Integrated primary behavioral health care for women veterans with disabilities.

Abstract

Women have had a presence in nearly every U.S. military conflict since the War for Independence (Burrelli, 2012). Although the number of women participating in the military, the roles held, and the nature of their experiences have varied throughout the years, their presence has been increasingly apparent for the past 20 years (Burrelli, 2012). During the most recent military conflicts (Operation Enduring Freedom [OEF], Operation Iraqi Freedom [OIF], and Operation New Dawn [OND]), 12% of American troops were women. To date, there are approximately 1 million active-duty service members inclusive of 200,000 women. Moreover, another 190,000 women currently serve in the military reserves and National Guard (Women in Military Service for America Memorial Foundation, 2011). According to the U.S. Department of Veterans Affairs (VA; 2015), there are more than 2 million female veterans in the United States and Puerto Rico, and this number is anticipated to grow, as the Secretary of Defense has ordered the military to open all military positions-including combat positions-to women.

Disability culturally competent sexual healthcare.

“…Men continue to experience a great deal of social pressure to be autonomous, physically dominating, and focused on achievement, and gay disabled men, in particular, may be affected by “lookism” (e.g., appearance based discrimination), resulting in further stigma related to physical differences (Saad, 1997). Similarly, women with disabilities are often desexualized by society, potentially engendering an asexual identity, and they may encounter assumptions that women with disabilities are less desirable than women without disabilities or are incapable of being effective mothers (Clemency Cordes, Cameron, et al, 2016; Clemency Cordes, Mona, et al, 2016). Psychologists are encouraged to be knowledgeable about the difficulties of claiming an identity that may be newly acquired and potentially marginalizing, but also, in contrast, about the possibility of a developmental arc involving temporary immersion in disability culture to the exclusion of other identities (Phinney, 1990).…”

“…In fact, the American Psychological Association’s (APA’s) “Guidelines for Psychological Practice in Health Care Delivery Systems” (APA, 2013) states that “it is important that [psychologists] maintain cultural competence for healthcare delivery to diverse patient groups, including specific competence for working with patients of varying gender, race and ethnicity, language, culture, socioeconomic status, sexual orientation, religious orientation, and disabilities” (p. 5). Given that sexual health and well-being are essential elements of mental health maintenance for some individuals, including people with disabilities (PWD) and chronic health conditions (Clemency Cordes, Cameron, Mona, Syme, & Coble-Temple, 2016; Clemency Cordes, Mona, & Saxon, 2016; Dunn & Andrews, 2015), disability culturally competent health care should routinely include sexual health as a focus (Cameron et al, 2011). Psychological research, training, and clinical practice domains do not yet fully embrace disability as a multifaceted diverse identity, rather than a medical status, or incorporate sexuality as an important component of well-being among PWD.…”

“…Additionally, PWD may have missed out on sexual health information as a matter of education and/or standard practice given that educational experiences of PWD during childhood and adolescence vary significantly in terms of setting and content, and medical providers may not have provided sexual health care and education that they might have considered routine for nondisabled teens and young adults (Boehning, 2006; Clemency Cordes, Mona, et al, 2016; Mona et al, 2014). Thus, a PWD’s knowledge of ways to improve quality of life by enhancing sexual well-being may have been neglected.…”