Apologies for the momentary halt to postings.
> Ilona Meagher, 9:14 AM | Article |0 comment(s)
The U.S. House of Representatives and the U.S. Senate recently passed budgets that boost funding for veterans’ health care and other veterans’ needs at amounts higher than the Bush Administration’s proposal. The Bush budget boosts total VA funding by about 1.6 percent, or $1.7 billion.
The House bill adds about $600 million to the Bush proposal, which would bolster overall spending to about 2.6 percent. The Senate adds $3 billion, making the overall spending increase about 5 percent.
Many veterans groups have favored the congressional proposals saying the number of veterans entering the VA health system from wars in Iraq and Afghanistan warrants the extra funding. In fact, Congress and the president in the most recent fiscal year boosted VA funding by an “emergency” $3.7 billion appropriation midway through the budget year after seeing tremendous increases in health care costs for veterans returning from Iraq and Afghanistan. That figure is close to the increase being proposed by Bush.
The funding is aimed at not only taking care of the increase in VA patients, but also aimed at reducing, for example, the time it takes for the VA to process a disability claim. In 2007, it took 183 days to process a claim. That figure dropped to 169 days in 2008 and the current budget aims to bring that down to 145 days. That’s still a long time to wait for veterans who may have no other way to earn money when they are disabled.
The Bush budget also cuts medical research by 10 percent for the VA and major construction projects budget is cut by 50 percent. Both are restored to some extent in the House and Senate budgets. ...
The national office of the Veterans of Foreign Wars says the Bush budget is a good start but “demands” Congress up the funding for construction projects and medical research. The research funding would go toward what VFW national president George Lisicki calls the “signature wounds of war.” That research would help the VA better treat traumatic brain injuries, post traumatic stress disorder, prosthetics and improve treatments for burns and blind rehabilitation. ...
The cost of the Bush tax cuts are significant when compared to the VA budget needs. One tenth of the revenue from removing just tax breaks to hedge fund managers would fund the increase in the VA that Congress is proposing.
Labels: benefits, bush, claims, editorial, funding, house, legislation, senate, shortfalls, stats, tbi
> Ilona Meagher, 12:38 PM | Article |0 comment(s)
Labels: counseling, grassley, jobs, legislation, reintegration, resources, senate, vietnam
> Ilona Meagher, 1:14 AM | Article |3 comment(s)
Back in September, I sat down with Diane Strand, a reporter for DeKalb's MidWeek News, to discuss combat PTSD and other issues covered in my book, Moving a Nation to Care.What does a veteran have in common with a college student? Unfortunately for some, it may be Post Traumatic Stress Disorder. Typically, PTSD affects people who have been victims or have witnessed a death, disaster, injury or other crisis. If the shock has not diminished after a month, the diagnosis may be PTSD. ...
Herb Holderman, who heads the county's Veterans' Assistance office, says he has seen several individuals with PTSD from Vietnam, and recently is seeing more Iraqi War vets. Holderman said he refers individuals to psychologist Peter Coe, in Sycamore, who has had a contract for counseling with the Veterans' Administration for several years.
Professionals who have followed the history of Iraqi vets after they return home, have found cases of depression, suicide and homicide, and they predict widespread cases of PTSD as more Iraqi vets return.
Could victims of the Cole Hall tragedy at NIU be vulnerable to such a disorder? “Absolutely,” said Lynette Spencer, a licensed social worker at DeKalb Clinic. “It can be caused by any exposure to an extreme event---injury or death. It can also happen to witnesses of the event...even first responders and hospital workers.”
Coe said individuals in the room where the shooting took place, Cole Hall, would be most inclined to suffer from PTSD, but any prior traumas they've experienced might increase the possibility. He noted that most students will get past the grieving and loss without complications.
Coe and Spencer agree that repressing what happened is unhealthy and may lead to depression and substance abuse. In fact, Coe said 80-85 percent of Vietnam vets with PTSD turned to alcohol and drug abuse and may still be addicted. A history of broken marriages, arrests and DUIs may have followed.
Later in counseling, the individual will develop coping skills and relaxation techniques, Coe said, to deal with the memories. Their sense of identity and place in the world, often distorted by the experience, can be rebalanced.
At NIU, “those most at risk are those who were in the actual classroom,” Coe said.
Spencer noted NIU's many counseling resources including the Employee Wellness and Assistance Program, the Counseling Center and the Psychology Clinic within the psychology department. She supported the university's effort to have instructors and counselors available to all students on the initial days back on campus.
