Finding Balance and Resilience 101: Free Workbooks and Guides for Veterans, Military Families and Counselors

Last summer, I crossed paths with Pamela Woll, MA, CADP.

A Chicago-based author and consultant in writing, training, and instructional development, Woll works on getting individuals and organizations to "recognize and build on resilience; understand the nature, neurobiology, and effects of stress and trauma; and promote successful recovery from the effects of embodied stress and trauma."

While her entire Human Priorities website is well worth more than one visit (so much good information to be found there), I'd like to point you to two sets of resources she's created specifically with veterans, military families and counselors in mind.

Combat, Trauma and Healing PTSD: A Collection of Educational Videos for Caregivers and Patients

Some top notch educational combat trauma and PTSD videos are available online, specifically aimed at patients/counselors. Above, from the Hazelden Foundation's "A Guide for Living with PTSD: Perspectives for Professionals and Their Clients:"

Through compelling client testimonials and expert guidance from renowned researchers at the Dartmouth Psychiatric Research Center and the Department of Veterans Affairs National Center for PTSD, this video educates clinicians, clients, and families on the history, epidemiology, challenges, and treatment of post-traumatic stress disorder (PTSD). Sample cognitive-behavioral therapy sessions between counselor and client model realistic applications of the concepts presented. Free online training with credits is available from the National Center for PTSD.

VA Begins Major Expansion of Outpatient Services

From the VA:

World-Class Health Care Brought Closer to More Veterans

WASHINGTON – Veterans will have easier access to world-class health care under a Department of Veterans Affairs (VA) plan to open 31 new outpatient clinics in 16 states. Secretary of Veterans Affairs Dr. James B. Peake announced [on December 4, 2008 the] VA will establish new clinics in Alabama, Arkansas, California, Florida, Georgia, Hawaii, Illinois, Iowa, Maryland, Michigan, Minnesota, Mississippi, Missouri, North Carolina, Pennsylvania and Vermont. ...

With 153 hospitals and about 745 community-based clinics, VA operates the largest integrated health care system in the country. VA’s medical care budget of more than $41 billion this year will provide health care to about 5.8 million people during nearly 600,000 hospitalizations and more than 62 million outpatient visits.

“Community-based medicine is better medicine,” said Dr. Michael Kussman, VA’s Under Secretary for Health. “It makes preventative care easier for patients, helps health care professionals have closer relationships with their patients and permits easier follow-ups for patients with chronic health problems.”

The community-based outpatient clinics, or CBOCs, will become operational by late 2010, with some opening in 2009. Local VA officials will keep communities and their veterans informed of milestones in the creation of the new CBOCs.

Full list of proposed VA outpatient clinics.

The VA and the State of Louisiana also "jointly announced the selection of adjacent downtown sites for construction of their replacement medical center projects. The two projects, called the Veterans Affairs Medical Center and the Louisiana State University Academic Medical Center, restore greatly needed health care capability lost in New Orleans during flooding after Hurricane Katrina in late August 2005."

War and Sleep: LA Times Offers Story, Live Chat on PTSD Sleep Disorders

An invitation from the Los Angeles Times Booster Shots blog asking us to join in on an upcoming exploration -- both in print and online via a live chat this Tuesday, August 5 -- of the difficulty many combat veterans face in getting a fitful night's sleep. (Heaven knows writers and other creatives like myself generally fall into the night owl category, too, but our lack of sleep is obviously of the less mentally draining and certainly less alarming sort.)

First, details from the Times, and below the fold you'll find a number of recently related reports that have turned up in the news and clinical journals:

Mitch Hood, 25, spent two tours in Iraq with the Marines. Now, like many other veterans, he faces a new enemy: sleep.

Hood has nightmares nearly every night, many like the one above, laced with the fear he felt when he was in Iraq. Most nights, he battles his own body's need to sleep, opting to stay awake so he doesn't fall into nightmares.

Hood knows he is not the only one with these problems. Sleep and wakefulness issues are the most common health problems described by recently returned soldiers, researchers at Walter Reed Army Medical Center found in a study published last year.

