Military Sexual Trauma-Veterans Administration in-patient treatment facilities

MILITARY SEXUAL TRAUMA / SEXUAL TRAUMA RESIDENTIAL TREATMENT RESOURCES   INFO UPDATED MAY 2009

This list consists of programs identifying themselves as providing MST or sexual trauma-specific treatment in a residential or inpatient setting. Only programs open and actively accepting referrals are included, such that programs under development are not listed. Programs range from those solely dedicated to the treatment of sexual trauma; to those with a special track emphasizing the treatment of sexual trauma; to those with two or more staff members with expertise in sexual trauma who, in the context of a larger program not focused on sexual trauma, provide treatment targeting this issue. More detailed information about each program is provided on the pages following this summary list.

VISN 1 VA Boston HCS/Jamaica Plain Campus, Boston, MA: Women Veterans’ Therapeutic Transitional Residence Program VA Boston HCS/Brockton Campus, Brockton, MA: Women’s Integrated Treatment & Recovery Program

VISN 2 VA Western New York HCS/Batavia Campus, Batavia, NY: Women Veterans’ Residential Program

VISN 3 VA New Jersey HCS, Lyons, NY: Women’s Military Sexual Trauma Residential Program

VISN 5 VA Maryland HCS/Baltimore Division, Baltimore, MD: Dual Diagnosis PTSD/Substance Abuse PRRTP

VISN 7 Augusta VAMC, Augusta, GA: MST Clinic & Domiciliary Residential Rehabilitation and Treatment Program

VISN 8 Bay Pines VAHCS, Bay Pines, FL: Center for Sexual Trauma Services

VISN 10 Cincinnati VAMC, Cincinnati, OH: Residential PTSD Program VISN 12 Clement J. Zablocki VAMC, Milwaukee, WI: Rehabilitation and Transition Unit – Trauma Track North Chicago VAMC, North Chicago, IL: Stress Disorder Treatment Unit

VISN 15 VA Eastern Kansas HCS/Topeka Division, Topeka, KS: Stress Disorder Treatment Program

VISN 17 Central Texas Veterans HCS, Temple, TX: Women’s Trauma Recovery Center

VISN 21 VA Palo Alto HCS/Menlo Park Division, Menlo Park, CA: Women’s Trauma Recovery Program

VISN 22 VA Long Beach Healthcare System, Long Beach, CA: “Renew” & “Bridges”

 Please see the pages that follow for more detailed information about each program.

 VISN 1 Facility: VA Boston HCS/Jamaica Plain Campus (Boston, MA) Type of program: PTSD Transitional Residence Program name: Women Veterans’ Therapeutic Transitional Residence Program (TRUST House) Phase of treatment targeted: Flexible, ranges from stabilization and skill-development to trauma processing. MST-specific treatment available: Veterans receive therapy through the Boston Women’s Stress Disorder Treatment Team, a clinic with an explicit emphasis on treating sexual trauma. TR staff also have expertise in this area. Notable admission criteria: Prefer 90 days sobriety; able to function independently; ability to work 20 hours/week; prefer 60 days without suicidal behavior. Some criteria are flexible depending on the individual case. Treat both men and women? Women only. Rolling vs cohort admissions & length of program: Rolling admissions. Ask for commitment of at least 3 months though prefer veterans to stay for a year; maximum stay is 18 months. Contact information: Erica Sharkansky, PhD – (857) 364 – 4925; erica.sharkansky@va.gov Facility: VA Boston Healthcare System, Brockton Campus (Brockton, MA) Type of program: Women’s Residential Program Program name: Women’s Integrated Treatment & Recovery Program Phase of treatment targeted: Emphasis on integrated treatment of substance abuse and trauma; group therapy focuses on skills building for maintaining abstinence and managing PTSD symptoms. MST-specific treatment available: Individual therapy focused on processing sexually traumatic experiences using a CPT model with and without exposure. Staff members have expertise in the area of sexual trauma. Notable admission criteria: Commitment to abstinence; medically stable; linked to outpatient care and have a discharge plan; no acute psychotic symptoms, suicidal or homicidal ideation. Treat both men and women? Women only. Rolling vs cohort admissions & length of program: Rolling admissions with 8-week length of stay which may be extended to 90 days under certain circumstances, if for example, a veteran awaiting admission to a subsequent program needs to meet criteria for a length of sobriety greater than 56 days or is awaiting housing. Contact information: Sharon L. Baker, Ph.D. – (774) 826-1312; sharon.baker3@va.gov

