Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations Final Assessment (2014) / Chapter Skim
Currently Skimming:
3 PTSD Programs and Services in the Department of Defense and the Department of Veterans Affairs
3 PTSD Programs and Services in the Department of Defense and the Department of Veterans Affairs
Pages 47-78
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 47... ...
This is particularly true for DoD, where various mental health programs are under the authority of the DoD central office and dispersed across the service branches, installation commanders, and medical commanders. In VA, policy and oversight for PTSD programs are managed from the central office, but regional and local health care directors have responsibility for day-to-day operations and program or service innovations.
|
From page 48... ...
PTSD-related or -focused services are offered at military treatment facilities (MTFs) , embedded mental health clinics, and primary care clinics.
|
From page 49... ...
In 2013, it is estimated that about 9.66 million beneficiaries1 were eligible for DoD medical care -- 15.2% were active-duty service members and 3.7% were members of the National Guard or reserves -- and 5.5 million beneficiaries were enrolled in TRICARE. According to TRICARE Management Activity, a network of 56 hospitals and medical centers and 361 ambulatory health clinics provide direct care in the MHS, and more than 3,300 network acute-care hospitals and 914 behavioral health facilities provide purchased care (TRICARE Management Activity, 2013)
|
From page 50... ...
NOTE: ASD = Assistant Secretary of Defense; MTF = military treatment facility; USD = Under Secretary of Defense; USMC = U.S. Marine Corps.
|
From page 51... ...
The effectiveness of this program is discussed in Chapter 7. Navy and Marine Corps The foundation for psychological health promotion and mental disorder prevention in both the Navy and Marine Corps is their Combat and Operational Stress Control (COSC)
|
From page 52... ...
The meetings, however, are not considered to be treatment for exposure to a traumatic event and, therefore, often are not documented. Screening and Diagnosis Services DoD has a series of screenings and assessments for mental health during the deployment cycle for all service members -- the pre-deployment health assessment, the post-deployment health assessment (PDHA)
|
From page 53... ...
For example, the Marine Corps administers the PDHA and the PDHRA in deployment health clinics along with other screening tools, such as automated neuropsychological assessment metrics for traumatic brain injury. As noted in the phase 1 report, symptoms of PTSD may be underreported on the PDHA and PDHRA, and as a result, the true prevalence of PTSD in Operation Enduring Freedom (OEF)
|
From page 54... ...
The Army's Re-engineering Systems for Primary Care Treatment of Depression and PTSD in the Military (RESPECTMil) model of integrating mental health care in primary care settings has been replaced by a PCMH network of over 40 embedded behavioral health clinics that support combat brigades, expand intensive outpatient programs, and standardize case management (U.S.
|
From page 55... ...
Marine Corps deployment health clinics also have embedded providers to treat for mild to moderate mental health conditions in a timely manner and thus reduce the need for referrals. During 2005–2012, 5,390 marines had PTSD encounters in primary care clinics, 16,483 had encounters in mental health settings, and 1,496 had encounters in other clinics.
|
From page 56... ...
Some military installations offer intensive outpatient treatment programs that include evidence-based psychotherapy and pharmacotherapy as recommended in the VA/DoD Clinical Practice Guideline for Management of Post-Traumatic Stress (VA/DoD, 2010) , as well as such complementary and alternative therapies as meditation, recreational therapy, and biofeedback.
|
From page 57... ...
Patient outcomes are assessed by using the clinician-administered PTSD scale and the PCL-M, but no program results have been published. Residential PTSD treatment programs offer 24-hour intensive care with medication management, group psychotherapy, individual and family therapy, and complementary and alternative therapies (O'Toole, 2012)
|
From page 58... ...
Case managers coordinate service members' medical appointments and treatments. Some of those programs, such as the Marine Corps' Wounded Warrior Battalion, have long-term follow-up designed to monitor the needs and outcomes of program alumni in the years after discharge, but how often such follow-up occurs and whether it is successful in connecting those in need with effective services are unknown.
|
From page 59... ...
Each 8-week intensive PTSD treatment cycle has a maximum of eight patients who receive cognitive processing therapy (CPT) , group sessions, trauma bereavement, and complementary and alternative therapies (such as art therapy)
|
From page 60... ...
found that although a great variety of mental health services and programs were offered at military installations -- including family, medical, and religious programs -- there were "various degrees of segregation of these programs and no consistent plan for collaboration in promoting the psychological health of service members and their families." The report also noted that "the services are stovepiped at the installation and service levels." This section discusses some of the most recent and comprehensive evaluations of DoD programs and services for PTSD. Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoEs)
|
From page 61... ...