A Times reporter and videographer stayed up all night with the former Marine and his fiancee to witness his struggles. The print story will appear in Tuesday's newspaper. A video of the vigil, plus interviews with Hood and other veterans, accompany the story on the Web.

Join us for a live Web chat at noon Tuesday to discuss the influence of war on sleep and how physicians try to treat the problems. We will be doing a question-and-answer session with Dr. Thomas C. Neylan, director of the Posttraumatic Stress Disorders (PTSD) Program at the San Francisco Veterans Affairs Medical Center, and Steve Woodward, director of the Sleep Research Laboratory at the VA's National Center for Posttraumatic Stress Disorder in Palo Alto.

Mark your calendars and set your bookmarks -- the chat happens right here Aug. 5 at noon Pacific time.

Hiring More Vets, Keeping Them in Their Homes, Offering Group Therapy, East Texas Resources

• KTRE-Ch 9/East Texas has published a comprehensive veterans resources guide chock full of phone numbers and information that is a must to check out if you're an area military family.
  
  
• Sen. Chuck Grassley [R-IA] and the White House are tossing letters back-and-forth with one another, the senator aiming to get the president to "establish the goal that 10 percent of all new hires by federal agencies be veterans." Meanwhile, Senate colleagues are attempting to extend foreclosure protection for veterans to nine months following return from overseas deployment.
  
  
• The National Alliance on Mental Illness (NAMI)--Kern County, Calif., chapter offers returning vets, military families local support group services. Phone 661-868-5061 for more information.
  
  
• On the other end of the country, a related feel good story: 11 Tampa Bay-area Vietnam veterans, aka 'Group 11,' have had their PTSD group therapy sessions reinstated after the VA abruptly terminated the program. "We're pleased, and we're shocked," said one member after hearing the news.

Unknown Allies: School Shooting Victims and Combat Veterans

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.

Those of you who read PTSD Combat regularly know I'm currently a student at Northern Illinois University and shared my experiences the day of the shooting and beyond.

Just this past Wednesday, I posted here on my column that ran in the Northern Star, relfecting on the fact that veterans are a dazed school shooting student's natural ally; they understand the pain and trauma of being in danger and in the vicinity of extreme violence (on an entirely different level than those of us on campus that day, however). Another commonality is an increased risk for post-traumatic stress disorder.

A&E 'Intervention' Program Features Iraq Veteran with PTSD

A&E's Intervention program recently featured a segment on Brad, a young man coping with his PTSD by self-medicating with alcohol and marijuana after two Iraq tours with the 101st Airborne.

For those unfamiliar with the show, Intervention is a "series in which people confront their darkest demons and seek a route to redemption" by profiling "people whose dependence on drugs and alcohol or other compulsive behavior has brought them to a point of personal crisis and estranged them from their friends and loved ones." Brad's journey is a powerful and important episode.
Program videos in extended.

Vietnam Veterans Reach Out to Today's Returning Troops

A few recent reflections on the invaluable role Vietnam veterans play in helping those returning from Iraq and Afghanistan today. The first, from the North County Times:

In combat, the older former warrior told the young Marines, "funny things happen." Weeks, months and even years after combat, he continued, those "funny things" can re-emerge as haunting nightmares, jittery paranoia or the root of any number of abhorrent and self-destructive behaviors.

"You cannot take a normal person and put them in that environment without it affecting them," the speaker, David Pelkey, told about 25 Camp Pendleton Marines who recently returned from Iraq. Pelkey, a Mira Mesa resident and a Vietnam veteran who served in the Army's 1st Cavalry Division, is the national director of American Combat Veterans of War, a nonprofit group founded seven years ago by Carlsbad resident Bill Rider, also a Vietnam veteran.

"We try to use ourselves as an example of what not to do in terms of denying the fact that you have been impacted by the war," Rider said about the program. While theirs is not the only program about post-traumatic stress, Rider said that American Combat Veterans of War is unique in providing firsthand advice from other veterans to the troops.