VISN 2: Facility: VA Western New York HCS/Batavia Campus (Batavia, NY) Type of program: Women’s Residential Program Program name: Women Veterans’ Residential Program Phase of treatment targeted: Emphasis on trauma processing as well as intensive self-regulatory and interpersonal skill development. MST-specific treatment available: Individual and group therapy focused on processing sexually traumatic experiences. Staff members have expertise in the area of sexual trauma. Currently have mixed-trauma cohorts, though at times cohorts end up being entirely composed of veterans with sexual trauma histories. Notable admission criteria: 30 days sobriety; medically stable; linked to outpatient care and have a discharge plan; no acute suicidal or homicidal ideation. Treat both men and women? Women only. Rolling vs cohort admissions & length of program: Utilize a cohort system with a 10 week length of stay. If the cohort has openings, short-term stays of one to two weeks are possible for veterans wishing to focus on skill-building and supportive therapy. Contact information: Terri Julian, Ph.D. – (585) 297-1205; terri.julian@va.gov VISN 3: Facility: VA New Jersey HCS, Lyons, NJ Type of program: MST Residential Treatment Program Program name: Women’s Treatment Unit Phase of treatment targeted: Emphasis on skill building and trauma processing. Group treatment is central with individual psychotherapy for processing of traumatic material. PE and CPT available. MST-specific treatment available: Program as a whole is devoted to MST treatment. Childhood trauma, combat-related PTSD, and SUD also addressed as needed. Admission criteria: No psychotic symptoms; Not in need of detox from drugs or alcohol; ability to work intensively in group format; no recent violent behavior; cannot present as danger to self or others; must be able to manage own medications; must be medically stable. Treat both men and women? Women only. Rolling vs cohort admissions & length of program: Rolling admissions. Average length of stay 6-8 weeks Contact information: Suzanne Loftus, Psy.D. – (908) 647-0180 ext 5896

VISN 5 Facility: VA Maryland HCS/Baltimore Division (Baltimore, MD) Type of program: Psychosocial Residential Rehabilitation Treatment Program with Focus on Comorbid PTSD & Substance Use Disorders Program name: Dual Diagnosis PTSD/Substance Abuse PRRTP Phase of treatment targeted: Flexible, ranges from psychoeducation and skill-development to trauma processing. MST-specific treatment available: Multiple staff members with expertise in treating sexual trauma using empirically supported treatments. Individual and group therapy. Notable admission criteria: PTSD and substance abuse/dependence; prefer 30 days sobriety and that have had at least one significant period of sobriety within the past year; ability to function independently in daily life; psychiatrically and medically stable. Treat both men and women? Yes. Have both mixed and single-sex groups. Women stay in individual rooms with private, non-attached bathrooms. Rolling vs cohort admissions & length of program: Rolling admissions. 45 – 56 day stay. Contact information: Lorie Morris, Psy.D. — (410) 605-7418; lorie.morris@va.gov

VISN 7 Facility: Augusta VAMC (Augusta, GA) Type of program: MST Clinic in conjunction with Domiciliary Residential Rehabilitation and Treatment Program Program name: MST Clinic & Domiciliary Residential Rehabilitation and Treatment Program Phase of treatment targeted: Emphasis on trauma processing. MST-specific treatment available: Veterans receive therapy through the outpatient MST clinic where staff have expertise in the treatment of sexual trauma. Notable admission criteria: No pending legal issues; no physical assaults in past six months; current sobriety; not taking any controlled medications more than two times/day. Treat both men and women? Yes. Women stay in lockable two- to four-person rooms. Some women-only groups, but others are mixed-sex. Rolling vs cohort admissions & length of program: Rolling admissions. Length of stay for up to 120 days. Contact information: Lorraine Braswell, Ph.D. — (706) 733-0188 x7735; lorraine.braswell@va.gov

