VA OIG -- Healthcare Inspection: Post Traumatic Stress Disorder Counseling Services at Vet Centers: The VA Office of Inspector General (OIG), Office of Healthcare Inspections (OHI) completed an inspection of the Readjustment Counseling Service (RCS) Vet Centers’ post traumatic stress disorder (PTSD) counseling services. The purpose of our inspection was to assess the quality of RCS Vet Centers’ PTSD counseling services to determine: (1) how Vet Centers screen clients for PTSD, (2) if documentation of clients’ treatment is in compliance with policy, and (3) if providers are trained to provide PTSD counseling services according to policy. In a previous OIG review of the RCS Vet Centers’ operational services provided during FY 2008 (Report No. 08-02589-171, dated July 20, 2009), we found that documentation in client treatment records and staff PTSD counseling training needed improvement. As part of this review, we evaluated whether any improvements had occurred in these areas. We found that RCS Vet Center counselors utilized appropriate tools to screen clients for PTSD. Client treatment case file documentation improved from our FY 2009 report. Staff training also improved. Approximately 85 percent of Vet Center providers had attended RCS’ required training on PTSD, and 53 percent of the providers had attended Veterans Health Administration-sponsored PTSD training. In addition, some Vet Center providers received supplemental training in Evidence-Based Therapy (EBT), and most Vet Centers were providing EBT to PTSD clients. Although RCS made improvement from our previous review, we found that the Team Leaders were not consistently providing supervision and consultation to the Vet Center providers in accordance with RCS policy. (2011)
Guide to VA Mental Health Services for Veterans & Families: The Guide to VA Mental Health Services for Veterans and Families is intended for Veterans, Veteran family members, members of Veterans Services Organizations, or members of other groups interested in VA mental health care. You can use this handbook to learn what mental health services your local or regional VA health care facility has pledged to provide to Veterans. (2012)
Practice Guidelines: VA Evidence-Based Practice works with the Department of Defense (DoD) to develop evidence-based practice guidelines to be used within the VA and DoD.
Efficacy of Complementary and Alternative Medicine Therapies for Posttraumatic Stress Disorder (August 2011): Posttraumatic stress disorder (PTSD) is the emotional disorder most frequently associated with combat and other potentially traumatic experiences that may occur during military service. It is often chronic and may be associated with significant comorbidities and functional impairments. Current first-line PTSD therapies include trauma-focused cognitive behavioral psychotherapies, stress inoculation training, and pharmacotherapies. Complementary and alternative medicine (CAM) interventions include a range of therapies that are not considered standard to the practice of medicine in the U.S. CAM therapies are widely used by mental health consumers, including Veterans, and numerous stakeholders have expressed strong interest in fostering the evidence base for these approaches in PTSD. Thus, this evidence synthesis was requested by VA Research and Development to inform decisions on the need for research in this area.
VA OIG -- Combined Assessment Program Summary Report: Re-Evaluation of Suicide Prevention Safety Plan Practices in Veterans Health Administration Facilities (March 2011): The VA Office of Inspector General, Office of Healthcare Inspections completed a re-evaluation of Veterans Health Administration (VHA) facilities’ suicide prevention safety plan (SPSP) practices. The purpose was to evaluate the extent VHA mental health (MH) providers consistently developed SPSPs for patients assessed to be at high risk for suicide. Inspectors evaluated SPSP practices at 45 facilities during Combined Assessment Program reviews conducted from January 1 through September 30, 2010. VHA facilities recognized the importance of developing comprehensive, timely SPSPs for high-risk patients. Additionally, VHA issued appropriate timeframes for initiating SPSPs. However, despite VHA’s efforts to comply with suicide prevention program requirements, problems with SPSP development continue to occur. We recommended that the Under Secretary for Health, in conjunction with Veterans Integrated Service Network and facility senior managers, ensure that MH providers develop and document timely SPSPs that meet all applicable criteria. The Under Secretary for Health concurred with the finding and recommendation. The implementation plan is acceptable, and we will follow up until all actions are complete.
Cognitive Behavioral Therapy for Depression in Veterans and Military Servicemembers, Therapist Manual (2011): Although the focus of this manual is on the application of CBT for depression, the manual and treatment protocol are based on core CBT competencies that can be adapted and applied to treat other mental health and behavioral health conditions. In this protocol, cognitive and behavioral theory and strategies are incorporated in an integrated fashion and guided by a careful case conceptualization, which is an important component of this treatment. In addition, the protocol places significant emphasis on the therapeutic relationship, which is a critical contextual variable in CBT. We believe that CBT done well requires a very strong and supportive therapeutic alliance. In this way, CBT for Depression in Veterans and Military Servicemembers strongly emphasizes the therapy in Cognitive Behavioral Therapy and differs from more psychoeducational or primarily skills-based approaches to CBT. In our experience, case conceptualization-driven treatment and the focus on the therapeutic relationship are especially important therapy ingredients when working with depressed Veterans.
Iraq War Clinician Guide, 2nd Edition (June 2004): This manual, developed with the Department of Defense, addresses the unique needs of Veterans of the Iraq and Afghanistan wars. Appendix J has 10 separate educational handouts.
Safety Plan Treatment Manual to Reduce Suicide Risk: Veteran Version: This manual describes a brief clinical intervention, safety planning, that can serve as a valuable adjunct to risk assessment and may be used with veterans who have made a suicide attempt, have suicide ideation, have psychiatric disorders that increase suicide risk, or who are otherwise determined to be at high risk for suicide (cf. Stanley & Brown, 2008). This manual is intended to be used by VA mental health clinicians, including suicide prevention coordinators, as well as other VA clinicians who evaluate, treat, or have contact with patients at risk for suicide in any VA setting. A safety plan is a prioritized written list of coping strategies and sources of support that patients can use during or preceding suicidal crises. The intent of safety planning is to provide a pre-determined list of potential coping strategies as well as a list of individuals or agencies that veterans can contact in order to help them lower their imminent risk of suicidal behavior. It is a therapeutic technique that provides patients with something more than just a referral at the completion of suicide risk assessment. By following a pre-determined set of coping strategies, social support activities, and help-seeking behaviors, veterans can determine and employ those strategies that are most effective. The purpose of this manual is to provide a detailed description of how VA clinicians and patients may collaboratively develop and use safety plans as an intervention strategy to lower the risk of suicidal behavior. This approach is consistent with the Recovery Model, which views veterans as collaborators in their treatment and fosters empowerment, hope, and individual potential.