Breaking Down Barriers to Care for Veterans with PTSD

jonFourth of July is coming up and most people spend it outside with their flags raised honoring both the holiday and those serving in the military. What many may not consider is how this display of patriotism may affect a veteran, particularly one with post-traumatic stress disorder (PTSD).

It is important to note that anyone who has experienced or witnessed a traumatic event can develop PTSD, not just military personnel. That said, today’s blog focuses on the impact of PTSD on veterans and military family members.

Studies show that 12.5 percent of veterans who served in Iraq and Afghanistan have PTSD. However, only half of those with PTSD ever seek treatment. Some symptoms of untreated PTSD include intrusive painful memories, flashbacks, nightmares, avoidance of reminders and previously enjoyable experiences, depression and anxiety, and in extreme cases, suicidal thoughts or behavior.

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Veterans in our community are not just warriors, they are also parents, spouses, siblings, and members of families who love them and can’t bear to see them suffering. That is why Easterseals partnered with the Cohen Veterans Network to open the Steven A. Cohen Military Family Clinic at Easterseals (Cohen Clinic) in 2017. Our Clinic serves veterans and military family members by providing them with high-quality behavioral health care, regardless of their ability to pay and regardless of their discharge status.

More importantly, the Cohen Clinic treats each client with a holistic approach to address the complex challenges that veterans and military family members might be facing.

anneke croppedTo help provide more insight to veterans living with PTSD, we spoke with Anneke Vandenbroek, Ph.D., ABPP – a licensed clinical psychologist and the lead clinician at the Steven A. Cohen Military Family Clinic at Easterseals – who has been working with military service members for over 20 years in the treatment of PTSD, depression, anxiety disorders and other behavioral health disorders. She shares with us HOW the Cohen Clinic is helping veterans break down barriers to get the support they need for PTSD.

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Q: The Cohen Clinic provides evidence-based therapies to help veterans with PTSD. What EXACTLY are evidence-based therapies?

Evidence-based therapies are treatments that have been researched across multiple studies and proven to be effective. Those studies might compare different treatments to each other, or they might compare a treatment to no treatment. Larger studies look at all the evidence across multiple studies to figure out which treatments are most effective. The treatments that are most effective are considered the ‘gold standard’ and that’s what we practice here.

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Q: How effective are evidence-based therapies for treating PTSD?

The two most commonly used, and researched as being the most effective treatments for PTSD, are Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE). Clients can choose either one and do equally well with them.

As for outcomes, studies indicate that about 50 percent of clients with PTSD who are treated with either treatment will no longer meet the criteria for PTSD when treatment is completed. Of the remaining 50 percent, about 60 percent will have significant improvement in their symptoms. This means overall, 80 percent will have a positive outcome from these treatments.

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Q: What can veterans expect to happen during treatment?

CPT consists of twelve 50-minute sessions of individual therapy. It can also be done as a group, but right now we only offer it as an individual treatment. It focuses on the change to thoughts and beliefs that have come about as a result of trauma. We help clients identify and examine those thoughts and beliefs and work to modify them. It’s very focused on improving the thinking aspect of PTSD.

PE consists of 90-minute sessions that vary from 6 to 12 total sessions, depending on the client. This therapy focuses on the avoidance component of PTSD and getting people back to the activities and things they enjoyed prior to the time they had PTSD. So we are looking at addressing the memories and the behaviors that have been avoided because of PTSD. For instance, people may stop going to the grocery store because they are uncomfortable in crowds. PE really focuses on helping people resume those activities that have become difficult for them as a result of the trauma.

Q: What kinds of traumas have been addressed with clients who have PTSD?

We have seen clients with a variety of traumas including combat-related, traumas that healthcare providers may encounter in combat situations or as casualty situations. So, for instance, working on a ship, like The Comfort, and responding to humanitarian disasters or a first responder kind of trauma, like a 9-11. Then there are traumas that result from early childhood abuse, being a victim of a crime or physical assault, as well as other miscellaneous traumas, like a car accident or something similar.

Q: Previously, stigma has been flagged as a major barrier for veterans and military family members when seeking adequate support for PTSD. However, now we are also learning that veterans have a hard time accessing care. Is access becoming more of a barrier than stigma for veterans when trying to get help?

I think the stigma is still a challenge for a lot of people, but we also know that barriers to care make it more difficult for people to get treatment. Barriers could be things like excessive wait times, the expense of coming to treatment, the logistical challenges around travel or times that our services are available.

The Cohen Clinic addresses these things on multiple fronts. For instance, we offer early morning appointments, we have weekend and evening appointments in order to work around people’s schedules. We offer childcare for when people need to come to appointments but have young children. We want to make it easier for them to make their appointments knowing that their children will be cared for while they take care of themselves. The ability to pay for services is not a barrier to care here.

018We also offer telehealth services, which is one of the BIGGEST things we can do to overcome barriers to treatment because people can access care from their living room, office or even a parked car. They don’t have to take time to travel to the clinic. It really only takes 50 minutes out of their day to attend the appointment, so they don’t need to use leave time, travel time, get stuck in Beltway traffic to get here. It’s really fantastic.

Telehealth definitely reduces barriers and make it easier for people to access care. The technology is easy to use. If you can use an app on your smartphone, then you can use telehealth services. And I think it allows people who normally have difficulty accessing care to come in and get treatment.

Overall, it’s really up to the clients to decide what they are comfortable with. They can choose to come in person, connect via telehealth or even try a combination of both. The critical thing is just to be available to them.

Q: Is the quality of care via telehealth as good as in-person?

Telehealth really is an effective way to engage with clients and research shows that it is equally effective. The outcome for clients who engage in telehealth is as good as outcomes for clients who engage in in-person therapy. An additional benefit is that it is so much easier to come to appointments and keep appointments. For example, let’s say one of our clients who normally comes in caught a cold. Instead of canceling his/her appointment, we could still do it via telehealth. Perhaps a schedule change came up and one of our clients now needs to head somewhere else in the area. With telehealth, he/she can still make the appointment.

I also really like it. In some ways, it’s actually easier than an office because I can share handouts and things to the clients immediately. I can show them links to resources online or just share my computer screen. At first, I thought it could be emotionally cold or disconnected, but I didn’t find that to be the case at all. I feel I have the same relationships with my clients via telehealth that I do in person. Clients also report a high degree of satisfaction with their services over telehealth.

Q: How does the clinic protect privacy with online therapy?

We use ZOOM, which is a HIPPA compliant, encrypted platform, and is very secure. Every telehealth session has a unique identifier that no one else can use to log in. The client gets a link and they are the only person with that link for the meeting.

Q: Are there any disadvantages to using telehealth for mental health services?

The only disadvantage I can think of with telehealth is that with new technology it can be a little bit challenging for some people. On occasion, there might be some connection problems due to slow internet service or low bandwidth. Usually, there are workarounds when those issues arise.

In order to address that, we always do a telehealth initial check with our data manager. She connects with the clients before the first scheduled appointment to make sure that they know how to use the link that is sent to them and is able to connect via smartphone, tablet, laptop or whatever they are using so that they know how to use it and are ready to go with their sessions.

For more information on how to connect with the Steven A. Cohen Military Family at Easterseals to get help with PTSD or any other related behavioral health support, please go to our website at mfc.eseal.org.

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