Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations Final Assessment (2014) / Chapter Skim
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Pages 1-12
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In phase 1, the committee requested extensive data from DoD and VA on their PTSD programs and services; in addition, it looked at collaborative efforts of the two departments; provided a scientific overview of the neurobiology 1
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on programs and methods available for the prevention, screening, diagnosis, treatment, and reha bilitation of post-traumatic stress disorder. The committee will highlight collabora tive efforts between DoD and the VA in those areas.
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Of veterans entering specialized outpatient PTSD programs (SOPPs) in 2012, 47% were OEF and OIF era, 20% were 1990–1991 Gulf War era, and 34% were Vietnam era.
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Most psychotherapy or pharmacotherapy treatments for PTSD in DoD are provided on an outpatient basis and occur in general mental health clinics, primary care settings, or specialized PTSD programs. All service branches are embedding mental health care providers in primary care clinics to reduce barriers to care.
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Although improving mental health is one of VA's 16 major initiatives in the strategic plan, highlighting improved PTSD care as a specific major initiative might help to focus attention on the needs of the growing population of veterans, including women, who have PTSD. Although the DoD and VA are coordinating strategic efforts such as the DoD/VA Integrated Mental Health Strategy and the National Research Action Plan for Improving Access to Mental Health Services for Veterans, Service Members, and Military Families, these activities have not proven to
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The installations and medical centers that had the most coordinated PTSD treatment and the most options for their patients appeared to be the ones that have strong, effective, and knowledgeable leaders and good communication among leaders, providers, and support staff. In DoD and each service branch, leaders at all levels of the chain of command are not consistently held accountable for implementing policies and programs to manage PTSD effectively, including those aimed at reducing stigma and overcoming barriers to accessing care.
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VA is also in the process of expanding its electronic health record to capture the types of psychotherapy that veterans are receiving, but the revised record still will not include regularly administered outcome measures. Although VA has been collecting data on its SOPPs and SIPPs for many years and publishes the compiled data in an annual internal publication, useful outcome data are scarce and available only for SIPPs.
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Having standards, procedures, and requirements for direct care and purchased care providers will help to ensure that they are trained in evidence-based treatments that are consistent with VA/DoD Clinical Practice Guideline for Management of Post-Traumatic Stress, understand military culture, continuously measure patients' progress, and, in the case of purchased care providers, coordinate with patients' DoD or VA refer
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DoD and VA are also integrating complementary and alternative therapies into some of their specialized PTSD programs, but the interventions need to be studied to establish their evidence base and to ensure that their use does not deter patients from receiving first-line, evidence-based treatments. DoD and VA are exploring approaches to deliver treatment more expeditiously, including the use of technological applications that extend the reach of clinical care and service delivery, such as virtual reality, videoconferencing, patient avatars, and mobile applications for patients and providers.
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All stakeholders, including families and direct and purchased care providers, would benefit from ready access to a routinely updated database in which programs are described and evaluated according to standardized measures. Existing resources, such as the National Center for PTSD, could be leveraged to develop more comprehensive information about VA-wide PTSD programs and services (not just specialized ones)
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VA, including Vet Centers, provides peer counselors and peer support groups that help to engage veterans in treatment, reduce stigma, and promote empathy, but data on the number of veterans who seek treatment as a result of peer counseling or who participate in support groups are not available. Vet Centers also provide counseling services for family members.
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Recommendation H: PTSD research priorities in DoD and VA should reflect the current and future needs of service members, veterans, and their families. Both departments should continue to develop and imple ment a comprehensive plan to promote a collaborative, prospective PTSD research agenda.
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