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VA INTERNSHIPS: TRAINING PSYCHOLOGISTS TO MEET THE NEEDS OF RETURNING MILITARY PERSONNEL

VA INTERNSHIPS: TRAINING PSYCHOLOGISTS TO MEET THE NEEDS OF RETURNING MILITARY PERSONNEL. VA TRAINING IN PSYCHOLOGY. Internships 71 funded programs; 327 slots per year 15% of APA accredited internship slots Postdocs 30 funded programs; 78 slots per year Overall $11.9 million

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VA INTERNSHIPS: TRAINING PSYCHOLOGISTS TO MEET THE NEEDS OF RETURNING MILITARY PERSONNEL

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  1. VA INTERNSHIPS: TRAINING PSYCHOLOGISTS TO MEET THE NEEDS OF RETURNING MILITARY PERSONNEL

  2. VA TRAINING IN PSYCHOLOGY • Internships • 71 funded programs; 327 slots per year • 15% of APA accredited internship slots • Postdocs • 30 funded programs; 78 slots per year • Overall • $11.9 million • ¼ the total budget for associated health training in VA

  3. GOALS OF VA TRAINING • Education is one of the core VA missions • Work force development: Training future staff for VA • Work force development: “For the nation”

  4. INTERPROFESSIONAL MODEL OF TRAINING • Holistic: emphasis on person as a whole • Biopsychosocial • Integrated care: attention to relationships between physical health and mental health

  5. OEF/OIF GROUPS SERVED BY VA • Veterans • VA Medical Centers • Primary Care • Long term care • Special programs: Polytrauma Rehabilitation, Spinal Cord Injury, Blindness Rehabilitation • MIRECCs: Mental Illness Research, Educational and Clinical Centers • Community Based Outpatient Clinics • Vet Centers

  6. Active military personnel: Active Duty Rehabilitation program • Multiple severe injuries as a result of explosions and blasts account for 65% of combat injuries • 60%-62% of injured military personnel have some degree of traumatic brain injury • Survivors return with high rates of PTSD  • They typically awake at scene of the blast and see their own injuries (e.g., traumatic amputations) • See their friends (other soldiers) lying wounded or dying nearby • Feel vulnerable and helpless

  7. US Congress recognized emerging pattern of military injuries • VHA Polytrauma rehabilitation lead centers   • Four centers at VHA TBI Lead Centers • Palo Alto, Richmond, Minneapolis, Tampa • Established April 2005 • Rehabilitation focus

  8. ISSUES FOR TRAINING • Skills for handling Presenting Problems • Emotional distress: PTSD, depression, adjustment disorder • Intellectual loss: traumatic brain injury • Vocational problems • Family distress • Substance abuse problems • Adaptation to physical problems: amputation, illness, blindness, spinal cord injury

  9. Skills for handling Military and VA concerns • Rank/rate • Military justice • VA health benefits & compensation-related issues • Sending patients back to active duty

  10. RESPONSES OF INTERNSHIP TRAINING PROGRAMS TO EMERGING NEEDS

  11. ROLES FOR INTERNS • Contact returning personnel for screening • “Seamless transition” philosophy of DOD • Conduct psychoeducational workshops • Returnees • Family members (spouses/partners, children, parents) • Deal with more acute presentations of PTSD or stress reactions

  12. Deliver family and couple’s therapy: • Major adjustments back into family roles • Family members have questions and feelings tied to the soldier’s absence and wartime experiences • Additional issues if the patient may be returning to active duty • Provide vocational counseling • Support Compensated Work Therapy • Employment activities within VA

  13. Work in Primary Care with returnees: • Contact for intake in the Primary Care clinics • Returnees feel less stigma than coming to “mental health” or “PTSD” offices • Provide accessible mental health services to women veterans • Many have been in active combat • Many deal with Military Sexual Trauma

  14. Emphasize recovery and rehabilitation in mental health care • Provide clinical services with Psychosocial Rehabilitation approach • Identify recovery-oriented research across the age span ready for development into best practice models • Develop demonstration pilots to test implementation strategies

  15. OPPORTUNITIES / CHALLENGES FOR TRAINING PROGRAMS • See important work being done in VA • Want to be to be part of it • Are proud to be part of it • Working with individuals of similar age • Reactions stirred helping those returning from war • Self-comparison with young patients • Trainees may know soldiers there

  16. NEW TRAINING PROGRAMS STRATEGIES • Seminars on Military Culture and basic military rank • Didactic material about new patterns of injuries • Directed supervision toward evaluating and treating multiple comorbidities • Attention in supervision to emotional issues interns face in this work

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