VISN 8 Facility: Bay Pines VAHCS (Bay Pines, FL) Type of program: MST Residential Program Program name: Center for Sexual Trauma Services, Residential Program Phase of treatment targeted: Emphasis on trauma work. MST-specific treatment available: Program as a whole is devoted to MST treatment. Patients are assigned a primary therapist who works with them to plan treatment based on individual needs and strengths. Treatment interventions may include Prolonged Exposure, Cognitive Processing Therapy, Skills Training, CBT Group, Therapeutic Recreation, Patient Education and other interventions. Notable admission criteria: History of MST (though can focus on any sexual trauma while in the program); cannot present a danger to self or others and must be able to manage the residential environment. Treat both men and women? Yes. Roommates are same-sex, but men and women are housed in the same area of the Dom and share the common living areas. Rolling vs cohort admissions & length of program: Rolling admissions; variable length of stay based on the individual’s treatment plan. Contact information: Judith Connelly, PsyD. (727) 398-6661, x 7297; Judith.Connelly2@va.gov or Carol O’Brien, Ph.D. – (727) 398-6661 x7381; carol.obrien1@va.gov

 VISN 10 Facility: Cincinnati VAMC (Cincinnati, OH) Type of program: PTSD Day Hospital with lodging Program name: Residential PTSD Program Phase of treatment targeted: Emphasis on trauma processing. MST-specific treatment available: Most staff have expertise in sexual trauma. Individual and group treatment; veterans working on sexual trauma get one extra individual therapy session a week as needed. Notable admission criteria: PTSD; 30 days sobriety (will, however, take veterans on benzodiazepines and/or methadone); no active mania or psychosis; no medical or legal issues; no registered sex offenders; able to tolerate group treatment and share trauma accounts in individual therapy. Treat both men and women? Yes. Men and women with separate living areas but eat in the cafeteria together. No mixed-sex therapy groups. Rolling vs cohort admissions & length of program: Cohort admissions. Length of stay of 7 weeks. Contact information: For referrals, Jennifer Lewis – (513) 861-3100 x3310; jennifer.lewis2@va.gov

VISN 12 Facility: Clement J. Zablocki VAMC (Milwaukee, WI) Type of program: PTSD DOM Program name: Rehabilitation and Transition Unit – Trauma Track Phase of treatment targeted: Flexible, depends upon veterans’ previous trauma work. MST-specific treatment available: Staff with expertise in sexual trauma by virtue of the high prevalence of it in the program. Veterans attend general programming but individual and group treatment would be focused on the sexual trauma. Notable admission criteria: 30 days sobriety; need to be capable of independent living and able to manage living with others. Treat both men and women? Yes. Mixed-sex groups and living arrangements. One all-female support group where all participants have a history of sexual trauma. Rolling vs cohort admissions & length of program: Rolling admissions. Length of stay of 6-9 months. Contact information: For referrals, Katie DeYoung at the Central Intake Unit – (414) 384-2000 x 41986. For more information, Vickie Wiese, Ph.D. — x 42367; vickie.wiese@va.gov Facility: North Chicago VAMC (North Chicago, IL) Type of program: PTSD Residential Rehabilitation Program Program name: Stress Disorder Treatment Unit Phase of treatment targeted: Flexible, from skills building to trauma processing. MST-specific treatment available: Individual therapy; clinicians have developed expertise in working with MST, given the number of sexual trauma cases they tend to see. Notable admission criteria: Combat-related PTSD (combat broadly defined); SC for PTSD; minimum 30 days sobriety; medically stable; no active suicidal ideation in the past 60 days; admission can’t be court-related; must be in outpatient treatment; prefer no benzodiazepines or anti-psychotic medications. Current PTSD symptoms must be too severe to be treated on an outpatient basis. Treat both men and women? Yes. Women with private room, but men and women participate in groups together. Rolling vs cohort admissions & length of program: Rolling admissions. Length of stay varies but average is around 35 days. Contact information: Karen Paddock – (847) 688-1900 x 83312; karen.paddock@va.gov