"We're here because we care about you, damn it, and there's something you don't understand that we do," said retired Marine Col. Al Slater, a Navy Cross recipient who also spoke to the returning troops. "We don't want your generation to go through the hell we did."

Navy, Marines May Send Psychologists to the Front

During the Russo-Japanese War (1904-1906), the first organized military system for treating combat fatigue occurred when physicians were placed close to the front ("forward treatment"). They were sent to perform evaluations of and administer care to traumatized soldiers.

The lessons of forward treatment, that soldiers receiving immediate care close to the action and their battle buddies were more resilient, is still relevant today. From the Associated Press:

Navy Chaplain Dick Pusateri has witnessed the stress of war on the faces of troops put in harm's way daily, in the strained relationships of families facing long deployments and the confessions of men shaken by the human cost of war.

For too long, chaplains were among the few people combat Marines felt they could turn to in a crisis. The Navy and Marine Corps aim to change that by sending teams of mental health professionals to the front lines after studies showed a jump in the past five years in cases of combat-related mental health disorders, primarily post-traumatic stress disorder.

"We've got a lot of knowledge about the way combat trauma affects people, and having somebody there to guide Marines through it in Iraq means we can respond to it more quickly," Pusateri said.

While psychologists and psychiatrists have long treated military service members on bases and in field hospitals, next month's deployment of teams of psychological professionals - one per regiment - to combat zones marks a new approach in identifying and treating mental health before problems arise.

Emotional Warmth and Sunny Saturday Light Chase Away the Darkness at NIU

I wanted to quickly share a few photos and reflections with you of my return visit to NIU yesterday [see them all at Flickr].

It was a chilly day, in the upper 20's; but, the warm hugs and heartfelt nods among Huskies -- now feeling more related and open to one another than at any time before -- leaning on one another cast a soothing glow in my heart. It was quite a tonic to my soul.

Free Suicide Prevention Book

There's been a lot of news about veterans' suicide of late, and I wanted to share a free resource with you today. It's a book called Suicide, the Forever Decision: For Those Thinking About Suicide and For Those Who Know, Love and Counsel Them, by Paul Quinnett, Ph.D. Meet him in this November KXLY4 report [Spokane, Washington/Northern Idaho]:

Christian Science Monitor's In-depth Military Chaplain Series a Worthy Read

A really informative 6-part Christian Science Monitor series is soon coming to a close, and well worth a read. For those who grew up in the era of M*A*S*H, who can forget the soothing salve of the unit's beloved Father Mulcahy?

These important caregivers are much-need, but unfortunately severely-strained (each deployed chaplain has a client base of about 1,000 troops to minister to). These professional souls do some of the most exigent work providing comfort and support in and out of the field to our warriors. Wonderful to see this work appreciated and recorded by CSM:

They carry no guns, yet US military chaplains are considered a force multiplier in the war theater. Today, in Iraq and Afghanistan, the military expects chaplains to meet the spiritual needs of troops. But it also recognizes their importance in everything from counseling the young soldier crying in his bunk over a Dear John letter to being a leveling moral presence among troops trained to fight and kill. Reporter Lee Lawrence spent three months with dozens of military chaplains in Iraq and Afghanistan. She profiles six of them in a weekly series.

One Iraq Veteran's Mission to Help Returning Peers

From the Fort Worth Star-Telegram:

Joel Chaverri has seen combat, having participated in the 2004 attack on Fallujah, Iraq, the scene of some of the most bitter street fighting involving U.S. forces since Hue in Vietnam. He knows the readjustment that a young man must go through when he leaves behind that kind of carnage.

So when Chaverri left the Marines and returned to North Texas, he accepted a job with the Department of Veterans Affairs. His mission: to go out and tell young combat veterans that it's OK to ask for counseling.

"I tell guys, 'You don't have to have a PTSD diagnosis or have a disability rating,'" Chaverri, 25, said. "'You don't have to have a disorder.' Our brochures never use the word PTSD. We offer readjustment counseling."

Center for Deployment Psychology Offers 2-Week Mental Health Provider Course

If you are an active duty, reserve or civilian behavioral health professional (or an intern, resident or other professional in training), you may be interested in attending one of The Center for Deployment Psychology's upcoming 2-week intensive programs.