What if the student doesn't report concerns? “As an instructor, I think you know your students..., at least in the smaller classrooms,” Spencer said
Labels: avoidance, counseling, depression, local, nightmares, niu, self medication, society, suicidal, violence
> Ilona Meagher, 11:08 PM | Article |2 comment(s)
Labels: counseling, disillusion, family, iraq, self medication, video
> Ilona Meagher, 12:15 AM | Article |0 comment(s)
Today’s Army is out of balance. The current demand for our forces in Iraq and Afghanistan exceeds the sustainable supply and limits our ability to provide ready forces for other contingencies. ...Current operational requirements for forces and insufficient time between deployments require a focus on counterinsurgency training and equipping to the detriment of preparedness for the full range of military missions.
Given the current theater demand for Army forces, we are unable to provide a sustainable tempo of deployments for our Soldiers and Families. Soldiers, Families, support systems, and equipment are stretched and stressed by the demands of lengthy and repeated deployments, with insufficient recovery time. Equipment used repeatedly in harsh environments is wearing out more rapidly than programmed.
Army support systems, designed for the pre-9/11 peacetime Army, are straining under the accumulation of stress from six years at war. Overall, our readiness is being consumed as fast as we build it. If unaddressed, this lack of balance poses a significant risk to the All-Volunteer Force and degrades the Army’s ability to make a timely response to other contingencies.
Both the Army and Marine Corps are working to increase their ranks by tens of thousands of troops -- to 547,000 active-duty soldiers and 202,000 Marines -- but newly created combat units will not be able to provide relief until about 2011.
U.S. soldiers are currently deploying for 15-month combat tours, with 12 months at home in between. Marines are deploying for seven-month rotations, with seven months at home. Both services seek to give their members at least twice as much time at home as time overseas. "Where we need to be with this force is no more than 12 months on the ground and 24 months back," Cody said.
The stress on the force from extended deployments could get worse before it gets better, top combatant commanders warned Congress on Tuesday.
No decision has been made on whether the U.S. military will go ahead with plans to cut troop levels in Iraq in July at what was supposed to be the end of the so-called “surge” of combat forces designed to give the Iraqi government time to stabilize, and more troops could be needed in Afghanistan, said Adms. William Fallon, chief of U.S. Central Command, and Eric Olson, chief of U.S. Special Operations Command.
At a Senate Armed Services Committee hearing, Fallon said there should be “little doubt of our desire to bring force levels down” and cited “encouraging trends.” But he said ground commanders also want to be cautious about withdrawing troops “because it is critical to not lose the ground that was so hard-fought this year.” ...
Olson said special operations forces do not expect to stand down if the Iraq and Afghanistan operations wind down. Operating tempo “will remain high even when conventional forces downsize in Iraq and Afghanistan,” he said, adding that his command “anticipates no relief from our deployed commitments even when U.S. force levels in Iraq and Afghanistan are reduced.”
The Iraq war has altered the dynamic for military units across the Pacific over the past five years. Along the way, there have been no shortages of stress and sacrifice. It’s carved out new roles for the Air Force and Navy, ushering in a brisk deployment tempo, and intense training sessions built specifically around prepping troops for duty on Iraq’s perilous streets and battlefields. ...
In recent years, the Army also has turned to the Navy and Air Force for help with security, civil engineering, infrastructure support and other critical roles in the war. In 2007, two Kadena Air Base squadrons, the 31st and the 33rd Rescue Squadrons, provided medical evacuation capabilities to other services in Afghanistan and Iraq. Defense contractors now routinely visit Pacific bases to teach airmen combat skills and convoy-ambush survival tactics.
Four-month rotations remain the standard for most Pacific airmen, but many are away for longer stretches. The wars in Iraq and Afghanistan were the first in which F-16CJ fighter jets were tasked to fly close-air support, providing cover, reconnaissance and munitions to coalition ground forces.
There are almost 1,400 Pacific Fleet sailors serving as individual augmentees in CENTCOM, with hundreds more at sea, the Navy said. The deployments range from six months to a year.
Navy leaders want to strike a better balance between war-on-terror requirements and improving stability for sailors and families at home, said Petty Officer 1st Class Shane Tuck, a Pacific Fleet spokesman. A new detailing process will be used for permanent-change-of-station transfers, rather than a “midtour, short-notice assignment,” he added.
The Navy also is feeling the strain, said Adm. Patrick Walsh, the vice chief of naval operations, even though ground forces are doing most of the fighting. The sea service has assigned thousands of sailors to support jobs ashore in the Middle East, using them to fill jobs that normally would be done by soldiers.
