Sunday, August 21, 2011

DOD & VA Addressing Unseen Wounds

Both the Department of Defense and the Veterans Administration look at both PTSD and TBI as the unseen wounds of war and both conditions can share a complex relationship. For example, an explosive device that causes a TBI can also produce a trauma leading to PTSD. In addition, common symptoms can make it even more difficult to diagnose each condition.

DOD’s initiatives to address the problem:

• Center for Deployment Psychology (CDP) and the National Center for Telehealth & Technology (T2) are component centers of the Defense Center of Excellence for Psychological Health and TBI. CDP trains train military, civilian psychologists, and other behavioral health professionals while T2 develops communications and information technologies to address psychological health and TBIs

• Defense and Veterans Brain Injury Center collaborates with organizations to advance research on TBIs. A major focus is to evaluate the quality and cost-effectiveness of treatments delivered to military personnel and veterans

• Deployment Health Clinical Center (DHCC) provides a gateway to information on deployment health and healthcare for providers, service members, veterans, and families. RESPECT.Mil is a treatment model designed by DHCC to screen, assess, and treat active duty soldiers with depression and/or PTSD

• National Intrepid Center of Excellence provides an interdisciplinary team assessment approach combined with high technology diagnostics to follow combat-related psychological health and TBI

TATRC has funded and developed virtual reality programs that allow soldiers with PTSD to revisit past wartime experiences and get past those events at their own pace. The virtual reality program helps a war fighter recognize their symptoms and find ways to obtain professional help.

Another TATRC product called “Mood Tracker” helps users monitor swings in moods, emotions, and behaviors resulting from therapy, medications, or other daily events. The application is designed for smart phone use and is able to record emotions for up to several months so that patient mental health can be documented over time.

TATRC developed and provides “Neurocognitive Baseline Testing” for troops prior to deployment. More than two million tests have been performed making it easier to detect changes and identify mild TBI later on if necessary.

The Army’s TriWest Healthcare Alliance takes care of all the active duty, retired military, and their families in 21 western states and is a leader in treating the unseen wounds of war. Stress related issues have increased dramatically in the past three years with repeated deployments. As a result, TriWest has increased their behavioral health professional staff from 7,000 to 25,000. TriWest’s ten year old behavioral health hot line is so successful that both the Army and Marine Corps asked TriWest to help them set up their own hotlines.

The Veterans Administration is also very active in serving the needs of veterans with PTSD through their National Center for PTSD. The Center has developed state-of-the-art assessment measures and treatments for clinicians to use to diagnose and treat patients with PTSD. Information is disseminated to clinicians through the Center’s web site, publications, and treatment manuals, also through assessment tools, nationwide training, and their in-person clinical training program.

Increased adrenergic activation among veterans with PTSD has led to clinical trials using anti-adrenergic medications. The Center is also working to identify a biomarker for PTSD that would help identify true cases with the disorder. This marker would be very useful for diagnostic purposes, for monitoring treatment responses, and for evaluating veterans seeking service-connected disability status for military-related PTSD.

The Center established the “Published International Literature on Traumatic Stress (PILOTS) electronic index to traumatic stress literature and other mental health issues. The PILOTS index includes all relevant publications regardless of their origin, linguistic, or geographic limitations.

A new initiative “Integrated Mental Health Strategy” highlights the most resourceful psychological health services available to assist the military and veterans available from not only from DOD and VA but also from other Federal agencies such as SAMHSA, Department of Labor, and HUD. All of these agencies have been involved in developing ways to provide the best resources in the field to help with psychological problems.

Posted by Carolyn Bloch at 6:27 AM

FBI program helps wounded soldiers

WTKR-TV3

9:11 p.m. EDT, August 19, 2011

Preparing wounded warriors for life after the military -- that's what the FBI's Wounded Warrior Program is doing.  As they recover from injuries, servicemen and women in the program can learn new skills and get valuable work experience.  SFC Eddie Lopez is one of them; He's been in the program at the Norfolk Division of the FBI since March.  He found out about the program while recovering from injuries sustained in Iraq in 2009.  "I have orthopedic injuries, I have PTSD (post traumatic stress disorder) and I also have TBI (traumatic brain injury). Because of that, I also wind up getting severe migraine headaches, nightmares, can`t sleep, a lot of different things like that," said Lopez.

