Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations Final Assessment (2014) / Chapter Skim
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7 Effective and Safe Care
7 Effective and Safe Care
Pages 129-148
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are achieving success in providing effective and safe treatments for PTSD and the difficulties that they have experienced in delivering these treatments. DETERMINING EFFECTIVE CARE Clinical practice guidelines provide recommendations on the best practices for the treatment of a condition on the basis of reviews of scientific 129
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has established standards for the development of trustworthy clinical practice guidelines (IOM, 2011)
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Adequate monitoring, education, and support from the health care provider can help ensure patient compliance, identify adverse reactions, and track treatment responses. DELIVERY OF EFFECTIVE CARE Optimal delivery of evidence-based treatment for PTSD requires organizational resources and leadership support, an organizational culture that expects and rewards the delivery of those treatments (Foa et al., 2013)
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From page 132... ...
The use of evidence-based treatments, complementary and alternative treatments, and prevention and resilience programs in DoD is also considered. Determining Effective Care Evidence-Based Treatment The Army Medical Command has mandated that all military treatment facility commanders, mental health care providers, and other medical care providers deliver evidence-based care for PTSD according to the VA/DoD clinical practice guideline (U.S.
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. Several PTSD programs in DoD use complementary and alternative therapies such as acupuncture, meditation, neurofeedback, and relaxation techniques, and some DoD mental health care providers and service members find benefits in those therapies for PTSD.
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The Army noted that "resilience training will likely result in only a slight reduction in the odds of a soldier experiencing one of these negative outcomes [PTSD, depression, or anxiety] as a result of the training." Furthermore, in an internal non-peer-reviewed report of the effect of Master Resiliency Training on five mental health diagnoses (including PTSD)
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For example, the Warrior Resilience Center at Fort Bliss, the Warrior Combat Stress Reset Program at Fort Hood, and the National Intrepid Center of Excellence at the Walter Reed National Military Medical Center differ in length, patient needs and characteristics, and use of adjunctive therapies. To make the PTSD intensive outpatient programs more consistent throughout the service branches and to encourage the use of standardized assessment tools and treatment outcome measures, TrIOPS has formed a network of 21 specialized PTSD
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Its guiding documents encourage the use of evidence-based care for PTSD: the VA/DoD Clinical Practice Guideline for Management of Post-Traumatic Stress (VA/DoD, 2010) , and Handbook 1160.05, Local Implementation of Evidence-Based Psychotherapies for Mental and Behavioral Health Conditions.
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It is unclear why, after more than 15 years of poorly sustained outcomes and high costs, the VA has not used these findings on the SIPPs to improve care for veterans who are being treated for PTSD. In 2012, VA also had 436 PTSD specialist sites in medical centers, CBOCs, and outpatient clinics and 127 specialized PTSD outpatient programs (SOPPs)
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. Many VA specialized PTSD treatment programs incorporate such complementary and alternative therapies as guided imagery, progressive muscle relaxation, and stress management–relaxation therapy, but there is considerable variability in what is offered in any particular program.
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. A 2012 evaluation of nearly 300 VA staff who had received CPT training found a statistically significant number of them agreed that adherence to the CPT protocol increased patient satisfaction with therapy, improved patient outcomes, was effective for most patients visiting outpatient PTSD clinics, and did not increase therapist burnout.
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PATIENT SAFETY IN DOD AND VA Patient safety is often neglected by health care practitioners and organizations. Although patient safety usually refers to the recognition and reporting of adverse effects that occur most commonly in connection with drug therapy and physically invasive procedures, they are also important in connection with other interventions, including psychotherapy.
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In February 2012, DoD issued Guidance for Providers Prescribing Atypical Antipsychotic Medication, which cautions that these drugs are not approved as treatments for PTSD or sleep disturbances and recommends monitoring of and provider training in their use. In April 2012, the Army issued Policy Guidance on the Assessment and Treatment of Post-Traumatic Stress Disorder (U.S.
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The use of multiple drugs may be warranted and is more likely to be encountered in veterans than in the active-duty military population for a number of reasons, including a higher degree of chronicity and accumulation of comorbid disorders over a veteran's lifespan, and there are fewer restrictions on the types of medications that may be used with veterans than with active-duty service members. DoD has recognized that the concomitant use of multiple medications can be a safety issue for service members who take multiple drugs for their PTSD and for any comorbidities, such as substance use disorder and chronic pain (Defense Health Board, 2011; U.S.
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. SUMMARY The VA/DoD Clinical Practice Guideline for Management of PostTraumatic Stress reflects the evidence base (and safety concerns)
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VA strives to provide effective and safe care for PTSD through the use of the Uniform Mental Health Services in VA Medical Centers and Clinics handbook and the VA/DoD clinical practice guideline. As with DoD, VA does not track adherence to either the guideline or the handbook, and the psychotherapy a veteran receives is not recorded in the electronic health record; pharmacotherapy is captured in the record.
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2013. The Comprehensive Soldier and Family Fitness Program Evaluation, report #4: Evaluation of resilience training and mental and behavioral health outcomes.
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2013. Inte grative medical practices for combat-related posttraumatic stress disorder.
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2013. A randomized stepped care intervention trial targeting posttraumatic stress disorder for surgically hospitalized injury survivors.
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