Walsh warned that the Navy's ability to maintain ships and aircraft will be imperiled unless lawmakers soon provide billions in extra funding sought by the Army and Marines to continue operations in Iraq. Without that money, Pentagon leaders will tap Navy and other noncombat accounts to pay war bills, he suggested. The Army is seeking an additional $66.5 billion and the Marines $1.8 billion this year for war-related expenses.
The military leaders' testimony at a Senate Armed Services subcommittee hearing fit a pattern of increasingly blunt warnings from the Pentagon about the war's toll on military families and equipment. The Bush administration began reducing the U.S. force in Iraq late last year, but Gen. David Petraeus, the top American commander there, is expected to recommend a pause in the drawdown when he testifies next week before House and Senate committees.
Airmen from the 379th Air Expeditionary Wing continue to maintain increased operations, both in the air and on the ground, in support of ground forces in Afghanistan and Iraq. ...
The 34th Expeditionary Bomb Squadron is called upon daily to provide close-air support to ground forces through precision bombing and shows of force and presence. The additional flying made for a busy week for aircrews and ground support.
"This was a good test for us to stretch our legs a little and get a taste of surge operations," said Lt. Col. Quinten Miklos, the 34th EBS director of operations. "It's an issue of stamina because what I'm asking people to do is to fly sorties more frequently."
Aircrew members are on a cycle that consists of crew rest, flying and recovering from a mission. A 12-hour sortie typically occupies the aircrew for 18 hours, Colonel Miklos said.
"For the crews, it presents a scheduling challenge because we are limited in the normal flow of sortie generation," Colonel Miklos said. "Our planners have to juggle the schedule to adjust crews to ensure the proper rest and time for planning."
Labels: afghanistan, army, cody, deployment, depression, dod, equipment, family, funding, house, iraq, marines, navy, oversight, petraeus, senate, shortfalls, stats, stress, tempo
> Ilona Meagher, 10:45 PM | Article |0 comment(s)
Post-traumatic stress disorder is among the most common diagnoses made by the Veterans Health Administration. Of the approximately 300,000 veterans from Operations Enduring and Iraqi Freedom who have accessed VA health care, nearly 20 percent –60,000 veterans- have received a preliminary diagnosis of PTSD. The VA also continues to treat veterans from Vietnam and other conflicts who have PTSD.
With the release of the 2007 IOM report “Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence,” we learned that we still have much work to do in our understanding of how to best treat PTSD. I hope that my colleagues will continue to work with me in supporting VA’s PTSD research programs.
I look forward to hearing testimony today from several organizations that are working to provide comprehensive and cutting edge treatment to those with PTSD. The committee recognizes that this is an important issue and one that will be with us for a long time to come. We are committed to ensuring that all veterans receive the best treatment possible.
I would like to briefly discuss the findings of three studies published since my last testimony to this committee in September 2006, which highlight both the successes and challenges in addressing the mental health needs of our service members.
The first is a study reported this past November in the Journal of the American Medical Association (JAMA) involving nearly 90,000 Soldiers who completed both the post-deployment health assessment (PDHA) and the post-deployment health reassessment (PDHRA) after return from deployment to Iraq. Soldiers completed the PDHA immediately upon their return and they completed the PDHRA six months later. The study confirmed that many mental health concerns do not emerge until several months after return from deployment, highlighting the importance of the timing of the PDHRA, particularly for Reserve Component Soldiers.
20% of Active Component and 42% of Reserve Component Soldiers were identified as needing mental health referral or treatment, most often for PTSD symptoms, depression, or interpersonal conflict. About half of Soldiers with PTSD symptoms identified on the PDHA showed improvement by the time of the PDHRA, often without treatment. However, more than twice as many Soldiers who did not have PTSD symptoms initially became symptomatic during this same period.
One counterintuitive finding was that we could not demonstrate any direct relationship between referral or treatment for PTSD as identified on the PDHA and symptom improvement six months later on the PDHRA. The difficulty in demonstrating the effectiveness of the PDHA assessment may reflect, in part, the inherent limitations in screening or the fact that mental health services remain overburdened with the current operational tempo, despite the extensive efforts to bolster services and training.
An encouraging finding was that many Soldiers sought care within 30 days of the PDHA and PDHRA even if they were not referred, which suggests these assessments may be encouraging individuals to seek help on their own following discussion of mental health issues with a health professional or participation in concurrent Battlemind education.