Now, the FBI's Wounded Warrior Program, is helping to prepare him for life after 24 years in the Army by allowing him to develop new skills while also getting valuable work experience as he recovers.  "It's opened my eyes to a lot of new things, you can see the things on TV, as far as the FBI, but when you get into the support side, it's very interesting," said Lopez.   Melanie Hayes, who does recruiting and staffing for the FBI, says "This is a way of giving back, it's a way of ensuring we are helping them have that easy transition into civilian workforce once they do leave the military."

The program can last anywhere from a few months up to two years. Lopez will be completing the program in early October and will retire from the military about a week later.   "It's sad because I love the military, and I wanted to continue on, but unfortunately I can't, so I'm seeking somewhere that I can be a part of something more than me and that I can also continue serving my country with something like the FBI," said Lopez.   To qualify, you must be a U.S. citizen, an active duty service member, have at least six months remaining on the WW status, be able to attain a Top Secret clearance, be cleared by DOD to participate, be able to get to and from the assigned work site and be in compliance with FBI's Employment Drug policy.    For information on applying, visit the Department of Defense's website Homefront Connections.

Caring for Those with Posttraumatic Stress Disorder

Last Updated: August 20, 2011

Does your wounded warrior…

·         Have difficulty sleeping or suffer from nightmares?

·         Have unwanted memories or thoughts?

·         Suffer from anxiety and panic attacks?

·         Become irritable or angry or express violent behavior?

·         Use alcohol or drugs to cope with stress?

·         Feel scared or confused?

·         Have trouble managing daily activities?

If so, he or she may be experiencing symptoms of posttraumatic stress disorder (PTSD). Many survivors of a traumatic event return to normal with time, whereas others take longer to heal—these individuals may develop PTSD.

Causes and symptoms of PTSD

PTSD is an anxiety disorder or condition that is common in wounded warriors who have been exposed to traumatic events while performing their military responsibilities.

According to Journal of Rehabilitation Research & Development, service members serving in Afghanistan and Iraq are involved in a variety of situations that can have an impact on the mental state and emotional well-being of an individual. They endure long periods of extreme stress, experience intense battlefield activity that poses personal harm and involves the taking of life, experience their own injuries, and witness the injuries and deaths of others.

PTSD is a silent, invisible injury that may be characterized by three main clusters of symptoms. According to the journal Aggression and Violent Behavior, the three clusters are re-experiencing symptoms, avoidance symptoms, and hyperarousal symptoms.

• Re-experiencing symptoms may be characterized by nightmares, flashbacks, and intrusive memories.
• Avoidance symptoms center on avoidance of thoughts associated with traumatic experiences.
• Hyperarousal symptoms include sleep disturbance, anger/irritability, difficulty concentrating, and an exaggerated startle response.

Strategies for helping and coping

Living with a wounded warrior who suffers from PTSD can place a heavy burden on the caregiver. PTSD patients may experience difficulties in social, professional, and family life, along with their own internal struggles. It's important to learn how to help your wounded warrior and yourself respond to your situation.

• Document your wounded warrior’s symptoms in a diary by paying special attention to how mood, feelings, and stress impact his or her daily activities.
• Reduce the stress you and your wounded warrior experience by trying behavioral therapy and relaxation techniques, such as meditation.
• Identify your wounded warrior’s triggers. Triggers are things that brings about a symptom of PTSD, such as sounds, smells, words, or even certain people. To avoid setting off triggers, develop a good communication system with your wounded warrior.
• Encourage contact with family and friends. A support system may help your wounded warrior get through difficult changes and stressful times.
• Check with doctors about antidepressant medications that may help your wounded warrior feel less sad.
• Recognize that your wounded warrior might not want your help all the time.
• Take walks, go for bike rides, or do other physical activities together. Exercise is important for keeping brain activity in balance.
• Establish routines.
• Join a support group for caregivers who are experiencing similar wounded warrior situations. Locate such groups by contacting your local Army installation's Soldier and Family Assistance Center (SFAC). 
• Learn as much about PTSD as possible. Knowing how PTSD affects people may help you understand what your wounded warrior is experiencing. 