Classes take place at the Uniformed Services University of the Health Sciences and National Naval Medical Center in Bethesda, MD, and Walter Reed Army Medical Center in Washington, DC. 2008 workshops: January 7-18, March 10-21, May 12-23

Details:

The 2-week intensive course covers topics in areas identified by military mental health professionals as particularly key to the care of service members and their families.

1. Deployment 101: examines the deployment cycle with attention to the unique culture, expectations and experience of military deployment including the reintegration with family and community upon return.

2. Trauma and Resilience: addresses issues of psychological trauma and resilience particular to the experience of combat deployment. This section also includes information pertaining to the assessment and treatment of PTSD and other problematic responses to trauma.

3. Behavioral Health Care of the Seriously Medically Injured: participants are introduced to issues that arise when providing behavioral health care to individuals suffering from serious medical injuries and traumatic brain injury.

4. Deployment and Families: explores the unique impact of military deployment on family members including children.

Limited to 30 participants, the program is free (civilians must pay for their own travel and expenses, while active duty and reserve component personnel may have their travel and per diem expenses covered). Download a registration form if interested in attending, and/or take a peek at course resources.

Joshua Omvig Veterans Suicide Prevention Bill Signed by President

From the Associated Press:

President Bush signed the Joshua Omvig suicide prevention bill on Monday, providing improved screening and treatment for at-risk veterans. The law is named after a 22-year-old soldier from Grundy Center, Iowa, who committed suicide in December 2005 after he returned from Iraq. ...

The new law comes amid growing concerns over mental health issues borne by veterans who have seen combat in Iraq and Afghanistan. The VA Inspector General, in a report last May, said Veterans Health Administration officials estimate 1,000 suicides per year among veterans receiving care within VHA and as many as 5,000 per year among all living veterans.

Rep. Leonard Boswell, D-Iowa, who sponsored the bill, commended Omvig's parents for their sacrifice and support of the new law.

"While suffering this personal tragedy, they went on to help other veterans and their families and have advocated for improving all mental health services at the VA," Boswell said.

Study: Internet-based Cognitive Behavioral Therapy Shows Promise for PTSD Treatment

From HealthDay News:

Internet-based cognitive behavior therapy (CBT) treatment for post-traumatic stress disorder (PTSD) shows promise, according to a pilot study in the November issue of The American Journal of Psychiatry.

The study found that 25 percent of U.S. military personnel assigned to an Internet-based, eight-week program of self-management CBT no longer had PTSD diagnosis after treatment or at six-month follow-up, compared to 5 percent after treatment and 3 percent at six-month follow-up for those assigned to regular supportive counseling. ...

CBT helps patients process traumatic memories therapeutically, understand and manage symptoms, and correct unhealthy thoughts and behaviors. While CBT is effective, it requires substantial training and expertise to administer, according to background information in the study.

These findings suggest that rapid online delivery of effective CBT treatment for PTSD could be expanded to a large population.

"We felt that the Web-based treatment was highly innovative and particularly well-suited for groups of people who have experienced a single highly traumatic event and want to resume their normal life as quickly as possible," Robert Freedman, editor of the American Journal of Psychiatry, said in a prepared statement.

Fort Carson Prepares for Return of 4,000

An update on things happening at Fort Carson, the Army base which came under scrutiny last year for reportedly stigmatizing troops from seeking help for their post-deployment stress, and this year for reportedly discharging so many soldiers with personality disorder rather than PTSD.

In January, the 2nd Brigade Combat Team's 4,000 infantrymen return following a second intense deployment to Iraq, and Fort Carson is joining forces with local community resources to provide better transition help this time. This is a great, great development.

From the Colorado Springs Gazette:

Leaders at Fort Carson said Friday they’re expanding community outreach initiatives in a bid to more quickly identify war-related mental illness and family problems in the ranks. The expansion of the post’s Warrior Family Community Partnerships precedes the homecoming of nearly 4,000 soldiers who have spent the past year battling in Ramadi and Baghdad.

