Thursday, July 11, 2013

Veteran Trauma Support & Recovery Program

Background

If you turn on the nightly news, odds are you will hear  a story about a veteran that is struggling. They may be struggling with mental health issues, or with hunger, homelessness, or even post-deployment  readjustment to family life.  According to military health policy research performed by the Rand Corporation a substantial number of the nearly two million military service men and women returning from the conflicts in Iraq and Afghanistan face mental health problems.  Approximately 35 percent of those back from deployment reported symptoms consistent with a diagnosis of post-traumatic stress disorder (PTSD) or depression.
There are identified gaps in the active-duty military and veteran’s health care systems that preclude returning service men and women from getting the type and quality of services that they need to address their mental health concerns.  Despite recent efforts to increase services available through the Department of Defense (DoD) and the Veterans Health Administration (VHA), there is still limited  care available at the community level and barriers to receiving services exist.  Currently, both civilian and military mental health resources  have insufficient capacity to treat all the returning veterans in need. In many parts of the country, including Sonoma County, specialized health care for conditions such as traumatic brain injury (TBI), PTSD and depression is not readily available.
     Most mental health specialists are concentrated in large counties and highly concentrated urban areas.  Even where specialty care is available, limited health plan coverage reduces access for veterans seeking care outside of the VHA.  The VHA expanded its mental health staff by 50% between 2005 and 2010, and yet they are still unable to keep pace with the increasing demand for services. Unfortunately, many community providers lack the therapeutic  skills needed to treat this specific population.  The VHA’s case-load crisis has been exacerbated by the phenomenon of older veterans who are already in the system filing for additional or increased benefits, as the diagnostic thresholds  for pre-existing medical conditions—often dating back to the Viet Nam war era—have been lowered.
     Technological advances in warfare and medical practices have resulted in service members  returning with wounds that would have produced fatalities in earlier conflicts,  but which now cause non-fatal but devastating effects in the psyches of these men and women. These wounds, called “invisible wounds”, exist in the form of PTSD, depression, anxiety, and TBI and are being reported in staggering numbers. Returning service members with these hidden wounds are likely to face marital breakdown, job instability, substance abuse, domestic violence, depression and child abuse. There has been a 300% increase in cases and severity of cases serving victims of violence associated with the military. Although the VHA, DoD and community organizations are doing the best they can, without thorough approaches to treatment our communities will be overwhelmed with veterans who cannot succeed in civilian life. Many lack the skills to be productive, stable citizens because of war-related trauma. While the DoD already funds more than 200 programs to address these issues, challenges to maximizing the effectiveness of these programs exist.
     There is a lack of knowledge of and/or specialized training  for war-related trauma among service providers, especially among CBO's where returning veterans often look to receive services. Additionally, most services are decentralized and lack a process to systematically develop, track and evaluate program effectiveness. Improved planning and coordination, the sharing of information, rigorous evaluation and offering services in nontraditional locations to expand access to care are key factors to expanding efforts to better support service members and their families.
     The Veteran Trauma Support & Recovery Program will provide CBO's with a tool-kit which includes specialized, evidence- and research-based practices to address the growing demand of this population. Petaluma People Services Center will be the first of many CBO's to be trained in the trauma treatment protocols of the Bernstein Institute for Trauma Treatment to help our service men and women return to healthy, productive functioning in our communities.  This program offers an expansion of what others have successfully done with peer-to-peer counseling, by purposefully incorporating into the treatment protocol the participation of a returning veteran who has a desire to follow a career path as a trained therapist or social worker.  Peer-to-peer trust is the basis of unit cohesion in all branches of the military, especially those with combat responsibilities. Numerous post-combat studies have shown that “fear of letting your buddy down” is far greater than “fear of injury of death” among combat soldiers and Marines. In short, peer-to-peer trust and loyalty is what keeps service members  in combat.  For fear of letting down their “foxhole buddy”, soldiers and Marines “gut it out and fight.”  A majority of veterans report that one of main challenges they face when attempting to re-integrate in civilian life is the loss of the close bonds with  their former comrades and others their small unit – usually a squad or platoon. By providing battlefield veterans as counselors and mentors, our peer concept will help the client form the initial, critical bond essential to keeping  client returning for subsequent phases of treatment.  We are specifically recruiting combat vets (i.e., Navy SEALS) to serve as clinically-supervised "peers" for veteran clients,  with the goal to create a safe environment.  This safe environment will retain the veteran in a program of therapy and counseling long enough to experience real healing.Longer-term retention of clients will also help us develop and perfect a training and dissemination program for the Veteran Trauma Support & Recovery Program protocols and also to create a sustainable, replicable program that can be utilized across our nation in years to come.   Participation in treatment also offers  service members who are looking for a new career an opportunity to obtain the required hours of internship training by teaming a peer counselor with a  supervising therapist.Our program will offer peer-to-peer treatment and career opportunities not normally obtainable for returning veterans. 