 VISN 15 Facility: VA Eastern Kansas HCS/Topeka Division (Topeka, KS) Type of program: Specialized Inpatient PTSD Unit Program name: Stress Disorder Treatment Program Phase of treatment targeted: Ranges from skill building to trauma processing. MST-specific treatment available: Though have ongoing admissions, try to cluster individuals with sexual trauma-related issues into “mini-cohorts.” Staff with training in treatment of sexual trauma. Notable admission criteria: 30 days sobriety; military trauma of some type; treatment can’t be court-ordered; no acute suicidal or homicidal ideation; no acute psychosis. Treat both men and women? Yes, but see relatively few women. Women and men are potentially, but not necessarily, in the same cohort. They participate in psychoeducational groups together but decisions about participation in trauma processing groups together are made on a case by case basis, depending on the size of the female mini-cohort. Women room together as appropriate but typically have private rooms with their own bathroom. Rolling vs cohort admissions & length of program: Rolling admissions. Length of stay of 7 weeks. Contact information: For referrals, Terry Falck, M.A. – (785) 350-3111 x 52139; for more information, Jonathan Farrell-Higgins, Ph.D. – x 52118; jonathan.farrell-higgins@va.gov

VISN 17 Facility: Central Texas Veterans HCS (Temple, TX) Type of program: MST Residential Treatment Program Program name: Women’s Trauma Recovery Center Phase of treatment targeted: Emphasis on trauma processing. MST-specific treatment available: Program as a whole is devoted to MST treatment. Notable admission criteria: History of sexual assault or attempted sexual assault while in military (for recently deployed women, sexual harassment only with a history of other military trauma is acceptable); no substance abuse for past 30 days; no suicidal or para-suicidal behavior for past 30 days; no acute inpatient psychiatric admission for past 30 days; no uncontrolled mania or psychosis; not significant organic impairment; no ongoing criminal or violent behavior. Treat both men and women? Women only. Rolling vs cohort admissions & length of program: Cohort admissions. Length of stay of 7 weeks. Contact information: Delicia Mclean, Ph.D. – (254) 743-1720; delicia.mclean@va.gov

VISN 21 Facility: VA Palo Alto HCS/Menlo Park Division (Menlo Park, CA) Type of program: PTSD Residential Program Program name: Women’s Trauma Recovery Program (WTRP) Phase of treatment targeted: Two tracks: 1) trauma processing; and 2) intensive skills building. MST-specific treatment available: Staff with expertise in the treatment of sexual trauma, particularly given the high prevalence of sexual trauma among veterans in the program. Notable admission criteria: Alcohol and illegal substance free for 5 days and off of benzodiazepines; problems are primarily due to PTSD; no active psychosis; no unresolved legal issues; no major medical problems that will interfere with participation in program. Treat both men and women? Women only. Rolling vs cohort admissions & length of program: Rolling admissions. 60 day to 90 day length of stay. Contact information: Kristen Marchak, LSW, Admissions Coordinator – (650) 493-5000 x 24692, kristen.marchak2@va.gov , Tasha Souter, MD – (650) 493-5000 x23158; tasha.souter@va.gov; Dorene Loew, PhD – (650) 493-5000 x23237; dorene.loew@va.gov

VISN 22 Facility: VA Long Beach Healthcare System (Long Beach, CA) Type of program: Sexual Trauma Residential Program Program name: “Renew”; (for information on “Bridges”, see box on ‘rolling vs cohort admissions’) Phase of treatment targeted: Emphasis on skill development and trauma processing. MST-specific treatment available: Program as a whole is devoted to treatment of sexual trauma. Individual and group treatment. Holistic focus. Notable admission criteria: 6 months sobriety; 6 months without psychiatric hospitalization; 6 months without suicide attempt or self-injury; ability to remain for the duration of the program. Treat both men and women? Women only. Rolling vs cohort admissions & length of program: Cohort admissions. Length of stay of 12 weeks. Also, potential for participation in “Bridges”: 12 week, rolling admissions residential and/or outpatient aftercare program consisting of 12 hours/week of community activity and support groups. Contact information: Lori Katz, PhD (program director) — (562) 826-8000 x4380; lori.katz@va.gov; or Sandy Dee Hoague (program coordinator) — x4820.

