ISTSS Logo
 
Home > Public Resources > Trauma Blog > 2016 - April > Military Matters: PTSD Consultation: Equipping Providers to Offer Great Care to Veterans In or Outsi

Military Matters: PTSD Consultation: Equipping Providers to Offer Great Care to Veterans In or Outside of the VA

April 2, 2016

There are approximately 22 million Veterans in the U.S. and more than 3.7 million have trauma-related mental health problems such as posttraumatic stress disorder (PTSD). Recent studies suggest that as many as 30-56 percent of Veterans prefer to receive care outside of U.S. Department of Veterans Affairs’ (VA) facilities, with particularly high rates among women Veterans.1,2 These statistics suggest that many U.S. mental health care professionals are likely to encounter Veterans in their practices. These providers may want to learn more about military culture, evidence-based treatments for trauma-related disorders or resources to help them effectively treat Veterans3 or they may have questions about the care of a particular Veteran.

The National Center for PTSD’s Consultation Program addresses these needs by offering free consultation to any provider treating a U.S. Veteran with PTSD. The overarching goal of the PTSD consultation program is to help clinicians provide excellent care to Veterans with PTSD. In 2011, the National Center for PTSD launched the consultation program for community providers caring for Veterans with PTSD. Consultation was initially only available to VA providers, but over time it became clear that a large number of Veterans were seeking some or all of their care outside of the VA. In early 2015, the PTSD Consultation Program received approval to offer consultation to any provider treating Veterans, whether in private practice, community treatment centers, or any other setting. Free CEU’s for participating in the PTSD Consultation Program’s monthly lectures series (http://www.ptsd.va.gov/professional/consult/lecture-series.asp) which covers topics relevant to treating Veterans with PTSD also became available to providers outside of the VA in 2015. 

On the program website, a collection of tabs with specific information introduces the program consultants, resources, FAQs and available lectures. The kinds of questions that come from providers outside of the VA, who have included psychologists, psychiatrists, social workers, licensed counselors, marriage and family therapists, have varied. Some of the providers contacting the program are new to treating Veterans – they ask for resources to learn about Veterans and military culture, treatment guidelines for PTSD, and how to make their practice inviting to Veterans. Others are already treating Veterans and have questions about how to proceed in specific cases like selecting a treatment for a particular Veteran or what options to consider in a particularly challenging clinical situation. Providers who are experienced in treating trauma and PTSD often contact the program when they are treating someone with a less common presentation, like someone who is dissociating or when there are safety concerns.

The National Center for PTSD is housed at the VA in White River Junction, Vermont, although some psychologist and physician consultants work virtually from other locations. A non-exhaustive list of common consultation topics includes: evidence-based treatment, clinical management, resources and referrals, assessment, collaborating with the VA on the care of a Veteran, and information about further education and training opportunities. Satisfaction with consultation has been high. As one social worker reported, “I have used this program several times and as always, the consultation is helpful and responses are timely. The consultant was knowledgeable and I was able to use his recommendations with a good outcome.”

Consultants at the PTSD Consultation Program are available to discuss issues related to common comorbities and co-occurring problems. For example, upwards of 40 percent of people with PTSD report some guilt related to their trauma.4 Trauma related guilt is also associated with increased risk of suicidal ideation.5,6,7 Among Veteran populations, guilt and moral injury frequently impact Veteran’s with PTSD and are predictors of other mental health problems and conditions.8 In addition to other problems with mental health, individuals with PTSD are at greater risk for a number of co-morbid physical conditions and complicated medical problems than those without PTSD.9 Education and training on the problems that commonly accompany a diagnosis of PTSD can also be found on the PTSD Consultation Program’s website via a link titled “PTSD 101 Curriculum and Continuing Education offerings”, some of which can be used for free CE/CME credits. Sleep problems, traumatic guilt, and medication for older Veterans are a few of the focused and featured topics currently available. 

Reintegration stress, traumatic brain injury, and suicide are issues which commonly impact Veterans diagnosed with PTSD. Cultural information about the military is beneficial for providers working with Veteran populations and provides valuable insights to presenting problems, barriers to treatment, and avenues for improving care. The monthly PTSD Consultation Program lecture series and PTSD 101 courses on the National Center for PTSD website address these pressing issues.