The second study I’ll discuss is the recently released Mental Health Advisory Team 5 (MHAT-V) report. We have conducted MHAT evaluations every year in Iraq since the start of the war, and twice in Afghanistan. The MHATs have shown that longer deployments, multiple deployments, greater time away from base camps, and combat intensity all contribute to higher rates of PTSD, depression, and marital problems.
The MHAT-V included for the first time a sizable number of Soldiers on their 3rd rotation to Iraq. The study showed that with each deployment there is an increased risk; 27% of Soldiers on their third deployment reported serious combat stress or depression symptoms, compared with 19% on their second, and 12% on their first deployment. The MHAT-V also showed that Soldiers in brigade combat teams deployed to Afghanistan are now experiencing levels of combat exposure and mental health rates equivalent to those experienced by Soldiers deployed to Iraq.
Soldiers encounter a variety of traumatic experiences and stresses as part of their professional duties. The majority cope extraordinarily well and transition home successfully. However, surveys in the post-deployment period have shown that rates of mental health problems, particularly PTSD, remain elevated and even increase during the first 12 months after return home, indicating that 12 months is insufficient time to reset the mental health of Soldiers after a year-plus combat tour. Many of the reactions that we label as “symptoms” of PTSD when Soldiers come home are, in fact, adaptive skills necessary in combat that Soldiers must turn on again when they return for their next deployment.
The 3rd study I’ll discuss is one that we just published in the New England Journal of Medicine pertaining to the relationship of PTSD to mild traumatic brain injury (or “mild TBI”). It is important to clarify terminology. Reports have indicated that as many as 20% of troops returning from Iraq and Afghanistan have had traumatic brain injuries, but what is not always made explicit is that the vast majority of these are concussions. “Mild TBI” means exactly the same thing as “concussion,” which athletes or Soldiers also refer to as getting their “bell rung” or being “knocked out.” I advocate using the term “concussion” because it is less stigmatizing than the term “brain injury,” is better understood by Soldiers and Families, and is less likely to be confused with moderate or severe TBI.
A concussion is a blow or jolt to the head that causes a brief loss of consciousness or change in consciousness, such as disorientation or confusion. Full recovery is expected, usually within a few hours or days. This is very different from moderate or severe TBI, where there is an obvious injury to the brain that almost always requires evacuation from theater.
Although most Soldiers are able to go back to duty quickly after concussions, there has been concern that concussions in combat, particularly from blasts, may have lasting effects that are not immediately visible. Some Soldiers report persistent symptoms (termed “post-concussive symptoms”), such as headaches, irritability, fatigue, dizziness, problems concentrating, sleep disturbance, balance problems, and cognitive or memory difficulties. Our study involving 2,500 infantry Soldiers was one of the first to look at the relationship between concussions Soldiers sustained while deployed to Iraq and these types of physical and mental health outcomes three months after their return.
There were three key conclusions from this study:
First, the study highlighted a problem that we face with not having an accurate diagnostic tool in the post-deployment period. We are not aware of any questionnaire or test that can accurately tell us who had a concussion while deployed, or which symptoms were caused by a concussion that occurred months earlier, as we are attempting to do with post-deployment screening. In our study sample, 15% of Soldiers reported a concussion while deployed based on the questions currently being used on the post-deployment assessment forms. However, only one-third of these, or 5% of the Soldiers, reported an injury in which they were knocked unconscious, usually for just a few seconds or minutes. The rest had injuries that only involved being briefly “dazed or confused” without loss of consciousness, and it was not clear how many of these were true concussions. We found that this type of injury did not confer much excess risk of adverse health effects after redeployment.
The second important finding was that having a concussion was strongly associated with PTSD. 44% of Soldiers who lost consciousness met the criteria for PTSD, compared with 16% of those who had other types of injuries and 9% who had no injury.
Third, and the most important finding, was that the symptoms that we thought were due to the concussions were actually attributed to PTSD or depression. If a concussion was the cause of the post-concussive symptoms we should have been able to confirm an association of these symptoms with a concussion, both in those Soldiers who had PTSD and in the larger group of Soldiers who did not. We did not see this in either group. Instead, all the physical health outcomes and symptoms were associated with PTSD or depression. Both PTSD and depression are biological disorders that are associated with a host of chemical changes in the body’s hormonal system, immune system, and autonomic nervous system. Many studies have shown that PTSD and depression are linked to physical health symptoms, including all of the symptoms in the “post-concussion” category, to include cognitive and memory problems.