The Tri-service Integrator of Outpatient Programming Systems (TrIOPS) activity within the Deployment Health Clinical Center is evaluating and attempting to synchronize the treatments offered in the 21 PTSD intensive outpatient programs among the service branches (O'Toole, 2012)
|
From page 62... ...
. During 2009–2011, RAND developed a comprehensive catalog of psychological health programs sponsored or funded by DoD.
|
From page 63... ...
Organization In July 2011, VA announced a reorganization of mental health programs and services in the Veterans Health Administration (VHA) central office to enhance oversight and reduce variation in the delivery of mental
|
From page 64... ...
The VA Office of Information and Technology, Secretary -- -- -- -- -- -- - Deputy Secretary Office of Information and Veterans Benefits Veterans Health National Cemetery Technology Administration Administration Administration Under Secretary for Health Deputy Under Secretary of Deputy Under Health Operations and Vet Centers Management Secretary for Health Directors of Veterans Office of Mental Health Office of Patient Care Integrated Service Operations Services Networks (VISNs) Medical Center/Care Office of Mental Health Line Directors Services Local Mental Health National Center for Services PTSD Local PTSD Services FIGURE 3-3 VA organization chart showing PTSD management responsibilities in various mental health departments and services.
|
From page 65... ...
The provider Web page allows access to the PILOTS database that contains references to the world literature on PTSD and has information on PTSD assessment tools and screens, clinical training tools, and a military culture course. Prevention Programs and Services In the forefront of VA prevention activities are the 300 readjustment centers (Vet Centers)
|
From page 66... ...
Treatment Programs and Services VA medical centers offer a full array of treatment services for PTSD, including pharmacotherapy, face-to-face mental health assessment and diagnosis, group and individual therapy, and psychotherapy (particularly 2 Military sexual trauma is a term used in VA for "sexual harassment that is threatening in character or physical assault of a sexual nature that occurred while the victim was in the military, regardless of geographic location of the trauma, gender of the victim, or the relationship to the perpetrator" (VA, 2012b)
|
From page 67... ...
Most PTSD treatment occurs in general mental health clinics or primary care clinics. Veterans may also receive counseling for PTSD symptoms in Vet Centers or from private community mental health care providers or choose to receive no care at all.
|
From page 68... ...
Primary Care Centers Many veterans receive PTSD treatment in VA primary care clinics. In 2011, 10.4% of veterans seen in primary care had a diagnosis of PTSD, compared with 3.5% of all U.S.
|
From page 69... ...
. There are six types of SIPPs: 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 (VA, 2012a)
|
From page 70... ...
. The women's trauma recovery programs are 60-day live-in rehabilitation programs that include PTSD treatment and coping skills for reentering the community.
|
From page 71... ...
Evaluations of VA Programs and Services VA conducted a review of the mental health programs and services in its 140 medical facilities during 2012 and provided the evaluation report to the committee in November 2013. VA also sponsored the RAND and Altarum Institute report Veterans Health Administration Mental Health Program Evaluation: Capstone Report (Watkins et al., 2011)
|
From page 72... ...
Although veterans in this cohort comprised only 16.5% of the VA patient population, they accounted for about 41% of acute inpatient discharges, 40% of outpatient encounters, and 34% of total costs. Psychotherapy, pharmacotherapy, and specialized services for PTSD were reported to be available at 96–99% of VA medical centers and 64–88% of CBOCs, but only 20% of veterans who had PTSD had documented use of at least one psychotherapy with cognitive behavioral therapy elements.
|
From page 73... ...
Most service members and veterans who have mild symptoms of PTSD receive care in primary care or general mental health clinics. Both DoD and VA are integrating mental health providers in primary care clinics to reduce barriers to care.
|
From page 74... ...
2013b. Report to Congress on the Institute of Medicine report "Treatment for post traumatic stress disorder in military and veteran populations: Initial assessment." Wash ington, DC: DoD, Under Secretary of Defense for Personnel and Readiness.
|
From page 75... ...
:46. Marine Corps Combat Development Command and Navy Warfare Development Command.
|
From page 76... ...
2012. Review of VA/DoD clinical practice guideline on manage ment of acute stress and interventions to prevent posttraumatic stress disorder.
|
From page 77... ...
2011. Veterans Health Administration Mental Health Program Evaluation: Capstone Report.
|
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.