MEMORANDUM FROM NANCY EVANKO, CRC MILITARY LIAISON – April 16, 2012
CRC AND THE MILITARY Q&A

•Do we have veterans on staff helping guide us to dealing with post-war drug and PTSD problems since they directly understand the specific stresses like involvement in killings?

CRC Tricare facilities do have prior service members on staff in clinical and non-clinical positions to assist in addressing the problems of PTSD and post-war drug use. Some clinicians have extensive experience working with active duty and Veterans. We also have veterans in top advisory positions constantly from state VA directors to local veterans’ officials and returning servicemen and servicewomen.

•Does the military train in advance (or well enough) to pre-empt these problems?

Training and education provided around:

  • Acute Stress Disorder ( Diagnostic Criteria)
  • PTSD Diagnostic Criteria
  • factors related to the development and persistence of PTS
  • factors that interfere with recovery
  • behavioral model for the development of PTSD
  • Alcohol Abuse
  • Sexual Assault Prevention
  • National Guard – Yellow Ribbon Events, pre, during and post-deployment mandatory events: discussing relationship, financial, family, communication, health/wellness, chemical and substance use
  • Clinical Practice Guidelines , Policies and Dissemination—responsibility from both the Command level as well as the MTF (Military Treatment Facility)

•Do repeated tours of duty contribute to the problems?

(Bob much of what I have here is taken from one of the Center for Deployment Psychology trainings I attended)

See increased medical problems with PTSD, GW1 Veterans: nervous system, mental, dermatologic, digestive system, musculorskelatar , respiratory, circulatory, genitourinary, infectious (Barrett et al, 2002)

Health Issues Related to PTSD Among OEF/OIF Veterans: Sleep Problems, Tire/Low Energy, Health is Poor/Fair, Sick Call 2+ last month (Hoge et al, 2007)

Suicidality and PTSD: PTSD patients are 6 times more likely to attempt suicide than the general population. PTSD has a higher risk of increased number of suicide attempts than all other anxiety disorders 19% of patients with PTSD will attempt suicide. (Kessler et al, Arch Gen Psychiatry, 1999; 56:617)

Association between Substance use Disorders and Trauma/PTSD (Arch Gen Psychiatry, 1999, 56:617)

Estimates of trauma exposure

In general population:40-70%

In SUD population: 35-90%

Estimates of PTSD

In general population: 5-12.5%

In SUD population: 30-50%

Estimates of Alcohol Dependence

In general population: 7-9%

In PTSD population: 30-68%

Although several OEF/OIF studies have shown an association between combat exposure and PTSD, a more revealing analysis would be the relationship between different types of exposures and patterns of outcomes. (National Center for PTSD, Volume 20/No. 1, ISSN: 1050-1835, Winter 2009)

•How specifically do we treat military, both active and returned – what differences are there compared to civilian population in specific treatment mechanisms?

  • Process groups with active duty and retired service members separate from civilian population
  • Hiring staff with military experience – ex: Counselor, PTSD Coordinator, treatment team members, technicians

•Are there tests (and what do they test for) before, during, and after service, that gauge likelihood of soldiers having/getting PTSD? (Much of this info taken from various sources and Deployment Health Clinic Center)

  • Standard Health Assessment Tools
  • DD Form 2795 Primer: Pre-Deployment Health Assessment: A health care provider must review after completion; Positive response to some questions (2,3,4,7,or 8) requires referral physician; Practitioner performs interview/exam, determines deployability
  • Post Deployment Clinical Assessment Tool (PDCAT): brief standardized illness-specific screens & assessments, can be used to assess and follow-up patients with post-deployment health concerns and illnesses. Measures: somatic symptoms; PTSD; depression; anxiety and panic; functional status; alcohol use; frequency of healthcare visits; social support; and satisfaction with healthcare.
  • PDCAT [PDF format]
  • PDCAT Primer
  • Patient Health QuestionnaireTM: used to screen/monitor patient in the areas of depression, anxiety, alcohol abuse and idiopathic physical symptoms; 8 questions
  • the PHQ-9 which deals with depression, 9 questions
  • the PHQ has 16 questions
  • PHQ-Brief
  • PHQ-9
  • PHQ 16
  • Post Traumatic Stress Disorder (PTSD) Checklist (PCL): Self-administered questionnaire, 17 questions for assessing trauma-related stress; three versions available:
  • PCL Primer
  • PTSD Checklist (PCL)
  • Short-Form 36 Health Survey (SF-36): measures overall health status, functional status, and health-related quality of life, generic measure, can be used to specific and general populations, to estimate disease burden and after deployment, it can be used to quantify the severity of an individual’s post-deployment health issue at any point in time as well as allowing comparisons of his or her health status over time.
  • SF-36
  • Follow-up and Ongoing Care
  • Upon re-deployment, all personnel who completed a DD 2795 must complete a Post-Deployment Health Assessment Form (DD 2796), receive a face-to-face interview with credentialed health care provider as part of Post Deployment health assessment
  • Additional Assessment tools available:
  • PTSD Check List, Military ( PCL-M)
  • PTSD Check List – Civilian (PCL-C)
  • Impact of Event Scale – Revised (IES-R)
  • Mississippi Combat Scale for PTSD
  • Mississippi Civilian Scale for PTSD
  • PTSD Symptom Scale Self Report (PSS-SR)
  • Posttraumatic Diagnostic Scale (PDS)
  • PK Scale of the MMPI-2
  • PTSD Cognitions Inventory (PTCI)
  • Structured Interviews for PTSD
  • Clinician Administered PTSD Scale (CAPS)
  • PTSD Symptom Scale – Interview (PSS-1)
  • Structured Interview for PTSD (SIP)
  • Structured Clinical Interview for DSM-IV (SCID)
  • Mini International Neuropsychiatric Interview (MINI), PTSD Module

N. Evanko, 4.16.2012