Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations Initial Assessment (2012) / Chapter Skim
Currently Skimming:
4 Programs and Services for PTSD in the Department of Defense and the Department of Veterans Affairs
4 Programs and Services for PTSD in the Department of Defense and the Department of Veterans Affairs
Pages 111-164
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 111... ...
; and a brief discussion of training opportunities for PTSD treatment. It then focuses on the transition between the DoD and the VA health care systems before providing an introduction to the VA health care system; a summary of current PTSD programs for resilience, screening, diagnosis, and treatment in the VA; and a discussion of training in evidence-based PTSD treatments.
|
From page 112... ...
In addition to several offices and programs, the MHS provides health care services through several military-wide organizations: Force Health Protection and Readiness, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) , Uniformed Services University of the Health Sciences
|
From page 113... ...
The Office of the Assistant Secretary of Defense for Health Affairs oversees Force Health Protection and Readiness programs and the purchased portion of TRICARE, and it has an administrative and policy relationship to the military treatment facilities 4-2 new(as indicated by the dotted line)
|
From page 114... ...
assigned to civilian primary-care managers because of a continued lack of resources and capacity in MTFs. Of the 9.7 million beneficiaries in the United States, about 34% were retirees and family members under 65 years old, 21% were retirees and family members 65 years old or older, 21% were active-duty family members, 14% were active-duty service members, 6% were National Guard or reserve family members, and 4% were members of the National Guard or reserves (TRICARE, 2011)
|
From page 115... ...
Traumatic Brain Injury and traumatic brain injury (TBI) to ensure the Department of Defense meets the needs of the nation's military communities, warriors and families" (DCoE, 2012a)
|
From page 116... ...
For example, service members and their families have the opportunity to seek counseling from chaplains, unit-embedded mental health care providers, community service programs (Tanielian and Jaycox, 2008) and from such facilities as Marine Corps counseling centers.
|
From page 117... ...
(For a list of all programs in the DoD that address psychologic health [including PTSD] and traumatic brain injury of U.S.
|
From page 118... ...
. One resource through which Navy and Marine Corps members can find assistance for mental health concerns is the Naval Center for Combat and Operational Stress Control, which is part of the Navy Bureau of Medicine and Surgery.
|
From page 119... ...
. Some of the concerns have been addressed by the Office of Comprehensive Soldier Fitness, as described by Seligman (2011)
|
From page 120... ...
. Like active-duty service members, National Guard and reserve service members are required to complete the predeployment and postdeployment health assessments.
|
From page 121... ...
. Although traumatic-event management -- whose purpose is to decrease the effect of the potentially traumatic event and prevent long-term adverse consequences -- is provided to individuals and units after an incident, military mental health providers may be hesitant to diagnosis acute stress disorder (ASD)
|
From page 122... ...
. Treatment Service members can be treated for PTSD in numerous services, programs, and settings, including counseling centers, general inpatient and outpatient mental health services, and specialized treatment programs.
|
From page 123... ...
Primary Care On-Base Treatment Mental Health Prac oner In Pa ent Specialized Out Pa ent Programs Ini al Diagnosis with On-Base Mental Health TRICARE Provider Prac oners Providers VA Facili es a Off-Base Military Treatment OneSource Private Prac oners FIGURE 4-3 PTSD treatment pathways available in the DoD. Military OneSource and care through private practitioners is available off base, but these treatment options do not originate from an initial diagnosis and referral from an on-base provider.
|
From page 124... ...
than those who did not use CAM therapies, possibly because they report more health conditions and symptoms. On Base Service members can receive PTSD treatment on base from a primary care provider, through referrals to mental health specialists or social workers, and in both inpatient and outpatient treatment settings.
|
From page 125... ...
. As part of the RESPECT-Mil initiative, primary care practices are working to include behavioral health consultants in the clinical staff.
|
From page 126... ...
Patients were referred to the psychologist by primary care providers in an integrated primary care and mental health clinic. The Navy has also integrated mental health and primary care services through deployment health clinics.
|
From page 127... ...
The South Texas Research Organizational Network Guiding Studies on Trauma and Resilience (STRONG STAR) -- funded by the DoD's Psychological Health and Traumatic Brain Injury Research Program -- is working toward early
|
From page 128... ...
TRICARE network providers include psychologists, psychiatrists, counselors, and social workers. Treatment availability depends on the population of mental health professionals who are practicing in the area around each military base.
|
From page 129... ...
For example, the Women's Trauma Recovery Program in Palo Alto, California, is a resource for women who have experienced military sexual trauma and have PTSD. An active-duty service member may also use a VA facility if the facility has available bed space in specialized intensive PTSD programs to handle DoD overflow.
|
From page 130... ...