This study allowed us to refine our knowledge about what distinguishes concussions in combat from concussions in other settings. Concussions on the football field, for example, are not known to be associated with PTSD. It is possible that there is an additive effect in the brain when a Soldier who is already seriously stressed in combat sustains a blow to the head, or there may be something unique about blast exposure, as many people are speculating. However, a hypothesis that is better supported by our data as well as other medical literature is the life threatening context in which the concussion occurs. Being knocked unconscious from a blast during combat is about as close a call as one can get to losing one’s life. There are frequently other traumatic events that occur at the same time, such as a team member being seriously injured or killed, all of which can precipitate PTSD or depression.
The most important implication of this study is that current post-deployment TBI screening efforts may lead to a large number of service members being mislabeled as “brain injured” when there are other reasons for their symptoms that require different treatment. The optimal time to evaluate and treat concussion is at the time of injury, and it is my opinion that post-deployment screening efforts months after injury may actually lead to unintended harmful effects. As a result, my research group has provided recommendations to medical leaders at Army and DoD to refine the post-deployment screening efforts to assure that all health concerns are addressed in a way that minimizes potential risks. These recommendations are now under consideration. In addition to screening and treatment, our study has important implications for educating Soldiers and Families about mild TBI (i.e. concussion).
The VA has made significant strides in preparing to meet the needs of returning OIF/OEF veterans but work remains to be done. AOTA urges Congress to continue to monitor how the VA uses occupational therapists and other professionals to assure that quality care is provided and that the full scopes of practice of all professions are brought to bear to meet veterans’ needs. Veterans deserve every service and intervention that professionals have been trained to provide. But they should receive services only from qualified professionals.
Throughout the VA system, but particularly within the Polytrauma Rehabilitation Centers, there should be a special focus on appropriate training and on evidence-based practice. Monitoring how each profession is integrated into the team should be done to provide for continuous quality improvement in these facilities.
Additionally, AOTA is concerned about the fragmented way the VA integrates or more problematically, does not integrate occupational therapists and other professionals into multidisciplinary teams for assessment and treatment of PTSD. While VA and Department of Defense (DoD) treatment guidelines for PTSD exist and include occupational therapy, it is the experience of our members that the inclusion of occupational therapists varies from site to site. This variation does not ensure full access to effective treatments and AOTA encourages the committee to look at this issue in detail.
It is also our concern that because of the primary role occupational therapy plays in the assessment and treatment of other conditions like TBI, low-vision and traumatic amputations, veterans with PTSD are not getting the access to occupational therapy they need. Occupational therapists are simply not as readily available as they need to be to address PTSD because their workload is so high in other areas. Additional therapists are needed to address PTSD because the unique, activity-based focus of occupational therapy is so critical to recovery from PTSD, particularly during the community reintegration phase of recovery.
It is possible for the private sector to supplement the Veteran’s Administration. Occupational Therapists at Washington University School of Medicine in St. Louis are currently contracted to provide services with three of our community based programs.
Veteran’s referred to us are evaluated by the Community Practice Program in their home to determine the issues that may be limiting their ability to care for themselves or others, get in and out of their homes if they are using mobility devices; and to determine if their home arrangements support them in daily tasks like toileting, bathing, preparing meals and maintaining the household. Their needs and goals are determined based on real life needs. If they have unmet mobility or work needs they are referred to either the Washington University Enabling Mobility Center (EMC) where they are evaluated and receive mobility and other equipment that will maximize their independence. If needed, they begin a program of post rehabilitation fitness (similar to what is provided at the Intrepid Center at Fort Sam Houston).
It is in the fitness program where the veteran can re-build their strength and endurance while socializing with other persons with mobility limitations on equipment designed for people in wheelchairs. If the veteran has a cognitive impairment and needs additional rehabilitation to be able to work or return to school they are referred to our Occupational Performance Center (OPC) where they learn strategies to perform work tasks and are assisted in maximizing their work potential using both simulated and then actual work tasks. The OPC team works with employers to create the right environmental fit to use the capacities of the worker. In this program people have gone back to complex jobs like nursing, teaching and the law in addition to trade jobs. ...
Roughly 750 occupational therapists are currently employed by the VA, but many more will be necessary to meet the needs of the new generation of veterans. Occupational therapy allows veterans with PTSD to return to activities of meaning that deliver a sense of normalcy and belonging to veterans and their families.
The Department of Veterans’ Affairs charged the Institute of Medicine committee with several specific tasks. We were asked to: (1) review the evidence and make conclusions regarding the efficacy of available treatment modalities; (2) note restrictions of the conclusions to certain populations; (3) answer questions related to treatment goals, timing and length; (4) note areas where evidence is limited by insufficient research attention or poorly conducted studies; and (5) comment on gaps and future research. ...