In addition to overviews and fact sheets on assessment, diagnosis, and medications for PTSD, practical assistance and further options for training are found in the “Resources” tab of the website. Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) are VA gold standards of evidence-based psychotherapies for trauma processing. Links to web-based learning of CPT and PE provide information for learning and utilizing the concepts of these therapies. 

Any provider from any discipline can contact the PTSD Consultation Program by email or telephone. Consultation is provided over email or by setting up a time to talk with a consultant. Response time is generally within a business day. To contact the PTSD Consultation Program, email ptsdconsult@va.gov or call 1-866-948-7880. Learn more about the program and the consultants at http://www.ptsd.va.gov/professional/consult/.

About the Authors

Sonya Norman, PhD, is director of the PTSD Consultation Program for the National Center for PTSD and an associate professor of psychiatry at the University of California, San Diego (UCSD). She earned her doctorate in counseling psychology at Stanford University. Dr. Norman previously directed the PTSD treatment program for Veterans who served in Iraq and Afghanistan for the San Diego VA. Her primary areas of research are in psychotherapies that treat PTSD and commonly co-occurring problems such as substance use disorders, posttraumatic guilt, and in treating PTSD in recently deployed Veterans. 

Belle Zaccari, PsyD, is a second year psychology research fellow in the Mental Illness Research, Education, and Clinical Center (MIRECC) in the Veterans Administration Portland Health Care System (VAPORHCS). Dr. Zaccari earned her doctorate in clinical psychology at the Adler School of Professional Psychology in Chicago and completed her pre-doctoral internship at the Southern Arizona Psychology Internship Center in Tucson. She is interested in the field of complementary and integrative health (CIH) in the VA and is piloting a study examining yoga as a complementary/alternative medicine (CAM) for the treatment of post-traumatic stress disorder (PTSD). She also collaborates on research investigating co-occurring PTSD and traumatic brain injury (TBI). Her clinical work specializes in substance use, co-occurring mental health and addictive disorders and CIH approaches to the treatment of trauma in Veteran populations.

References

  1. Department of Veteran's Affairs. Providing Health Care for Women Veterans: Resources for Non-VA Providers. 2013; http://www.womenshealth.va.gov/WOMENSHEALTH/providers.asp.
  2. Department of Veteran's Affairs. VA Health Care Utilization by Recent Veterans. 2012; http://www.publichealth.va.gov/epidemiology/reports/oefoifond/health-care-utilization/.
  3. Tanielian, T.L., Farris, C. Epley, C., Farmer, C. M., Robinson, E., Engel, E., Robbins, M. W., & Jaycox, L.H. Ready to Serve: Community-Based Provider Capacity to Deliver Culturally Competent, Quality Mental Health Care to Veterans and Their Families. RAND Corporation; RR-806-UNHF. Santa Monica, CA: November 2014.
  4. Miller, M.W., et al., The Prevalence and Latent Structure of Proposed DSM-5 Posttraumatic Stress Disorder Symptoms in US National and Veteran Samples. Psychological Trauma: Theory, Research, and Practice, 2012. 5(6): p. 501-512.
  5. Maguen, S., and Litz, B. (2012). Moral injury in veterans of war. PTSD Research Quarterly23(1), 1-6. 
  6. Hendin, H. and Haas, A.P., Suicide and Guilt as Manifestations of PTSD. American Journal of Psychiatry, 1991. 148(5): p. 586-591.
  7. Bryan, C.J., Ray-Sannerud, B., Morrow, C.E., and Etienne, N., Guilt is more strongly associated with suicidal ideation among military personnel with direct combat exposure. Journal of Affective Disorders, 2013. 148(1): p. 37-41.
  8. Bryan, C.J., Morrow, C.E., Etienne, N., and Ray‚ÄźSannerud, B., Guilt, shame, and suicidal ideation in a military outpatient clinical sample. Depression and Anxiety, 2013. 30(1): p. 55-60.
  9. Norman, S. B., Means-Christensen, A. J., Craske, M. G., Sherbourne, C. D., Roy-Byrne, P. P., & Stein, M. B. (2006). Associations between psychological trauma and physical illness in primary care. Journal of Traumatic Stress, 19, 461-470. doi:10.1002/jts.20129.