For the Navy and Marine Corps, mental health teams are integrated at the regiment level as part of the OSCAR program. The Army uses a dualprovider structure; each division has a psychiatrist and a senior noncommissioned officer, supported by a unit-embedded behavioral health officer and an enlisted mental health specialist (Tanielian and Jaycox, 2008)
|
From page 131... ...
In collaboration with Widener University, they also offer a 6- to 12-month post-master's degree certificate program that aims to give health care providers knowledge of best clinical practices for addressing the behavioral health needs of service members, veterans, and their families. Training seminars and courses are provided through other platforms.
|
From page 132... ...
and tran BOX 4-1 Eligibility for Department of Veterans Affairs Health Care Veterans who may qualify for health care benefits offered through the VA include those who served under active-duty military service in the Army, Navy, Air Force, Marines, or Coast Guard (or Merchant Marines during World War II) and reservists and National Guard members who were called to active duty by a Federal Executive Order.
|
From page 133... ...
The teams work with staff from VA's community-based readjustment counseling service centers (usually called Vet Centers) to seek out veterans recently discharged from active-duty status, including those in reserve components.
|
From page 134... ...
During FY 2010, 82,239 veterans of OIF and OEF are known to have received PTSD services through the VA health care system; they amounted to 24.6% of all OIF and OEF veterans using the system (NEPEC, 2011a) , although this underestimates the actual number because reporting from the Vet Centers is incomplete.
|
From page 135... ...
The VHA provides health care services for enrolled eligible veterans through a fully integrated system of health care delivery assets. Those assets include 152 VA medical centers that typically are composed of an acute-care hospi Secretary Deputy Secretary Veterans Benefits Veterans Health National Cemetery Administration Administration Administration Undersecretary for Health Deputy Under Secretary Deputy Under Vet Centers of Health Operations Secretary for Health and Management Directors of Veterans Office of Mental Office of Patient Care Integrated Service Health Operations Services Networks (VISNs)
|
From page 136... ...
. A substantial amount of mental health care is provided in hospital-based primary care clinics and the community-based outpatient clinics, as well as the Vet Centers.
|
From page 137... ...
The Vet Centers were formally established by an act of Congress in 1979, and were, by design, not aligned under the management of local VA medical centers (as shown in Figure 4-4)
|
From page 138... ...
. The VHA and Vet Centers have different policies with regard to PTSD treatment.
|
From page 139... ...
Vet Center representatives collaborate with the National Center for PTSD and have participated in the development of clinical practice guidelines. Whereas the VHA is responsible for providing care and services to veterans for PTSD, the VBA evaluates and adjudicates all claims for PTSD service connection and pays pensions awarded to veterans whose PTSD is found to be service connected.
|
From page 140... ...
PTSD Services and Programs After the Vietnam War, a small number of medical centers developed local specialized treatment programs for PTSD. In the mid 1980s, congressional funding spurred the expansion of the number of such programs throughout the VA health care system.
|
From page 141... ...
FOCUS (couples version) Moving Forward: A Problem-Solving Approach to Achieving Life's Goals Psychological First Aid Manual for Direct Care Staff Specialized Outpatient Treatment: PTSD Clinical Teams Substance Use PTSD Program Women's Stress Disorder Treatment Team Specialized Intensive Treatment: Evaluation and Brief Treatment PTSD Unit PTSD Day Hospital PTSD Domiciliary PTSD Residential Rehabilitation Program Specialized Inpatient PTSD Unit Women's Trauma Recovery Program Rehabilitation, Readjustment, and Disabilityb: Vocational Rehabilitation and Employment Program Compensated Work Therapy Individual Placement and Support Specialized Homelessness Services Strength at Home Stand Down Supportive Housing Services Community-Supported Homeless Prevention Programs Vet Centers a This is not a comprehensive list of programs offered by the VA, and not all those listed are exclusively for persons who have PTSD.
|
From page 142... ...
Every medical center and at least the largest community-based outpatient clinics are expected to have specialized PTSD services available on site. Mental health staff members devoted to the treatment of OIF and OEF veterans have also been deployed throughout the system (Zeiss, 2011)
|
From page 143... ...
Every veteran who receives services at a Vet Center is screened for PTSD and MST. Screening for PTSD is also available for all veterans through the VA's My HealtheVet website (VA, 2012l)
|
From page 144... ...
who is expected to have expertise in treatment for PTSD. The mental health TABLE 4-2 Care Setting in the VA for Veterans with a Primary Diagnosis of PTSD, FY 2010a Veterans Venue Treated General mental health clinics 275,838 PTSD specialists 31,023 Nonmental health clinics 67,871 PTSD clinical teams 117,313 aThe data do not include patients seen in Vet Centers.
|
From page 145... ...