VA’s MST Policies and Treatment Benefits

The following is  listing of the laws regarding the Veterans Administration MST Policies and Treatment. I stumbled onto these by accident one day-I feel they may be more useful in the hands of MST survivors and not kept closed and only available to VA staff as the headline I failed to copy had advised. You must read them carefully-and you can use them.

Summary DocumentsSummary of VA Laws, Directives, & National Policies Related to MST

 

Handout summarizing eligibility and billing rules related to MST

‘Office of General Counsel MST Eligibility Guidelines’ summary document

FAQs about payment for travel

• Please see our discussion forum thread on this topic

MST and the Compensation and Pension process (August 7, 2008 MST Teleconference Training Series presentation)

• Audio recording of this presentation

Overview / history of VA’s response to MST

MST-Related Laws, Directives, and Policies
Note: provisions that were changed in later Public Law, Directives, or policies appear with a cross-out line

1992: Public Law 102-585

• Added section 1720D to Chapter 17 of Title 38 (“Veterans Benefits“; 38 CFR 17), US Code of Federal Regulations to authorize VA to provide outreach and counseling (up to December 31, 1995) to help women veterans overcome “psychological trauma” from a “physical assault of a sexual nature, battery of a sexual nature, or sexual harassment” that occurred while the veteran was serving on active duty.
• Sexual harassment was defined as “repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character.”
• The Secretary was to “give priority to the establishment and operation of the program to provide counseling.”
• Veteran was required to seek counseling within two years of discharge.
• Treatment could last for up to a year.
• Mandated education of “mental health professionals and … other health care personnel” on MST issues.

1994: Public Law 103-452

• Amended section 1720D of 38 CFR 17 to extend VA’s authorization to provide treatment through December 31, 1998.
• Repealed requirement that veteran seek counseling within two years of discharge.
• Expanded treatment to men.
• Expanded treatment to physical conditions resulting from MST.
• Changed outpatient sexual trauma counseling, care, and services to priority I.
• Repealed limits on length of treatment.

1995: VA Directive 10-95-030

• Implemented PL 103-452.
• Made MST-related “counseling, care, and services” free of charge. However, “medication copayments will be charged for services provided for nonservice-connected conditions.”

1997: Under Secretary for Health’s Information Letter IL-10-97-037

• Based on a General Counsel Opinion (VAOPGCADV 17-97), clarified the eligibility rules for veterans seeking treatment for MST.
  • Persons are eligible for MST care and counseling services if they meet the definition of “veteran” in 38 USC Section 1720D. This includes reservists and members of the National Guard who were activated to full-time duty status in the Armed Forces. It does not include those who experienced MST while on active duty for training.
  • No minimum length of service requirements apply.
  • Veterans need not have filed a claim for service-connected disability.

1998: Public Law 105-368 [section 902 on Acrobat page 46 of this document]

• Amended section 1720D of 38 CFR 17 to extend VA’s authorization to provide treatment through December 31, 2001.

1998: VA Directive 98-058

• Notified VA healthcare personnel that VA’s authority to provide treatment had been extended through December 31, 2001 (as per PL 105-368.)

1999: Public Law 106-117 (“Millennium Bill”) [section 115 on Acrobat page 14 of this document]

• Amended section 1720D of 38 CFR 17 to extend VA’s authorization to provide treatment through December 31, 2004.
• Changed wording from VA “may” provide care to “shall” provide care.
• Required outreach to veterans about the MST-related counseling and treatment available, particularly in collaboration with DoD.
• Required VA to submit reports to Congress on outreach activities specified in this Public Law and on the number of veterans receiving MST-related counseling.

1999: VA Directive 99-039

• Instituted a nationwide system (“MST software application”) to “indicate a veteran’s claim of MST; indicate if a veteran’s treatment is related to MST; and generate statistical and demographic reports related to MST”.
• Stated that it is “important” that all Primary Care and Behavioral Health providers screen for MST.

2000: VA Directive 2000-008

• Provided a definition for MST, based on PL 102-585: “The law defines sexual trauma as sexual harassment, sexual assault, rape, and other acts of violence. It further defines sexual harassment as repeated, unsolicited verbal or physical contact of a sexual nature, which is threatening in nature.”
• Given the need for “confidentiality and sensitivity to the impact of MST on veterans”, mandated that all staff receive education on MST-related issues.
• Mandated screening all veterans for MST.
• Per Millennium Bill, required outreach, particularly in collaboration with DOD, to help overcome barriers to treatment.
• Required all facilities to designate an MST Coordinator.
• Required all facilities to implement the “MST software” and “track MST patients.”
• Required monitoring treatment rates for MST, aggegrated by gender.

