PTSD Treatment Kansas City VA Janet Constance, Ph.D. PTSD Clinical Team Overview • PTSD prevalence rates • PTSD treatment options at Kansas City Veterans Affairs Medical Center (KC VAMC) • Community collaboration • Potential barriers to VA treatment Rates of PTSD in Our Community • Projected lifetime risk for PTSD in U.S. at age 75 ▫ 8.7% • 12-month prevalence among U.S. adults ▫ 3.5% • Rates of PTSD are higher among veterans and others whose vocation increases the risk of traumatic exposure (e.g., police, firefighters, emergency medical personnel) • Highest rates are found among survivors of rape, military combat, and captivity ▫ Ranging from 1/3 to more than 1/2 of those exposed PTSD Rates at VAMC • Mental Health Service (FY 2012) ▫ 5,102 veterans with PTSD diagnosis were served ▫ 11% of all veterans served • PTSD Clinical Team (PCT) ▫ FY 2004  756 veterans served  5,593 visits  Average number of sessions – 7.4 ▫ FY 2010  2085 veterans served  17,751 visits  Average number of sessions – 8.5 PTSD Services – KC VAMC Outpatient Services • Mental Health Clinic (MHC) ▫ The full spectrum of MH disorders are treated within, including PTSD ▫ Multidisciplinary team comprised of psychiatry, psychology, social work, nursing, marriage & family therapy, & psychiatry and psychology residents • PTSD Clinical Team (PCT) ▫ Specialty clinic within MH service ▫ Provides specialty care for combat veteran and victims of military sexual trauma, as well as PTSD secondary to other trauma types ▫ Multidisciplinary approach PTSD Services – KC VAMC Inpatient Services • Substance Abuse Residential Rehabilitation and Treatment Program (SARRTP) ▫ ▫ ▫ ▫ Specialty clinic within MH service Regional VA inpatient substance treatment service 21-day program Multidisciplinary approach • Inpatient Psychiatric Unit ▫ Treats full spectrum of MH disorders ▫ Average length of stay 4 days ▫ Multidisciplinary approach Regional PTSD Services Residential Services • Stress Disorder Treatment Program (SDTP) ▫ 24-bed residential PTSD program at Topeka, KS VAMC ▫ 7-week program for male and female veterans ▫ All trauma types, with specialties in combat and military sexual trauma • Domiciliary Care Services ▫ 202-bed residential facility at Leavenworth, KS VAMC ▫ 120-day program, with flexibility to accommodate individual needs ▫ Treatment programs for a variety of issues including homelessness, substance abuse, chronic health issues, & chronic and persistent mental illness ▫ Multidisciplinary approach to rehabilitation Research into Practice • VA/Department of Defense (DoD) Evidence-Based Clinical Practice Guidelines for the Treatment of PTSD ▫ Gives guidance to clinicians regarding effective treatments for PTSD based on high quality clinical research ▫ Guidelines can be accessed at:  http://www.healthquality.va.gov/index.asp • Uniform Mental Health Services Handbook ▫ Outlines minimum requirements for VHA Mental Health Services ▫ Delineates essential components of mental health care that are to be implemented nationally ▫ Designed to ensure that all veterans, wherever they obtain care, have access to high quality mental health services Instructions In your life, have you ever had any experience that was so frightening, horrible, or upsetting that, in the past month, you: 1. 2. 3. 4. Have had nightmares about it or thought about it when you did not want to? YES/NO Tried hard not to think about it or went out of your way to avoid situations that reminded you of it? YES/NO Were constantly on guard, watchful, or easily startled? YES/NO Felt numb or detached from others, activities, or your surroundings? YES/NO • Current research suggests that the results of the PC-PTSD should be considered “positive” if a patient answers “yes” to any three items. • National Center for PTSD http://www.ptsd.va.gov/ Prins, Ouimette, Kimerling et al., 2003 The Primary Care PTSD Screen (PC-PTSD) PTSD Treatment Options • Treatment modalities available ▫ Psychotherapy  Individual psychotherapy  Group psychotherapy  Family & couple therapy  Evidence-based treatment, symptom management, support groups, peer support ▫ Pharmacotherapy ▫ Telemental health Evidence-Based Treatments at KC VAMC • PTSD ▫ Cognitive Processing Therapy ▫ Prolonged Exposure ▫ Seeking Safety • Depression • Substance Use Disorders ▫ 12-Step Facilitation ▫ CBT for Relapse Prevention ▫ Motivational Enhancement Therapy ▫ Acceptance and Commitment • Psychosis Therapy for Depression ▫ Cognitive Behavioral Therapy for Psychosis ▫ Cognitive Behavioral Therapy for Depression ▫ Social Skills Training • Borderline Personality Disorder ▫ Dialectical Behavior Therapy • Couple Therapy ▫ Integrative Behavioral Couples Therapy ▫ Emotion Focused Therapy ▫ Gottman Method Couple Therapy Evidence-Based Training Available at KC VAMC ▫ ▫ ▫ ▫ ▫ ▫ ▫ ▫ ▫ ▫ ▫ ▫ ▫ ▫ Prolonged Exposure Cognitive Processing Therapy Cognitive Behavioral Therapy for Insomnia Cognitive Behavioral Therapy for Depression Acceptance and Commitment Therapy for Depression Interpersonal Psychotherapy Social Skills Training Cognitive Behavioral Therapy for Management of Chronic Pain Behavioral Family Therapy Integrative Behavioral Couples Therapy Problem Solving Training Motivational Interviewing Motivational Enhancement Therapy for Substance Use Disorders Behavioral Couples Therapy Community Collaboration • Community collaboration is a growth area for the KC VAMC related to PTSD treatment • Current collaboration ▫ Fee basis  If specialty care not available at KC VAMC ▫ Ongoing case consultation with community providers ▫ Kansas City Vet Center  Counseling center focusing on adjustment counseling for combat veterans  Under the Veterans Affairs Administration, but separate from VAMC  Community presentations Challenges to Accessing VA Mental Health Care • Mental health stigma • Lack of knowledge about mental illness, PTSD, and available treatments • Access ▫ VA Eligibility ▫ Service-Connection  Exceptions: Combat veterans (5 years) and victims of military sexual trauma ▫ Navigation of the VA system  Need for case managers • Culture change related to evidence-based treatment ▫ Increasing effectiveness of care & access for all veterans • Child care • Community EBP training ▫ Training community providers to ensure that veterans have access to the same standard of care regardless of where they seek treatment Challenges Faced by Women Veterans • 58-year-old combat Navy veteran ▫ ▫ ▫ ▫ “I wasn’t aware I needed help.” “I thought the VA was only for medical issues.” “Being recognized as a female vet.” “After several bad experiences, I didn’t come back for 5 years.” ▫ “Once I got to mental health, my psychiatrist referred me right to you.” • 37-year-old Army veteran ▫ “The only issue the keep me from getting help was me.” ▫ “Once I decided to try mental health, I was seen right away.”