Fort Carson’s commander, Maj. Gen. Mark Graham, said he wants to work with police departments and schools to ensure that troops exhibiting signs of post-traumatic stress disorder or brain injury get help from the Army.

Graham said his officers are contacting experts nationwide in a bid to find better treatments for PTSD, which has been diagnosed in hundreds of Fort Carson soldiers since the Iraq war began in 2003.

“There’s not one medical solution to help our soldiers and our families get through this,” he said.

Driving the efforts is the upcoming return of the 2nd Brigade Combat Team of the 2nd Infantry Division, which is due home in January. Because the unit is on its second deployment and has seen intense combat, costing the lives of 42 of its soldiers, commanders expect a high rate of war-related mental illness that will tax the post’s staff of 37 mental health workers.

“The demand when 2nd (brigade) comes back will be really dramatic,” predicted Col. Jim Terrio, the post’s top doctor.

Montana Working to Destigmatize PTSD, Holds Its Largest Combat PTSD Conference in November

From the Helena Independent:

When Carroll Jenkins looks back over the past six years, he can’t help but credit the Sept. 11 terrorist attacks for creating a broader understanding of post traumatic stress disorder. For a psychotherapist specializing in PTSD, that’s a good thing.

“It seems like our society has to get hit right upside the head, pretty hard, to get it,” Jenkins said Friday. “I think we’ve got it this time. I’ve been battling this sucker for years. To see people sit around talking about PTSD the way they are now — we’re destigmatizing it.”

Jenkins was recently contracted by the Montana National Guard to help train therapists across the state in recognizing and dealing with PTSD.

Now, nearly a month later, he’ll help the Montana Chapter of the National Association of Social Workers in a related conference to be held in Helena next month.

John Wilkinson, executive director of NASW-MT, said the organization will host what’s believed to be the largest conference ever held in the state dedicated entirely to post-combat stress and veteran care.

More than 50% of Army's 948 Suicide Attempts in 2006 Sought Help First

The Hartford Courant recently ran a piece, "Suicides - A Treatment Issue," by Lisa Chedekel (who has done incredible reporting on combat PTSD issues). Noteworthy information.

From the Courant piece (via VFCS):

A recently released, first-ever analysis of Army suicides shows that more than half the 948 soldiers who attempted suicide in 2006 had been seen by mental health providers before the attempt - 36 percent within just 30 days of the event. Of those who committed suicide in 2006, a third had an outpatient mental health visit within three months of killing themselves, and 42 percent had been seen at a military medical facility within three months.

Among soldiers who were deployed to Iraq or Afghanistan when they attempted suicide in 2005 and 2006, a full 60 percent had been seen by outpatient mental health workers before the attempts. Forty-three percent of the deployed troops who attempted suicide had been prescribed psychotropic medications, the report shows.

The report offers no details on the type or duration of mental health care that troops received before they tried to kill themselves. But it is prompting calls from some soldiers' advocates for better training of medical and behavioral health specialists in recognizing and treating service members in distress.

OEF/OIF Vets Seeking PTSD Care from VA Jumps 70%, Mental Health Counseling Tops 100,000

From tomorrow's USA Today:

The number of Iraq and Afghanistan war veterans seeking treatment for post-traumatic stress disorder from the Department of Veterans Affairs jumped by nearly 20,000 — almost 70% — in the 12 months ending June 30, VA records show.

More than 100,000 combat veterans sought help for mental illness since the start of the war in Afghanistan in 2001, about one in seven of those who have left active duty since then, according to VA records collected through June. Almost half of those were PTSD cases.

The numbers do not include thousands treated at storefront Vet Centers operated by the department across the country. Nor do they include active-duty personnel diagnosed with the disorder or former servicemembers who have not sought VA treatment.

About 1.5 million U.S. troops have served in Iraq or Afghanistan. Of those, 750,000 have left the military and are eligible for VA health care. The nearly 50,000 VA-documented PTSD cases far exceed the 30,000 military personnel that the Pentagon officially classifies as wounded in the conflicts.