Because there is no centralized monitoring of the PTSD treatment workload provided outside of specialized PTSD programs, no additional data on the patients treated outside the programs or on the nature or intensity of their care are available, although it appears that such data could be developed. Readjustment counseling is offered through community-based Vet Centers.
|
From page 146... ...
. Non-VA, non-DoD primary care providers constitute a heterogeneous group, and this results in variation in the types of care they provide to veterans who have PTSD -- variation in the types of practice and the geographic locations; in the psychiatric, psychologic, social services, and financial resources that are available; in the providers' training and expertise related to PTSD care; and in the providers' level of involvement in the care of the spouses and children of veterans.
|
From page 147... ...
There is no uniform, national policy on admission criteria for specialized PTSD treatment programs. Individual programs may have specific inclusion or exclusion criteria, such as substance use disorder status or legal status (for example, not awaiting trial or sentencing)
|
From page 148... ...
. In addition to outpatient programs, the VA maintains 41 specialized intensive PTSD programs of six types: evaluation and brief treatment PTSD units, PTSD residential rehabilitation programs, PTSD domiciliary programs, PTSD day hospitals, specialized PTSD inpatient programs, and female trauma recovery programs.
|
From page 149... ...
There are only two of these programs in the VA, and they served fewer than 60 patients during FY 2009. Overall, about 5% of participants in all VA specialized intensive PTSD programs and 8% of all patients in specialized outpatient PTSD programs are female (NEPEC, 2011c,d)
|
From page 150... ...
. Master trainers are to be trained for each of the VISNs and for the Vet Centers to expand the training of clinicians closer to their work sites.
|
From page 151... ...
Among providers at 27 randomly selected Vet Centers, 98% of those who had been employed at a Vet Center for at least a year had attended mandatory training for PTSD assessment and counseling through the Readjustment Counseling Service. Nearly half had also attended VHA-sponsored training for PTSD; 37% reported receiving supplemental training in cognitive behavioral therapy, and 12% and 5% reported receiving supplemental training in cognitive exposure therapy and PE, respectively (VA, 2011a)
|
From page 152... ...
, the DCoE, the VA, and other federal agencies held the Second Annual Trauma Spectrum Disorders Conference: A Scientific Conference on the Impact of Military Service on Families and Caregivers; it focused on the impact of trauma spectrum disorders on military and veteran families and caregivers across deployment, homecoming, and reintegration. Trauma spectrum disorder encompasses injury or illness that occurs as a result of combat or an unexpected traumatic event, and covers a broad range of psychological health and traumatic brain injury issues.
|
From page 153... ...
For example, the Center for the Study of Traumatic Stress, which was established in 1987, is part of the USUHS Department of Psychiatry and is partnering with DCoE. Its work was started to investigate the physical and psychologic effects of traumatic events.
|
From page 154... ...
The centers were established to research the causes and treatments of mental disorders and to apply new knowledge to the VA's routine clinical practice. Four of the centers have at least a partial emphasis on PTSD and postdeployment issues, and all may conduct studies relevant to PTSD and its comorbidities.
|
From page 155... ...
coordinated care for veterans returning from OIF and OEF, including coordination of care for those who have PTSD. The VA's strategic plans for PTSD research include increased cooperation with DoD, the NIMH, the Centers for Disease Control and Prevention, and the Substance Abuse and Mental Health Services Administration.
|
From page 156... ...
The second was a naval postgraduate school master of science thesis (Kwan and Tan, 2008) that used administrative data from MTFs and TRICARE to estimate costs of PTSD treatment.
|
From page 157... ...
For example, only two people who served in the Marine Corps received inpatient services from a TRICARE provider. In addition to those published studies, there are some data from the VA on the costs of specialized PTSD programs, which treat about 25% of veterans who have PTSD.
|
From page 158... ...
http://www.dcoe.health.mil/ForHealthPros/PTSD TreatmentOptions.aspx (accessed January 30, 2012)
|
From page 159... ...
2008b. VA and DoD health care: Administration of DoD's post-deployment health reassessment to National Guard and reserve servicemembers and VA's interaction with DoD.
|
From page 160... ...
2010. Dissemination of evidence-based psychological treatments for posttraumatic stress disorder in the Veterans Health Administration.
|
From page 161... ...
Workload and direct cost for specialized outpatient PTSD pro grams for FY2004, FY2010, and the FY2004-2010 difference by VISN. Response to data request by the Committee on the Assessment of Ongoing Efforts in the Treatment of PTSD, January 23, 2012.
|
From page 162... ...
2009. Mobile Vet Centers: Reaching out in rural areas.
|
From page 163... ...
Post traumatic stress disorder counseling services at Vet Centers. Washington, DC: VA Office of the Inspector General.
|
From page 164... ...
2011. Programs addressing psychological health and traumatic brain injury among U.S.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.