2004: Public Law 108-422 [section 301 on Acrobat page 4 of this document]

• Amended section 1720D of 38 CFR 17 to make VA’s authority to provide sexual trauma counseling to veterans permanent.
• Extended MST treatment to active duty for training (ADUTRA) service members.

2005: VA Directive 2005-015

• Specified that Medical Center Directors are responsible for appointing a designated MST Coordinator.
• Medical Center Directors must also ensure that a “MST Counselor(s) or Team” is available so that all enrolled veterans are screened for MST.
• Mandated “necessary staff education and training.”
• Scheduling for outpatient MST-related care should be within 30 days, consistent with VHA performance standards of scheduling for special populations and mental health clinics.
• Required documentation of screening, referral, and treatment for MST-related care, aggregated by gender via use of the MST software and MST clinical reminder.
• Specified that even veterans who are otherwise ineligible for VA health care benefits based on length of military service may be provided MST-related care.
• Stated that veterans receiving MST-related counseling and treatment should not be billed for inpatient, outpatient, or pharmaceutical co-payments.
• Veterans “need to be informed of their eligibility to file a claim for service connected disability compensation” and told how to learn more about how to do this.

2007: Code of Federal Regulations, Title 38, 1720D (38 CFR 17) [section 1720D on Acrobat page 204 of this document] Note: This document loads VERY slowly.

• Title 38 description of coverage of veterans’ benefits related to MST, as last updated in 2007.

2008: Uniform Mental Health Services document (VHA Handbook 1160.01) [section 24, Acrobat page 42 of this document in particular, although other sections also reference MST (e.g., section 9, Acrobat page 13)]
Memo releasing this document
Note: Our June, 2008 MST Teleconference Training Series call and our PowerPoint on VA Laws, Directives, & National Policies have more information about this document.

• Describes mental health-related services that must be available at every VA facility.
• All facilities must install the MST clinical reminder in CPRS.
• All veterans must be screened using this reminder.
• Veterans who request treatment must be provided free care for mental and physical health conditions related to MST. Determination as to whether the care is MST-related or not is made by the clinician providing care and is indicated by checking the MST box on the encounter form for the visit.
• Facilities must monitor screening, referral, and treatment related to MST, aggregated by gender, by using the clinical reminder (for tracking screening) and the MST encounter form checkbox (to track treatment)
  Note: The MST clinical reminder and encounter form checkbox are what is used by the Office of Mental Health Services and the MST Support Team to evaluate local screening, referral, and treatment. If they wish, facilities may also choose to use stop code 524 or purpose of visit code 55 for monitoring of treatment, as suggested by the Uniform Mental Health Services Package and Directive 2005-015. However, this should be in addition to, not instead of, the use of the MST encounter form checkbox.
• Scheduling priority for outpatient care is consistent with VHA performance standards for scheduling clinics.
• Veterans may be eligible for free MST-related care even if they are otherwise ineligible for VA services.
• Every VISN must provide access to residential programs that can provide care for conditions resulting from MST.
• Fee basis is permissible if clinical, resource, or geographic reasons make it not feasible to provide counseling in a VA facility.
• Every VAMC must have an MST Coordinator who monitors and ensures that national and VISN-level policies related to MST screening, education and training, and treatment are implemented at the facility; serves as a point person and a source of information and problem-solving for MST-related issues at the facility; establishes and monitors mechanisms to ensure that all veterans are screened for MST and have access to treatment for conditions related to MST.
• Evidence-based mental health care must be available to all veterans with mental health conditions related to MST.
• When clinically indicated, facilities are strongly encouraged to give veterans the option of being assigned a same-sex mental health provider (or opposite-sex provider if the MST involved a same-sex perpetrator).
• “Necessary” staff education and training must be provided.

2009: VA Directive 2009-012

• Specifies that MST-related care is not subject to outpatient co-payments