Re tur ning Ve te r ans E xpe r ie nc e s of a Holistic T he r ape utic Pr ogr am Elda Kanzki-Veloso, Ph.D. & Angela Yehl, Psy.D. Nova Southeastern University
NSU Co lla b o ra to rs a nd Co mmunity Pa rtne rs � We ndy T ho mso n, MSN, � F t. L a ude rda le Ve t Ce nte r RN, NSU � Bro wa rd Co unty E lde rly a nd � Sa b rina Ste rn, RN, NSU Ve te ra ns Se rvic e s Divisio n � Dr. T o m K e nne dy NSU � Ve te ra ns o f F o re ig n Wa rs Sto ne o f Ho pe Pro je c t � Rivka Spiro , M.A., NSU � Dr. Ma rc e lo Ca stro , NSU � Dr. Ba rb a ra Ga rc ia - L a vin, NSU � Dr. K imb e rly Durha m, NSU � Dr. T imo thy Sc a la , NSU � Dr. Ja me s Pa nn, NSU � Dr. T o mmie Bo yd, NSU � Dr. Ro n Che na il, NSU � Ja c o b Co nno lly, M.S., NSU
� Operation Iraqi Freedom � Operation Enduring (OIF) Freedom (OEF) � 2003-2010 � 2001-Present “ Operation New Dawn ” (OND) August 31, 2010-Present (U.S. combat mission in Iraq had ended- transitional mission to assist Iraq ’ s Security Forces)
De plo yme nt � Appro xima te ly 2 millio n U.S. tro o ps ha ve b e e n de plo ye d to c o mb a t zo ne s sinc e Se pte mb e r 2001 (T a n, 2009). � Ma ny o f the se so ldie rs ha ve e nc o unte re d se rio us c ha lle ng e s re a djusting upo n the ir re turn ho me sinc e ma ny do no t suc c e ssfully a c c e ss ne e de d se rvic e s (I nstitute o f Me dic ine , 2010; Ho g e e t a l., 2004).
De plo yme nt c o nt., � F re q ue nt a nd le ng thy de plo yme nts ta ke the ir to ll no t o nly o n the so ldie r b ut fa mily me mb e rs a nd frie nds a s we ll.
Sta te me nt o f Ne e d � Several potential consequences to combat exposure, including: � Posttraumatic stress disorder (PTSD) � Depression � Substance abuse � Health problems/Traumatic Brain Injury (Hoge et al., 2004)
Adjustment Concerns: Family Views � In a mixed methods study conducted by Graf, Miller, Feist & Freeman (2011), family members identified the following concerns in their combat veteran family member � Anger and aggression � Distancing and isolation � Emotional numbing � Less consideration for others in the home and negative changes in attitude towards women
Re inte g ra tio n Co nc e rns � Re la tio nships � E mplo yme nt � Ho me le ssne ss � Suic ide � Se xua l Assa ult � He a lth Pro b le ms
Ba rrie rs to Ac c e ssing Se rvic e s Stigma associated with mental illness and concern regarding how the soldier/marine would be perceived among peers and superiors was identified as the primary barrier to provision of needed mental health services to military servicemen and women (Hoge et al., 2004)
Barriers to Care � Survey conducted by the National Council for Community Behavioral Healthcare (2009) � Access to Care � Long Distances � Stigma � Lack of Family Involvement http://www.afterdeployment.org/topics-stigma#videos
Pro g ra mma tic Ne e ds � The Department of Defense (DoD) has adopted several programs to assist with adjustment following deployment, such as: Courage to Care � Military One Source � Military HOMEFRONT � Project DE-STRESS (Delivery of Self Training and Education for Stressful Situations) � � These efforts are helpful for individuals who actively seek these services out; however, what appears to be missing is a centralized proactive program to facilitate patient to provider care (Robinson, 2004). Most recently the VHA Office of Patient Care Services (2010) has � implemented two new programs, Transition Patient Advocates (TPA) and Peer Support Technicians (PST).
Broward County � I n Bro wa rd Co unty, the re a re a n e stima te d 114,423 ve te ra ns (F lo rida De pa rtme nt o f Ve te ra ns Affa irs, 2009) � I t is pro je c te d tha t F lo rida will ha ve the la rg e st ve te ra n po pula tio n b e fo re the ye a r 2020. (F lo rida De pa rtme nt o f Ve te ra ns Affa irs, 2008),
Sta te me nt o f Ne e d � Curre nt lite ra ture c a lls fo r “ho listic ” tre a tme nts invo lving c o lla b o ra tio n o f suppo rt se rvic e s to a ddre ss the unde rutiliza tio n o f me nta l he a lth se rvic e s a nd ina de q ua c ie s in c urre nt me nta l he a lth mo de ls fo r ve te ra ns (Ro b inso n, 2004). � T his study so ug ht to b ridg e this g a p thro ug h the inve stig a tio n o f a wra pa ro und tre a tme nt pro g ra m tha t pro vide d ve te ra ns with me nta l he a lth se rvic e s, c a se ma na g e me nt, a nd pe e r suppo rt se rvic e s. a nd ve te ra ns’ re po rt o f e xpe rie nc e s.