Emotional impact of Care-giving

Helping an individual who has PTSD can be hard on the caregiver. As a caregiver, you may have your own feelings of fear and anger about what is happening to your wounded warrior, or you may wonder whether life will ever return to the way it was. These emotions can begin to affect your ability to serve. 

• Do not feel guilty or feel that you have to know it all. Remind yourself that nobody has all the answers and that it's normal to feel helpless at times.
• Do not feel bad if change is minimal. You cannot change anyone; people have to change themselves. 
• Take care of your physical and mental health.
• Make time for activities and hobbies that you normally enjoy.
• Take time to be alone. Find a quiet place to gather your thoughts.
• Exercise regularly; exercise offers a healthful way to deal with stress.
• Eat healthful foods to have the energy you need to carry you through the day. 

Caregiver resources

For more information about caring for those with PTSD, check out the National Center for Telehealth and Technology’s virtual PTSD tour to learn about causes and symptoms of PTSD and resources for information and care.

Also, call the Veterans Health Benefits Service Center toll free at 1-877-222-VETS, or go online to Specialized PTSD Treatment Programs, U.S. Department of Veterans Affairs. 

Contact your local Army installation’s SFAC for information about support groups and caregiver support services. For additional information on caregiving, visit the VA Caregiver Support website.

Helping a Family Member Who Has PTSD

When someone has PTSD, it can change family life. The person with PTSD may act differently and get angry easily. He or she may not want to do things you used to enjoy together.

You may feel scared and frustrated about the changes you see in your loved one. You also may feel angry about what's happening to your family, or wonder if things will ever go back to the way they were. These feelings and worries are common in people who have a family member with PTSD.

It is important to learn about PTSD so you can understand why it happened, how it is treated, and what you can do to help. But you also need to take care of yourself. Changes in family life are stressful, and taking care of yourself will make it easier to cope.

How can I help?

You may feel helpless, but there are many things you can do. Nobody expects you to have all the answers.

Here are ways you can help:

• Learn as much as you can about PTSD. Knowing how PTSD affects people may help you understand what your family member is going through. The more you know, the better you and your family can handle PTSD.
• Offer to go to doctor visits with your family member. You can help keep track of medicine and therapy, and you can be there for support.
• Tell your loved one you want to listen and that you also understand if he or she doesn't feel like talking.
• Plan family activities together, like having dinner or going to a movie.
• Take a walk, go for a bike ride, or do some other physical activity together. Exercise is important for health and helps clear your mind.
• Encourage contact with family and close friends. A support system will help your family member get through difficult changes and stressful times.

Your family member may not want your help. If this happens, keep in mind that withdrawal can be a symptom of PTSD. A person who withdraws may not feel like talking, taking part in group activities, or being around other people. Give your loved one space, but tell him or her that you will always be ready to help.

How can I deal with anger or violent behavior?

Your family member may feel angry about many things. Anger is a normal reaction to trauma, but it can hurt relationships and make it hard to think clearly. Anger also can be frightening.

If anger leads to violent behavior or abuse, it's dangerous. Go to a safe place and call for help right away. Make sure children are in a safe place as well.

It's hard to talk to someone who is angry. One thing you can do is set up a time-out system. This helps you find a way to talk even while angry. Here's one way to do this.

• Agree that either of you can call a time-out at any time.
• Agree that when someone calls a time-out, the discussion must stop right then.
• Decide on a signal you will use to call a time-out. The signal can be a word that you say or a hand signal.
• Agree to tell each other where you will be and what you will be doing during the time-out. Tell each other what time you will come back.