Goals and Objectives

With funding we hope to train a core group of mental health providers in a specialized treatment modality, e.g., Veteran’s Trauma Support & Recovery Program, to address the mental health and reintegration issues faced by our returning service members and veterans. The program goal  is to restore veterans to full, productive, successful lives following their traumatic experiences in theatres of operations around the world.  Program protocols have been developed and utilized in treating veterans for the past 40  years by the Bernstein Institute for Trauma Treatment (www.bernsteininstitute.com). We believe that while learning and practicing skills for coping with trauma is essential as a first step, healing trauma requires therapy that goes beyond counseling and an often  lifelong dependence on medication. Truly effective therapy for service members suffering from PTSD, depression, and other co-occurring conditions must address the traumatic memories and emotions stored in the body.
     Our approaches encompass all aspects of trauma resolution – physical, emotional, mental, and spiritual. We will work with the services member and their families to restore the quality of life these warriors deserve for the sacrifices they made for us.
     PPSC will follow a strict treatment protocol from which we can track outcomes and treatment effectiveness  to  allow for replication for a large scale rollout in years to come. We have already discussed collaborating with larger organizations that have the capacity to help us take the necessary steps along the way with data collection and tracking. Relationships with the greater community will play a major role in the operation and sustenance of the program.  Additional support will be provided during  the treatment process by introducing a peer navigator or coach in the first phases of the treatment and continuing throughout the process.  This peer-to-peer counseling has proven successful in this population because the peer coach personally understands the effects of PTSD and TBI. We also know that this navigator must maintain on-going contact with the client and his or her loved ones while they work through the treatment of their war-related trauma and its impact on the client’s family.
     Groups which support our program and stand ready to refer veterans to us include: Veterans Administration’s trauma treatment facilities in Santa Rosa, San Francisco and Palo Alto; Vietnam Veterans of California; Northbay Veterans Center; Northbay Veterans Resource Center; the Coming Home Project; Swords to Plowshares; the Wounded Warrior Project; local reserve and National Guard units; Two Rock Coast Guard base; Sonoma State University, Santa Rosa Junior College, College of Marin and San Francisco State University; and the local chapter of Veterans of Foreign Wars. Addiction therapy will be provided in partnership with local community treatment centers or hospitals. We will be working concurrently with these agencies, managing overall treatment, placement, and training decisions. With  this design we can continue to offer the most thorough and long-lasting treatment and case management which is consistent historically with the Bernstein Institute’s approach for all clients. Partnerships with local community organizations will be used to surround the participants with professionals, para-professionals, peers and mentors. Community misconceptions about returning service members with PTSD, depression, and other trauma-related disorders can be corrected by positive interaction with our program.
     The outpatient trauma treatment program will be comprised of five phases: Assessment; Debriefing; Main Treatment; Reentry; and Aftercare. Each phase of the treatment will be conducted by trained professionals and a peer navigator, who will potentially  have daily contact with the client.  With an intial capacity to treat up to 25 participants per week, the Veteran Trauma Support & Recovery Program will grow to serve 50-100 patients per week within one year. Average program involvement will be 9 months to one (1) year with a maximum involvement of 3 years. Length of participation will vary for each veteran. Participants will gain access to appropriate program and community support services as they transition through the program phases.

Conclusion

In review, effective mental health services for our returning veterans and first responders are lacking in accessibility and many community-based providers lack the specialized knowledge and training to treat complex war-related traumas. Additionally, many veterans or active-duty service members often seek mental health services outside government programs due to perceived discrimination; they are often fearful that if diagnosed with a mental disorder their standing in the military will be affected. Often, the veteran or service member is not the only family member  who needs assistance, and mental distress is not the only issue affecting the veteran and their family members. When veterans seek assistance from CBO's, ALL members of their families can receive assistance. This can be in the form of rental assistance, housing support, job placement and additional mental health services for other family members and children. These wrap services help create a strong support network around the returning veteran to help ensure a smoother transition into civilian life.
     Not only do many CBO's lack the knowledge and training needed to treat war-related trauma,there is currently no specialized training program that provides the Community Based Providers with the necessary knowledge and tools to treat our returning vets. Furthermore, if there was such a specialized program many CBOs lack the funding to undergo the training.

     PPSC is seeking funding to work in partnership with the Bernstein Institute for Trauma Treatment to develop and perfect a training model that will help train CBOs across the nation to meet the unmet needs of returning veterans and first responders. This funding is needed to help get  our program off the ground and become a model program.  Please help us provide for those men and women of our military who have sacrificially served our country over the past decade, and beyond.

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