Version 1 Best Practices for Trauma and Addiction -- Program Assessment 1
This assessment tool is designed to help programs in VA address PTSD and addiction using best practices. For further information,
contact . Some items and some formatting were drawn from http://www.dol.gov/wb/trauma/
Part 1: Staff Awareness
Staff serving veterans at all levels of the program are knowledgeable about the following topics (at a level appropriate to their staff role):
(a) Trauma and Mental Health / Strongly Disagree(this rarely or never happens) / Disagree
(this usually does not happen) / Agree
(this happens some of the time) / Strongly Agree
(this happens most of the time) / Do not know / Not pplicable to my program
1. The definition of trauma (e.g., in DSM-5)
2. The impact of trauma on the brain and body
3. Combat-related trauma and its impact
4. Military sexual trauma and its impact
5. Childhood trauma and its impact
6. Traumatic brain injury (TBI)
7. Domestic violence
8. How trauma affects development
9. How trauma affects relationships (including with staff)
10. The relationship between severe and/or repeated trauma and unsafe behavior (such as violence, self-harm, intimate partner violence, substance abuse, re-victimization)
11. How trauma affects physical health problems throughout the lifespan
12. The impact of trauma on chronic pain
13. Cultural differences in how people understand and respond to trauma
14. Trauma-related disorders such as acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in DSM5
15. How trauma affects mental health symptoms (e.g., depression, anxiety, anger)
16. How veterans' PTSD and SUD impact staff
Part 1: Staff Awareness
Staff serving veterans at all levels of the program are knowledgeable about the following topics (at a level appropriate to their staff role):
(b) Addiction / Strongly disagree(this rarely or never happens) / Disagree
(this usually does not happen) / Agree
(this happens some of the time) / Strongly agree
(this happens most of the time) / Do not know / Not plicable to my program
1. The definition of substance use disorders in DSM5
2. Behavioral addictions (e.g., gambling, spending, food,
sex, gaming, internet, exercise, work)
3. The impact of addiction on the brain and body
4. The relationship between addiction and chronic pain
5. The relationship between addiction and TBI
6. Addiction rates among military and veterans
7. The relationship between addiction and trauma
8. How addiction affects relationships (including with
staff)
9. Major substance types (alcohol, heroin, methadone, other opiates, barbiturates, sedatives / hypnotics / tranquilizers, cocaine, amphetamines, cannabis, hallucinogens, inhalants)
10. Key addiction phenomena (tolerance, withdrawal, overdose, post-acute withdrawal, early recovery, abstinence, harm reduction, controlled use, dry versus sober)
11. How different cultures understand and respond to addiction
12. Medication assisted treatments (MAT) for opioid addiction (e.g., methadone, buprenorphine, naltrexone)
13. Stages of change
14. Gender differences in addiction and recovery
15. Commons stereotypes about people with addiction
16. Prescription drug misuse
Part 1: Staff Awareness
Staff serving veterans at all levels of the program are knowledgeable about the following topics (at a level appropriate to their staff role):
(c) Military / veterans / Strongly disagree(this rarely or never happens) / Disagree
(this usually does not happen) / Agree
(this happens some of the time) / Strongly agree
(this happens most of the time) / Do not know / Not pplicable
to my program
1. The different branches of the military
2. Types of discharges from the military
3. Service-related compensation (e.g., per cent service-connected; number of years of VA medical care)
4. The unique experiences of female service members
5. Key aspects of military culture (e.g., bonding, groups)
6. The process for attaining benefits and services through a local VA
7. Benefits and programs for veterans (e.g., VA, SSI, housing options, education)
8. Veteran's crisis line / hotline number
9. Barriers/challenges to accessing services for veterans (e.g., availability, location, experiences with the VA)
10. How to obtain a VA consult on mental health or SUD
11. Culture /historical attitudes toward substance use in the military
12. Culture /historical attitudes toward trauma in the military
Part 2: Program Elements
The program successfully carries out the following assessments routinely for ALL patients (at a level appropriate to the program mission):
(a) Assessment / Strongly Disagree(this rarely or never happens) / Disagree
(this usually does not happen) / Agree
(this happens some of the time) / Strongly Agree
(this happens most of the time) / Do not know / Not pplicable to my program
1. Screening of lifetime traumas using a validated measure [List the measure(s): ]
2. Screening for PTSD (and/or ASD) using a validated measure [List the measure(s): ]
3. Screening of for SUD (both alcohol and drug) using a validated measure [List the measure(s): ]
4. Screening for major behavioral addictions (e.g., gambling, spending, binge eating) using validated measures [List the measure(s): ]
5. Screening for physical harm to self / others (both history of and current impulses)
6. Screening for domestic violence, both as victim and perpetrator
7. Screening for TBI
8. Screening for mental health issues
9. Presence of weapons in the home
10. Screening for physical health problems, including chronic pain
11. Military service (branch, rank, job in the military)
12. Social supports in the family and the community
13. History of other major life factors that can influence treatment (e.g., emotional abuse, neglect, loss, legal problems, community violence, gang involvement, homelessness, loss of custody of children, financial problems, discrimination based on culture/gender/sexual orientation, etc.)