VA asked the committee to comment on what the literature tells us about the meaning of recovery, the effect of early intervention, and the impact of treatment length (e.g., brief vs. prolonged therapy). The committee found no generally accepted and used definition of recovery in PTSD. We recommend that clinicians and researchers work toward common outcome measure that are valid in research, allow comparability between studies, and are useful to clinicians.
We interpreted early intervention to mean keeping cases of PTSD from becoming chronic. Intervention before the diagnosis of PTSD or before the possibility of meeting the definition of PTSD (generally, early intervention in the literature occurs immediately post-trauma, referring to a condition that’s a precursor to PTSD, such as Acute Stress Disorder) was not part of our scope, because it refers to people who do not yet have or may never develop PTSD. We could not reach a conclusion on the value of early intervention, and recommended that further research specify time since trauma and duration of PTSD diagnosis. Interventions should be tested for efficacy at clinically meaningful intervals.
On length of treatment the committee found that the research varied widely in length of treatment even for a single modality, and was not able to reach a general conclusion. We recommend that trials focus on optimal length of given treatments, and that trials of comparative effectiveness between treatments should follow. There is also a need for longer-term follow-up studies after treatment concludes.
Our last two tasks were to address areas inadequately studied, and recommendations for further research. Our overall message here is that PTSD needs more attention from high-quality research, including in veterans. The committee highlighted several research-related issues in the report, including internal validity (for example, was there blinding in the study, was there adequate follow-up of patients, were missing data handled with appropriate analyses?), investigator independence, and special populations.
As outlined in our methods and in a technical appendix, the committee found much of the research on PTSD to have major limitations when judged against contemporary standards in conducting randomized controlled trials. While recognizing that PTSD research perhaps presents special challenges, we know that high quality studies are possible because we found them in our search, and there are authorities in the field of PTSD research who have called for more attention to methodologic quality. We recommend that funders of PTSD research take steps to insure that investigators use methods to improve the internal validity of research.
The committee also noted that the majority of drug studies have been funded by the pharmaceutical manufacturers, and the majority of psychotherapy studies have been conducted by the individuals who developed the techniques or their close collaborators. The committee recommends that a broad range of investigators be supported to conduct replication and confirmation studies.
The committee recognized that PTSD is usually associated with other problems such as comorbid substance abuse, depression, and other anxiety disorders. More recently, there’s been growing concern about people with PTSD and traumatic brain injury. The research literature is not informative on this issue of patients who have PTSD and other disorders. It also does not address PTSD in special veteran populations such as ethnic and cultural minorities, women, and people with physical impairments. We recommend that the most important such subpopulations be defined to design research around interventions tailored to their special needs.
Finally, the committee made two general recommendations about research in veterans. First, the committee found that research on veterans with PTSD is inadequate to answer questions about interventions, settings, and length of treatment. We recommend that Congress require and insure that resources are available to fund quality research on the treatment of veterans with PTSD, with involvement of all relevant stakeholders. Second, the committee found that the available research is not focused on actual practice. We recommend that the VA take an active leadership role in identifying the high impact studies that will most efficiently provide clinically useful information.
In closing, I would like to highlight the three key messages of this report.
1. Many of the studies that have looked into the effectiveness of PTSD therapies have methodological flaws and therefore do not provide a clear picture of what works and what does not work.
2. Various pharmaceuticals and psychotherapies may or may not be effective in helping patients with PTSD; we simply do not know in the absence of good data in most cases. To strengthen study quality, we need: larger studies, longer and more complete follow-up of all participants (including those who discontinue treatment before the study is over), and better selection of which treatments to study and which to compare to each other, with priority given to the most widely used therapies. Also, greater focus on veteran populations and special subpopulations (e.g. those with traumatic brain injury, substance abuse).
3. Given the growing number of veterans with PTSD and the seriousness of this disorder, the VA, Congress, and the research community urgently need to take steps to ensure that the right studies are undertaken to yield scientifically valid and generally applicable data that would help clinicians most effectively treat PTSD sufferers.
Labels: army, dod, house, michaud, oversight, reserve, stats, studies, tbi, va
> Ilona Meagher, 6:21 PM | Article |0 comment(s)
We at home often don’t realize the full value of our returning veterans. While some of us know we should be there for them as they return to us after deployment, many of us don’t realize that they are equipped to help us, too. Their knowledge and presence are more important to us as a civilian population than we realize.
It’s been nearly seven weeks since NIU’s Veterans Club lost one of its own – 12-year Army veteran Julianna Gehant – on that dark February day that took the lives of five others on our campus.
