Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations Final Assessment (2014) / Chapter Skim
Currently Skimming:
10 Findings and Recommendations
10 Findings and Recommendations
Pages 215-230
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From page 215... ...
It is clear that the number of service members and veterans who have symptoms of PTSD and the number in the subset who seek treatment in the Department of Defense (DoD) military health system and the Department of Veterans Affairs (VA)
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From page 216... ...
Standardization and consistency of PTSD programs and services among facilities and service branches are not evident, and they often appear to have been developed and sustained at the local level without coordination with similar programs on other installations. Although the Defense Centers of Excel
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From page 217... ...
Although the IMHS was developed to provide a comprehensive public health approach to mental health management in DoD and VA, it is not PTSD-specific and the committee found little information and no formal reports on the status of the strategy's implementation. DoD, VA, and other federal departments are also coordinating and collaborating on such other efforts as the National Research Action Plan for Improving Access to Mental Health Services for Veterans, Service Members, and Military Families.
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From page 218... ...
Leaders also should be responsible for all service members or eligible veterans in their catchment areas, not only those who are receiving treatment for PTSD in their facilities. In DoD, and in each service branch, unit commanders and leaders at all levels of the chain of command are not consistently held accountable for implementing policies and programs to manage PTSD effectively.
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From page 219... ...
Variability in leadership engagement in PTSD management in both DoD and VA can result in similar variability in the types and quality of the PTSD programs and services that are available to service members and veterans. The committee found in its site visits that 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 had strong leadership and excellent communication among providers and support staff.
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From page 220... ...
The BHDP will provide real-time and aggregate data to clinicians and leaders; however, the system is in its infancy and no information on outcomes or provider and patient satisfaction has been reported. Moreover, no outcome data are available for any of the DoD specialized PTSD programs with the exception of a small amount of short-term outcome data from the National Intrepid Center of Excellence, which treats service members who have severe PTSD and traumatic brain injury.
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From page 221... ...
because approximately 46,000 veterans who have PTSD receive care in both a Vet Center and a VA medical facility. VA has been collecting information on its specialized outpatient PTSD programs (SOPPs)
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From page 222... ...
Resources need to be available to provide the necessary infrastructure to facilitate ac cess to mental health programs and services. S uch standards, procedures, and requirements will help to ensure that providers are trained in evidence-based treatments that are consistent with the VA/DoD Clinical Practice Guideline for Management of Post Traumatic Stress understand military culture, measure the progress of patients on a continuing basis, and, in the case of purchased care providers, coordinate with patients' DoD or VA referring providers regularly.
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From page 223... ...
DoD does not appear to have a similar mechanism for ensuring that its purchased care providers are trained in and using evidence-based treatments or that service members are accessing the most appropriate providers. Both departments offer training in military culture to direct care providers.
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From page 224... ...
, lack of time to schedule patients for the requisite number of visits in the recommended time, and patients' not being ready to engage in trauma-focused therapy. To help engage patients in treatment, DoD and VA are also integrating complementary and alternative therapies into some of their specialized PTSD programs.
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From page 225... ...
Currently, there is no single, central resource of PTSD programs and services that are available throughout DoD and only a limited directory of programs available in VA. In the absence of a central directory of programs and services, the committee found it impossible to compare programs and services, to identify the ones that are effective and use best practices, and to recognize the ones that need improvement or should be eliminated.
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From page 226... ...
However, many of the clinicians and other mental health care providers with whom the committee spoke seemed to be unaware of the range of programs to which they might refer service members who needed more PTSD care than they were able to provide. VA maintains a catalog of specialized PTSD programs with its The Long Journey Home annual report, but the report does not include all PTSD treatment settings, such as general mental health clinics and women's health clinics, and it does not contain descriptive information on any of the programs.
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From page 227... ...
They often expressed a preference for family-based PTSD interventions over individual treatment that excluded their family members. Only a few studies have examined whether family therapy improves PTSD outcomes in service members or veterans, but studies of couple therapy and family therapy are building the evidence base for their efficacy.
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From page 228... ...
Nevertheless, DoD and VA are funding broad PTSD research portfolios and are working collaboratively with the National Institutes of Health (NIH) , other organizations, and academe to fill research gaps (for example, developing the joint National Research Action Plan for Improving Access to Mental Health Services for Veterans, Service Members, and Military Families for improving access to mental health services)
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From page 229... ...
However, in spite of well-intentioned and often innovative efforts to provide high-quality PTSD management, the committee found that neither department knows whether its many programs and services are effective in reducing the prevalence of PTSD in service members or veterans. It may be that current efforts are beneficial in the long term or that new approaches are necessary, but the committee believes that, until prevention and treatment outcome data are collected, analyzed, and evaluated at all organizational levels, it will be impossible to determine the success of any of those efforts.
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From page 230... ...
But gaps remain, and current efforts to address them can be confusing, cumbersome, and disjointed and can fall short of what would be expected of a high-performing PTSD management system. If the many dedicated and thoughtful mental health care providers and leaders that the committee spoke with during its site visits and open sessions are representative of the talent available in each department, improving short-term and long-term PTSD management for service members and veterans should be not only possible but probable.
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