• CPS - Rebecca Glidewell

     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 from WWII!

    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 courts.

    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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