At Julianna’s funeral service, Rev. James E. Kruse spoke of the decorated soldier’s life and the circumstances of her death. He speculated about Julianna: Was she the woman students heard calling for others to run from a shooter as he reloaded and prepared to strike again?
“I don’t know for certain, but she’s a hero in my mind,” Kruse said at the Holy Cross Church service.
This Friday, many of us will gather together at NIU’s Veterans Memorial to remember Julianna’s service to our country and her time as a Huskie. We will join in laying a dedication plaque and paying our respects to an individual who embodied what it meant to be a good citizen and student. And we will offer our support for our Veterans Club members still grieving their great loss. And we will learn from them as well. ...
The dedication ceremony for Julianna Gehant begins at 11 a.m. Friday at the NIU Veterans Memorial, on the corner of College Avenue and Castle Drive (across from Lowden Hall and next to the East Lagoon). The public is invited to attend, as are all students and faculty.
I hope to see you there.
[UPDATE April 4, 2008] I had the privilege to attend today's dedication service along with my husband. As you might sense from the photos below (and in the entire set at Flickr), the morning began with a chill in the air and overcast, gloomy skies. Gathered in the shadow of Altgeld Hall listening to the strums of a Kenny Chesney song Julianna's friend dedicated to her, many in the audience wept.Sunny days seem to hurt the mostWear the pain like a heavy coat
I feel you everywhere I go
I see your smile, I see your face
I hear you laughing in the rain
Still can't believe you're gone
Chorus:
It ain't fair you died too young
Like a story that had just begun
The death tore the pages all away
God knows how I miss you
All the hell that I've been through
Just knowing no one could take your place
Sometimes I wonder who you'd be today
Would you see the world?
Would you chase your dreams?
Settle down with a family?
I wonder, what would you name your babies?
Some days the sky's so blue
I feel like I can talk to you
And I know it might sound crazy
Chorus
Today, Today, Today
Today, Today, Today
Sunny days seem to hurt the most
I wear the pain like a heavy coat
The only thing that gives me hope
Is I know I'll see you again someday
Friends and community members gather to pay tribute to one of the shooting victims at NIU. Seven weeks after the shootings on NIU's campus, students still mourn the loss of their classmates. One campus organization remembers a friend and army veteran.
Dozens of NIU Veterans Club members joined friends from Gehant's hometown of Mendota to reflect on the 32-year-old soldier who loved children, the army, and country music. Childhood friends of Gehant will always remember her smile and her positive spirit. Kristina Diemer says Julianna's commitment to the army inspired Diemer to pursue her dreams. ...
Gehant served in the US Army as an engineer for over twelve years before enrolling as an education major at NIU. During her service, she taught interior electrician courses, recruited future soldiers, and completed a mission in Kosovo.Major Sergeant Clayton Slater tells 13 News, "Sergeant first class Gehant's significant engineer and instructor expertise represents a fine example of the 100 division's motto train them tough."
Friends say Julianna placed others above herself even moments before her death. Friend Jennifer Webster says, "Julie served others through the last moments of her life, warning others that the shooter was reloading, Julianna Gehant is a hero."Even though J.D. Kammes lost his ballroom dance partner, Gehant's spirit pushes him to live each day with hope. Kammes says, "Sometimes it's just hard, some days I wake up and I am like what's the point. But then I think about her and she wouldn't want me to quit anything so that helps."
A plaque now sits at NIU's Veterans Memorial flag honoring Gehant's service to her country.
> Ilona Meagher, 11:04 AM | Article |0 comment(s)
Jackie Eckhart of the Virginian-Pilot is one of the lucky few to have had the opportunity to review a copy of a free comic book, "Coming Home: What to Expect, How to Deal When You Return from Combat," now being offered to service members at Military OneSource. Well, the way she tells it, the men in her life understood the value of the magazine better than she did at first:"Coming Home: What to expect, how to deal when you return from combat" is a new project by Military OneSource. Created by comic book masters Sid Jacobson and Ernie Colon, who formerly worked at Harvey and Marvel comics, it is aimed at service members who have worn combat gear every day for a year. It's aimed at people who see potential IEDs at every intersection. It is aimed at guys who come back to the States to feel fury at traffic, and women who find that half the world thinks they're bad mothers because they had to serve overseas, and family members who can't understand why their returning soldier or Marine is drinking so darned much.
This comic is aimed to help folks who need to learn about post-traumatic stress disorder. Because I wasn't one of those people, and I wasn't sure how I felt about treating a subject as serious as combat and operational stress response in a comic book, I threw "Coming Home" into a stack of reading material to look at later.