While you are taking a time-out, don't focus on how angry you feel. Instead, think calmly about how you will talk things over and solve the problem.

After you come back

• Take turns talking about solutions to the problem. Listen without interrupting.
• Use statements starting with "I," such as "I think" or "I feel." Using "you" statements can sound accusing.
• Be open to each other's ideas. Don't criticize each other.
• Focus on things you both think will work. It's likely you will both have good ideas.
• Together, agree which solutions you will use.

How can I communicate better?

You and your family may have trouble talking about feelings, worries, and everyday problems. Here are some ways to communicate better:

• Be clear and to the point.
• Be positive. Blame and negative talk won't help the situation.
• Be a good listener. Don't argue or interrupt. Repeat what you hear to make sure you understand, and ask questions if you need to know more.
• Put your feelings into words. Your loved one may not know you are sad or frustrated unless you are clear about your feelings.
• Help your family member put feelings into words. Ask, "Are you feeling angry? Sad? Worried?"
• Ask how you can help.
• Don't give advice unless you are asked.

If your family is having a lot of trouble talking things over, consider trying family therapy. Family therapy is a type of counseling that involves your whole family. A therapist helps you and your family communicate, maintain good relationships, and cope with tough emotions.

During therapy, each person can talk about how a problem is affecting the family. Family therapy can help family members understand and cope with PTSD.

Your health professional or a religious or social services organization can help you find a family therapist who specializes in PTSD.

How can I take care of myself?

Helping a person with PTSD can be hard on you. You may have your own feelings of fear and anger about the trauma. You may feel guilty because you wish your family member would just forget his or her problems and get on with life. You may feel confused or frustrated because your loved one has changed, and you may worry that your family life will never get back to normal.

All of this can drain you. It can affect your health and make it hard for you to help your loved one. If you're not careful, you may get sick yourself, become depressed, or burn out and stop helping your loved one.

To help yourself, you need to take care of yourself and have other people help you.

Care for yourself

• Don't feel guilty or feel that you have to know it all. Remind yourself that nobody has all the answers. It's normal to feel helpless at times.
• Don't feel bad if things change slowly. You cannot change anyone. People have to change themselves.
• Take care of your physical and mental health. If you feel yourself getting sick or often feel sad and hopeless, see your doctor.
• Don't give up your outside life. Make time for activities and hobbies you enjoy. Continue to see your friends.
• Take time to be by yourself. Find a quiet place to gather your thoughts and "recharge."
• Get regular exercise, even just a few minutes a day. Exercise is a healthy way to deal with stress.
• Eat healthy foods. When you are busy, it may seem easier to eat fast food than to prepare healthy meals. But healthy foods will give you more energy to carry you through the day.
• Remember the good things. It's easy to get weighed down by worry and stress. But don't forget to see and celebrate the good things that happen to you and your family.

Get help

During difficult times, it is important to have people in your life who you can depend on. These people are your support network. They can help you with everyday jobs, like taking a child to school, or by giving you love and understanding.

You may get support from:

• Family members.
• Friends, coworkers, and neighbors.
• Members of your religious or spiritual group.
• Support groups.
• Doctors and other health professionals

PTSD Treatment Programs in the U.S. Department of Veterans Affairs

NOTE: As of July 13, 2010, VA has New Regulations on PTSD Claims.

Each medical center within VA has PTSD specialists who provide treatment for Veterans with PTSD. Plus, the VA provides nearly 200 specialized PTSD treatment programs. A referral is usually needed to access the specialty programs. You can use this VA PTSD Program Locator to see if there is a specialized program near you. (NOTE: If you are in crisis dial 911 or 1-800-273-TALK/8255.)

Not all VA's offer the same programs. Your doctor can help you decide which program is best for you. This fact sheet describes the specialized PTSD programs and also the other options within VA for getting PTSD treatment.

Who is covered for VA care?