Ho listic T he ra pe utic Pro g ra m � Intensive case management (Community Partners)- 1 hour every two weeks � Individual therapy- 1 hour/week � Family/marital therapy- 1 hour/week � Group therapy (Community Partners)- 1 hour every two weeks
Brie f Stra te g ic F a mily T he ra py � Family is part of a larger social system � Focus on relationships within the family, as well as within contextual frameworks (i.e., school, work, neighbors, etc.) and how these contribute to the development or maintenance of problems
Gro up T he ra py � Gro up the ra py wa s pro vide d o n a n “a s ne e de d b a sis” to e ng a g e o the r se rvic e me n a nd wo me n in the pro visio n o f suppo rt a nd e nc o ura g e me nt thro ug h the o fte n diffic ult a djustme nt o f re turning to c ivilia n life .
Re se a rc h Me tho do lo g y � A mixe d-me tho ds a ppro a c h wa s e mplo ye d a nd a llo we d fo r the inve stig a tio n o f pa rtic ipa nts’ e xpe rie nc e o f the ho listic the ra pe utic pro g ra m while a lso a sse ssing fo r c ha ng e s in sympto m pre se nta tio n (i.e ., via pre - a nd po st-tre a tme nt PT SD q ua lita tive q ue stio nna ire s, fa mily sa tisfa c tio n, a nd q ua lity o f life a sse ssme nt me a sure s) to tria ng ula te q ua lita tive finding s. � A T ra nsc e nde nta l Phe no me no lo g ic a l a ppro a c h wa s use d to e xa mine in-de pth pa rtic ipa nts e xpe rie nc e s o f the pro g ra m. T his a ppro a c h is c o nc e rne d with e xplo ring the live d e xpe rie nc e o f phe no me na , “just a s we se e the m a nd a s the y a ppe a r to us in c o nsc io usne ss” (Mo usta ka s, 1994, p. 49).
Pa rtic ipa nt Re c ruitme nt � Co nve nie nt sa mpling wa s use d to ta rg e t ve te ra ns b e twe e n the a g e s o f 18-40 ye a rs o f a g e who se rve d during OI F , OE F o r De se rt Sto rm fo r pa rtic ipa tio n in the pro g ra m. � Pa rtic ipa nts we re re c ruite d thro ug h re fe rra ls fro m the Bro wa rd Co unty Co mmissio n E lde rly a nd Ve te ra ns Se rvic e s Divisio n, F t. L a ude rda le Ve t Ce nte r, a nd VF W Sto ne o f Ho pe Pro je c t
Pa rtic ipa nts � Sixte e n individua ls we re initia lly re c ruite d fro m lo c a l ve te ra ns’ o rg a niza tio ns fo r pa rtic ipa tio n in the study a nd me t with c linic ia ns a t NSU to c o mple te a n inta ke a sse ssme nt. � Of the se sixte e n individua ls, six individua ls pa rtic ipa te d in a n initia l a sse ssme nt, a t le a st nine the ra py se ssio ns, a nd a q ua lita tive inte rvie w a nd we re the re fo re a b le to b e inc lude d in the fina l da ta a na lysis.
Pre / Po st Me a sure s � The instruments that were administered are as follows: � Detailed Assessment of Posttraumatic Stress (DAPS) � Family Environment Scale-Real Form (FES-R) � Quality of Life Inventory (QOLI)
Cha ng e s I n T ra uma Sympto ms � Ve te ra ns’ T o ta l Po st tra uma Sympto ms de c re a se d fro m pre to po st-inte rve ntio n a s me a sure d b y the De ta ile d Asse ssme nt o f Po sttra uma tic Stre ss. � Additio na lly, de c re a se s we re no te d a mo ng the fo llo wing sympto ms: � Pe rc e ptio ns o f Sub sta nc e Ab use de c re a se d b e twe e n pre a nd po st- inte rve ntio n. � Sympto ms re la te d to Suic ida lity de c re a se d b e twe e n pre a nd po st inte rve ntio n. J2 � De c re a se s in sympto ma to lo g y we re a lso e vide nt in the sympto ms o f re - e xpe rie nc ing tra uma tic e ve nts, hype r-a ro usa l, a nd disso c ia tio n.
Slide 21 J2 May want to take this out as these were not part of our original data set of interest. Jakers, 1/23/2012
Cha ng e in T ra uma Sympto ms Table 1. Detailed Assessment of Posttraumatic Stress Pretest and Posttest Subscales Descriptive Statistics Pretest Posttest Scale n Mean SD Mean SD DAPS Posttraumatic Stress- Total Scale 6 80.83* 20.87 76.33* 22.95 DAPS Substance Abuse Scale 6 61.50 13.34 54.17 7.99 DAPS Suicidality Scale 6 52.17 11.32 50.17 6.52 *denotes clinical significance
Cha ng e in Pe rc e ive d L e ve l o f F a mily Co he sio n � Pe rc e ptio ns o f ve te ra ns’ le ve l o f fa mily c o he sio n a s me a sure d b y the F a mily E nviro nme nt Sc a le - Re a l F o rm, sho we d g re a te r fa mily c o he sio n fo llo wing the ho listic tre a tme nt inte rve ntio n.
Cha ng e in F a mily Co he sio n Ove r T ime Table 2. Family Environmental Scale Real Form Subscale Pretest and Posttest Subscales Descriptive Statistics Pretest Posttest Scale n Mean SD Mean SD Family Environmental Scale Real Form-Cohesion 6 48.17 20.32 59.67 6.38
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