Not a minute later my 14-year-old picked it up. Then the kindergartner. Then our houseguest, a 48-year-old former Navy helicopter pilot. "What kind of aircraft is that?" he asked, holding the cover up to the light from the sliding glass doors. Then he read the whole thing.
[A]ll four main characters in the comic suffer one or more classic symptoms of combat and operational stress response after coming home. The reader gets the idea that sleep disturbances, sensitivity to certain sounds, anger, apathy, avoidance and increased alcohol use are the normal reaction to a year of living dangerously. It would be abnormal to go out on patrols in a war zone for such an extended period of time and not be altered. ...
We need to start assuming that our service members will need some kind of treatment if they have been under fire. ... That the reaction to war is normal. That the treatment is normal. We have to stop telling our military members and their families that it is OK to get treatment, implying tolerance for damage or weakness. Instead we have to start saying it is brave to get treatment. It takes courage to go back into the heart of darkness and evict the things the war has installed.
Because combat changes things. In small ways for some troops, in larger ways for others. Coming Home: What to Expect, How to Deal When You Return from Combat, sends a riveting message about issues that many returning service members face. Created by the legendary Sid Jacobson and Ernie Colón with guidance from military experts and service members who’ve been there. Order your free copy today.
1. What is Coming Home?
Coming Home is a short (32-page) “graphic novel” – the term used currently to describe highest-quality books with comic-style illustrations. It’s designed to give returning troops a heads-up about issues they may face at home – issues like marital stress, drug and alcohol abuse, aggressive driving, sleep problems, and combat stress symptoms – and where and how to get help.
The story involves four returning service members. Each has been affected by combat in some way and to a different extent:
* Marine Sergeant Jason Fetterman experiences insomnia and anger, and works to renew his relationship with his wife and build a new one with their infant son.
* Army Sergeant Mandy Clark deals with re-entry into life at home as a single mother.
* Army Specialist Danny Moreno drinks too much, drives too fast, and is having problems with his relationship with his girlfriend.
* First Sergeant Peter Douglas, a member of the Army National Guard, works to welcome the newly returned service members and guide them to resources that will make their reintegration easier to handle.
Each character, with the help of his or her buddies, friends, and family, comes to recognize the importance of getting support – from the Command, installation programs, and Military OneSource. Using these resources, each character surmounts the challenges of reintegration after combat.
The book also contains an extensive list of resources available to service members and their families.
2. Who created Coming Home?
Coming Home is a Military OneSource publication. Sid Jacobson, who wrote the storyline, is former editor-in-chief at Harvey Comics and executive editor at Marvel Comics. Ernie Colón, who drew the illustrations, served in the Army National Guard and in the Air National Guard as a gunner on a B-26 during the Korean Conflict, and oversaw production of Wonder Woman, the Green Lantern, Blackhawk, and the Flash at DC comics. Mr. Jacobson and Mr. Colón worked closely with military experts, Military OneSource staff, and service members (at Walter Reed Army Medical Center, Bethesda Naval Hospital, and Marine Corps Base Quantico) to make Coming Home as accurate a portrayal of the service member’s experience as it can be.
3. Who is Coming Home meant for?
* Coming Home is meant primarily for service members of all branches, but especially Army and Marine Corps, about to return home after combat, or who have recently returned home from combat.
* Spouses of these service members will also benefit from the situations described and the resources listed in the book.
* Command leadership will also benefit from the book’s portrayals and resources.
Parents should be aware that Coming Home is not meant as an educational material for young children. It deals with situations that are best understood by adults, such as marital stress, combat-stress symptoms, alcoholism, and depression, including suicidal depression.
4. How will Coming Home be distributed?
* Individual copies of Coming Home may be ordered by service members or their family members by visiting www.militaryonesource.com or by calling 1-800-342-9647.
* Military community service providers, Commanders, chaplains, and other personnel helping service members and their families may place bulk orders for appropriate events such as return and reunion briefings, PDHRA activities, and other events supporting returning military service members.
Labels: anger, avoidance, freebies, homecoming, humor, hypervigilence, reintegration, self medication, sleeplessness
> Ilona Meagher, 1:03 AM | Article |0 comment(s)
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and the goal."
Ilona Meagher is an independent Illinois-based online writer, new media developer and author of Moving a Nation to Care: Post-Traumatic Stress Disorder and America's Returning Troops.
After reading of a soldier's lost battle with combat stress/PTSD in 2005, she decided to pursue the then under-reported topic.
It would change her life.
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