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Learning Center Experience
By Dr. Reba Glidewell, Instructor, Kaplan University School of Social and Behavioral Sciences
Hello. My name is Dr. Reba Glidewell and I am a psychologist
at the Overton-Brooks VAMC. Since this is National PTSD Awareness Month, I’ve
been asked to share some of my experiences and perspectives on where PTSD
treatment is headed. Since my experience is within the VA system, I’ve mostly worked
with combat veterans. One of the biggest trends I have noticed is the move
toward using more evidence-based, recovery oriented treatments instead of the
old “psychiatric treatment as usual” model. I specialized in working with
veterans returning from combat in Afghanistan and Iraq. Of course I also worked
with veterans from Korea, Operation Desert Storm, Vietnam, and even some veterans
The VA system has made a concentrated effort to train
clinicians in evidence-based therapies for PTSD and other mental disorders. One
of the evidence-based treatments is called “Prolonged Exposure Therapy” which
was developed by Dr. Edna Foa and others specifically for the treatment of
PTSD. Another is Cognitive Processing Therapy. Both include elements of
exposure to the traumatic memories but the names really say what they do. As
with any systematic change, there are roadblocks to overcome. One of them has
been hiring enough qualified clinicians to be able to offer the evidence-based
therapy, which is more intense than other treatments. Another roadblock is
getting those clinicians trained and certified to offer the therapies. Yes, the
VA requires certification in addition to the required license. There has also
been some resistance to change from clinicians who are being asked to change
the way they have been doing the job for many years.
Another trend that I have noticed is the growing number of
veterans who are involved in the criminal justice system. Based on my
experience and research I have read, approximately 10 percent of people who are
incarcerated at any one time are veterans (http://www.bjs.gov/content/pub/pdf/vsfp04.pdf).
Many of those veterans have mental illness, substance abuse problems, or both.
Included in the number of veterans who are incarcerated are combat veterans who
have PTSD, which is typically not treated while the veteran is incarcerated. A
systematic barrier that you might not know about is the regulation that
prevents VA clinicians from providing treatment to veterans while he or she is
incarcerated. That makes it even more important that we reach veterans prior to
incarceration, prevent incarceration if appropriate, and engage them in
treatment after release.
In order to reduce the unnecessary incarceration of
veterans, the VA began an initiative called the “Veterans Justice Outreach
Initiative.” The initiative uses a
sequential intercept model, which basically means that we attempt to connect
with veterans before, during, and after involvement with the justice system. I
am a Veterans Justice Outreach Specialist and do outreach to veterans who are incarcerated
(pre-conviction) and work with veterans after being released. I also provide
education to law enforcement, court personnel, and probation officers regarding
the treatment options available to veterans through the VA system. We are also
starting a Veterans Treatment Court where veterans will engage in active
treatment for mental illness, substance abuse, or both instead of
incarceration. The main focus is on non-violent crimes for the treatment
You might be asking yourself what the Veterans Justice
Outreach Initiative has to do with PTSD. Good question! In my work (which is
also consistent with research), a growing number of those incarcerated veterans
have PTSD and the majority also have substance use disorders. By engaging the
veterans in treatment (back to those evidence-based options), we have a better
chance to reduce the monetary cost of incarceration. By more importantly, we
have a chance to reduce the personal cost to our veterans and their families
who sacrificed for the country by volunteering to serve. Don’t we owe them our
best when they gave (and continue to give) so much?
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