by William Brim, PhD
Caregivers who wish to work effectively with service members, veterans, and their families, must understand this distinct culture and unique needs
The United States Military has deployed more than 2 million individuals in support of Operation Iraqi Freedom (OIF), Operation New Dawn (OND) and Operation Enduring Freedom (OEF). Many of these service men and women have been deployed multiple times. The deployment cycle places tremendous stress on our service members and their families. It is estimated that approximately one-third of those deployed will report symptoms of PTSD, Depression, or Traumatic Brain Injury (TBI), with as many as five percent reporting symptoms of all three. As the number of military deployments has increased, so have the behavioral health difficulties for service members and their families. Our military and veteran healthcare systems are challenged to adequately provide care for service members and veterans, even without addressing the needs of their families. Another significant issue is meeting the healthcare needs of National Guard and Reserve members and their families. Many return home with significant needs but with little or no access to military or veteran healthcare systems.
The military is a diverse population. Caregivers who wish to work effectively with service members, veterans and their families must understand this distinct culture and unique needs. We need a trained and prepared civilian healthcare force who are willing to meet the needs of service members and families.
The Center for Deployment Psychology (CDP) prepares psychologists to better meet the deployment-related emotional and behavioral health needs of military personnel and their family members. The CDP was established by Congress in conjunction with the American Psychological Association in 2006. The program is an innovative Department of Defense training consortium combining live presentations with distance learning and ongoing consultation to provide state-of-the-art education and training to professionals. The CDP is a quad-service center training psychologists, psychiatrists, social workers, mental health interns/residents, and other behavioral health professionals from the Services. These individuals along with civilian professionals provide high quality behavioral health services to military personnel, veterans, and their families. The Center has four inter-related programs for meeting our mission: the Advanced Training Institute, Mobile Training Programs, Military Treatment Facility Based Deployment Psychologists, and Online Programs.
The Advanced Training Institute
The Advanced Training Institute (ATI) offers two main programs. The Topics in Deployment Psychology course is an eight-day training course primarily geared towards active duty providers in the mental health field. This includes psychologists, psychiatrists, social workers, and psychiatric nurses, as well as chaplains and individuals from other health care professions. Through a combination of didactic and experiential sessions, participants learn about the cycle of military deployment and its impact on service members and their families. To date, the CDP has completed twenty-two iterations of this course to a combined audience of more than 800 military behavioral healthcare providers. Overwhelmingly positive provider feedback indicates increased knowledge in the targeted areas.
The CDP has evaluated the impact of the training programs. In addition to the global evaluations, we have examined the increase in knowledge in specific topic areas using a series of brief quizzes administered prior to and following selected modules in the two-week workshop. Participants have demonstrated increased knowledge across all of the surveyed areas. The average change across the areas is almost 25 percentage points, which represents about 50% improvement.
As part of the Center’s effort to improve our programs, we asked participants in the first ten iterations of the Topics in Deployment Psychology course to complete a brief online survey of their use of two clinical techniques taught in our program: Prolonged Exposure (PE) or Cognitive Processing Therapy (CPT), which are empirically validated treatments for PTSD. Of the 114 providers who completed the survey (response rate of 47%), 75% indicated that they had used one of the protocols to treat at least one patient with PTSD and almost 85% reported that they found the treatment to be moderately to very effective in treating the PTSD symptoms.
The other course offered by the ATI is the one-week workshop Addressing the Psychological Health Needs of Service Members and their Families. The shorter time commitment greatly enhances the CDP’s ability to reach more civilian providers. The CDP has conducted 20 courses in which 2000 participants learned a variety of topics including:
• Mechanisms, assessment and care for individuals with traumatic brain injury.
• Basic awareness of military cultural issues and the impact of the deployment cycle on service members and their families.
• Evidence-based assessment and treatment of depression and suicide risk.
• Evidence-based approaches to access and treat combat operational stress, PTSD, and assessment and treatment of sleep disturbances.
As with the two-week course, evaluations completed by individuals who attended these one-week programs are extremely positive. Furthermore, assessments of knowledge gain indicate that providers are learning the content.
Mobile Training Teams
The CDP offers workshops in the use of two evidence-based treatments for PTSD, PE, and CPT. Additionally, we offer a two-day workshop in CPT for Insomnia. The workshops incorporate didactic components designed to introduce clinical skills through actual case material and active role-playing exercises. CDP workshops also incorporate information specific to the treatment of military personnel. These workshops are taught across the country in collaboration with military and civilian organizations and also incorporated into the two-week and one-week courses taught by the CDP. Nearly 4,500 providers have completed training in evidence-based treatments through CDP workshops or workshops co-led by CDP staff.
In the last year the CDP has initiated the University Counseling Center Competency Course. This one-day course is designed to educate university staff including financial aid and registration staff, residence assistants, counselors and university leadership on the unique needs of service members and veterans; and to make the college counseling center staff aware of clinical issues. Currently, this program has been offered at twenty universities with a growing list of colleges and universities interested in hosting training in the next year.
Military Treatment Facility Based Deployment Psychologist
The CDP coordinates activities across a network of military internship training sites at 11 regional Department of Defense health facilities nationwide. Designed as a hub-and-spoke structure, the CDP is headquartered at the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Maryland. In addition to the personnel located at USUHS, the CDP houses one Deployment Behavioral Health Psychologist (DBHP) at each of the eleven Military Medical Centers that offer APA-accredited Psychology Internship programs. These DBHPs train the pipeline of psychologists and social workers entering military service. The DBHPs work in military and civilian communities within their region to promote quality behavioral health care for service members and families through training and education programs.
The CDP website, www.deploymentpsych.org, hosts an array of education tools for providers working with service members, veterans and their families. There is a growing list of online training courses including: Military Culture, Epidemiology of PTSD, Overview of Prolonged Exposure, Traumatic Brain Injury and Impact of the Deployment Cycle on Military Families. Psychologists trained by CDP have access to a portal with additional training tools and material. The CDP offers a weekly consultation phone call for psychologists trained in PE or CPT and a Providers Message Board where individuals working with military members and veterans can share information or ask questions to CDP experts or one another. Finally, in April of this year the CDP offered archived webcast and podcast versions of our courses along with DVDs of select education courses.
In the coming year the CDP will continue to expand our training and education offerings both through live and web-based platforms. We are also developing pilot programs specifically for primary care providers, nurses and chaplains as well as programs designed to bridge the gap between primary care providers and psychologists in the community.
Psychologists must move out of their one-on-one, office-based comfort zone and partner with primary care providers to treat service members, veterans, and their families in communities where they are most comfortable providing them effective and culturally sensitive care. The proud men and women of the military, our veterans and their families deserve nothing less than best efforts of our profession, a level of effort that we know we are capable of giving.
Dr. Brim is Deputy Director of the Center for Deployment Psychology