VA services are provided to all Veterans who have the following:

• completed active military service in the Army, Navy, Air Force, Marines, or Coast Guard (or Merchant Marines during WW II)
• discharged under other than dishonorable conditions
• includes National Guard members and Reservists who have completed a federal deployment to a combat zone

At times, the VA has special agreements to provide care to Active Duty service members and family.

What services are offered?

Each PTSD program offers education, evaluation, and treatment. Program services include:

• One-to-one mental health assessment and testing
• Medicines
• One-to-one psychotherapy and also family therapy
• Group therapy (covers topics such as anger and stress, combat support, partners, or groups for Veterans of specific conflicts

The VA provides treatments shown by research to be effective in treating Veterans. To learn about these treatments and the VA provider training programs, see our fact sheets: Cognitive Processing Therapy and Prolonged Exposure.

Services are conducted by mental health care workers. For more information about types of mental health care workers, see our fact sheet Finding and Choosing a Therapist.

PTSD specialists

Every VA Medical Center has providers that have been trained to offer PTSD treatment. Please be aware that even if your VA Medical Center does not have one of the special PTSD programs described below, you can still get effective PTSD treatment. Ask your doctor to refer you to a mental health provider who is a PTSD specialist. Below you will also find information about other options for getting PTSD treatment within VA.

Specialized Outpatient PTSD Programs (SOPPs)

SOPPs include three basic types of clinics. At these outpatient (not live-in) clinics, you can meet with a provider on a regular basis.

• PTSD Clinical Teams (PCTs) provide group and one-to-one treatment.
• Substance Use PTSD Teams (SUPTs) treat the combined problems of PTSD and substance abuse.
• Women's Stress Disorder Treatment Teams (WSDTTs) provide women Veterans both one-to-one and group treatment.

Specialized Intensive PTSD Programs (SIPPs)

SIPPs provide PTSD treatment services within a "therapeutic community." Many programs are residential (live-in). Activities offered are social, recreational (relax), and vocational (work), as well as counseling.

• PTSD Day Hospitals (DH) are outpatient. They provide one-to-one and group treatment for 4-8 hours each visit. Patients come in daily or several times a week.
• Evaluation and Brief Treatment of PTSD Units (EBTPUs) provide PTSD treatment for a brief time ranging from 14 to 28 days.
• PTSD Residential Rehabilitation Programs (PRRPs) provide PTSD treatment and case management. The goal is to help the trauma survivor return to healthy living in the community. Stays at a PRRP tend to be 28 to 90 days long.
• Specialized Inpatient PTSD Units (SIPUs) provide trauma-focused treatment. Hospital stays last from 28 to 90 days.
• PTSD Domiciliary (PTSD Dom) provides live-in treatment for a set period of time. The goal is to help the Veteran get better and move to outpatient mental health care.
• Women's Trauma Recovery Program (WTRP) was opened by the VA in Palo Alto, CA, in 1992. This live-in program focuses on war zone-related stress as well as Military Sexual Trauma (MST). In the program Veterans can work on skills needed to deal comfortably with other people. The program is 60 days long.

Other options

Some VA medical centers are now offering walk-in clinics. By walking into the primary care clinic, a Veteran can be seen that day by a mental health provider.

Other VA treatment locations where a Veteran can get PTSD treatment include:

• Community Based Outpatient Clinics (CBOCs)
• Primary care programs
• Provide care in a local setting
• Services include mental health care (some locations)

• Vet Centers are operated by VA's Readjustment Counseling Service. Call toll free during normal business hours: (Eastern) 1-800-905-4675, OR (Pacific) 1-866-496-8838.
• Located outside medical facilities
• Many workers are Veterans
• Provide a mix of counseling and help with accessing other programs
• No information about your treatment will be given to any person or agency (including the VA) without your consent

In summary

The goal of the VA is to provide the best care for our Veterans.

Go to the VA Facilities Locator to find a VA medical center, an outpatient clinic, or a Vet Center. You can also find a specialized PTSD program using the VA PTSD Program Locator.

Call VA Benefits: 1-800-827-1000

Call VA Health Care Benefits: 1-877-222-8387