14. Additional diagnostic/detailed assessment as needed, by a qualified assessor, for any positive responses to items above
15. Results of assessment, including diagnoses of PTSD and SUD, are shared with the veteran
Part 2: Program Elements
The program is knowledgeable about and successfully carries out the following treatment strategies routinely for ALL patients who have PTSD and SUD (at a level appropriate to the program mission and to the patient):
(b) General treatment strategies / Strongly Disagree(this rarely or never happens) / Disagree
(this usually does not happen) / Agree
(this happens some of the time) / Strongly Agree
(this happens most of the time) / Do not know / Not pplicable to my program
1. Education about stages of recovery (stage 1, safety; stage 2, mourning, stage 3, reconnection)
2. De-escalation strategies such as grounding (ways to help veterans calm down before reaching a crisis)
3. How to cope with PTSD and SUD triggers (e.g., reminders of dangerous or frightening experiences)
4. A written safety and crisis prevention plan developed with the veteran, with a copy given to the veteran
5. Timely consultation for needed specialty care (such as PTSD, SUD, TBI, chronic pain, physical health problems, psychiatric medication, etc.)
6. Case management strategies for helping veterans make community-based provider connections (e.g., VA, housing, employment, education)
7. A list of safe people the veteran can go to for support
8. Educational information about PTSD-- pamphlets, websites-- are available in patient areas
8. Educational information about SUD--pamphlets, websites--are available in patient areas
9. Veterans are guided to understand important linkages between PTSD and SUD
10. A supportive rather than confrontational approach for both PTSD and SUD
11. Treatment strategies are sensitive to culture, gender, military experience, age, cognitive ability, sexual orientation, spiritual beliefs (including atheism), type of trauma
12. Empowerment and motivational interviewing are used (open-ended questions, affirmations, listening)
13. The veteran's strengths are emphasized in verbal and written communications
Part 2: Program Elements
The program is knowledgeable about and successfully carries out or refers out for the following evidence-based treatments routinely for ALL patients who have PTSD and SUD (at a level appropriate to the program mission and to the patient):
(c) Evidence-based treatments / Strongly Disagree(this rarely or never happens) / Disagree
(this usually does not happen) / Agree
(this happens some of the time) / Strongly Agree
(this happens most of the time) / Do not know / Not pplicable to my program
1. Screening, brief intervention, and referral to treatment
(SBIRT)
2. Evidence-based "stage 1" therapy for PTSD/SUD (integrated treatments) such as Seeking Safety, in whole or part, to teach coping skills
3. Evidence-based therapies for SUD (non-integrated treatments) are offered or referred, e.g., Relapse Prevention, Motivational Enhancement, Contingency Management, 12-Step, 12-Step Facilitation
4. Evidence-based "stage 2" therapies for PTSD (non-integrated treatments) based on veteran readiness and staff certification to conduct those, e.g., Prolonged Exposure, Eye Movement Desensitization and Reprocessing, Cognitive Processing Therapy, Narrative Exposure Therapy
5. Family involvement: family are invited in for psychoeducation, how to support the veteran's recovery, referrals as needed to Al-Anon and other family-relevant modalities, including child care / child treatments
6. Evidence-based therapies for other mental health conditions as needed
7. Medication-assisted SUD treatments (e.g., Antabuse, Methadone, Naltrexone, Buprenorphine)
8. Evidence-based therapies, both psychosocial and medication, for other mental health conditions as needed
9. Staff know how to look up independent information on whether a treatment is "evidence-based" (e.g., PubMed literature reviews)
Part 2: Program Elements
The program has clear and consistent policies on the following topics and they are implemented routinely (at a level appropriate to the program mission):
(c) Policies / Strongly Disagree(this rarely or never happens) / Disagree
(this usually does not happen) / Agree
(this happens some of the time) / Strongly Agree
(this happens most of the time) / Do not know / Not pplicable to my program
1. Staff can obtain training in trauma-informed care, PTSD, SUD, mental health, domestic violence, homelessness, TBI, chronic pain, veterans issues
2. Policies are applied consistently across veterans, especially related to substance relapse
3. Staff are encouraged to make referrals outside of VA as needed for PTSD and SUD (for services unavailable in VA)
4. Veterans' treatment plans explicitly focus on PTSD and SUD, if present
5. Staff and veterans have a way to provide anonymous feedback about the program
6. The program has a trauma-sensitive policy on how to respond to veterans' crises (e.g., self-harm, suicidality, aggression) without use of restraints
7. To receive services, veterans are not required to be abstinent nor motivated to reduce substance use
8. The program has a written policy to help staff (e.g., re boundaries, self-care, vicarious trauma, burnout, supervision, debriefing after crisis)
9. Veterans are not automatically excluded from the program for SUD nor for SUD-related medication use such as methadone (unless essential for veteran safety)
10. Veterans are not automatically excluded from the program for PTSD or mental health problems (unless essential for veteran safety)
11. For complex PTSD and/or SUD cases (e.g., related to chronic pain, TBI, repeated relapse) expert consultation is sought
12. At least annually, the program meets and updates a written plan on how to best address PTSD / SUD
Part 3: Program Type
Is your program… Please check all that apply:
Pa. VHA Medical Center
b. CBOC
c. Vet Center
d. Veterans Justice Outreach
e. SUD Specialty Care
f. General Mental Health Clinic
g. PTSD Specialty Care
h. Emergency Room
i. Infectious Disease Clinic
j. Homeless program
k. Primary Care Clinic
l. Research Clinic
m. Fee based or contract provider
n. Outpatient
o. Inpatient
p. Day program
q. Residential Treatment Program
r. Other or additional descriptors (please list): ______