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

The Department of Defense 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 Department of Defense 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.