Medical
Center and ask to speak to the MST Coordinator.
- Adapt your care. Interactions with healthcare providers can be complicated for Veterans who experienced
MST because the patient-provider relationship can resemble some aspects of the victim-perpetrator relationship
- for example, being in physical pain; physical exposure and touching of intimate body parts; power differentials;
and feeling like you lack control over what's happening. Physical exams and procedures may be particularly difficult.
Victims of MST may prefer to receive their care from female providers.
- Because of this, it's important to employ extra sensitivity and care when providing medical care to Veterans
who experienced MST. For example, when possible and consistent with appropriate professional boundaries, providers
should do what they can to reduce the power differential between themselves and the Veteran.
- Whenever possible, have conversations while the Veteran is fully dressed.
- Sit at the same level as the Veteran, preferably without a desk in between you. Make eye contact.
- Give the Veteran options and choices whenever possible.
- Be transparent, explaining your reasoning for choosing certain courses of action.
- View the Veteran as an expert on her own body and functioning. Attend carefully to her identified concerns.
- When conducting physical exams or procedures:
- Anticipate and prepare. Explain that it is not unusual for MST survivors to have strong reactions to
certain procedures. Describe the procedure and ask the Veteran what she anticipates will be the most difficult part.
Brainstorm with the Veteran about coping strategies, such as seeing the procedure suite in advance , having a
chaperone or family member present, using sedation or pain medication, if appropriate, or finding ways to
distract (e.g., headphones, music, focused breathing, discussion of pleasant event).
- Ensure the Veteran feels in control. Ask permission before touching and let the Veteran know you will stop if she asks.
Keep a running commentary of exactly what you are doing and about to do. Check in periodically and ask how she is doing.
- Respect the Veteran's subjective experience, even if it seems extreme given the objective circumstances.
Never ignore or dismiss a Veteran's request or expression of distress.
- Avoid:
- Touching the Veteran without her consent
- Moving closer or "invading her space"
- Making loud noises (e.g., hand clap, finger snap)
- Responding to strong reactions. Despite the best preparations, there will still be times when Veterans have strong
reactions to patient-provider interactions or exams/procedures. At these times, it can be helpful to listen empathically,
acknowledging the Veteran's distress, apologize, if appropriate, and explain the reasoning behind your behavior.
Think about the reaction as likely due to feelings of helplessness, of vulnerability, or of being unsafe. Explore with the
Veteran what you can do to restore her feeling of being in control.
- When a Veteran has a strong reaction during a procedure, stop the procedure if at all possible. It may help to assist her in
"grounding" herself. For example, asking "Are you still here with me?", calling her name in your regular speaking voice,
or asking her to focus on sensations: "Can you feel your feet on the floor? Good. Now how about focusing your attention on
the sensation of sitting in your chair..." Other strategies include offering her a drink of water, an extra gown, or a warm
or cold washcloth for her face.
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