Ellen Herbst

Overcoming barriers to care for returning Veterans: Expanding services to college campuses

INTRODUCTION The need to expand mental health and social work care available to Veterans in the community and for increased Department of Veterans Affairs (VA) and community partnership has become increasingly recognized [1]. Over 2.4 million men and women have served in Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and/or Operation New Dawn (OND) since 2001 [2]. Following their deployments to combat zones and separation from the military, many Veterans are faced with the choice of obtaining employment, enrolling in college, or both. The Post-9/11 GI Bill, passed by Congress in 2008, greatly expanded educational benefits for Veterans who served in the Armed Forces on or after September 11, 2001 [3], and increasing numbers of former servicemembers are using this benefit. According to the Veterans Benefits Administration (VBA) Office of Educational Services, the number of Veteran students and beneficiaries (i.e., dependents or spouses) accessing VBA educational benefits across the United States has increased from 397,598 Veteran beneficiaries in 2000 to 564,487 in 2009 and to 1,014,227 in 2012, totaling over

Mobile Technology for Treatment Augmentation in Veteran Smokers With Posttraumatic Stress Disorder

10.5 billion in utilized benefits (in 2011 alone) [4]. However, while the number of Veterans enrolled in college has dramatically increased, student Veterans have generally had lower graduation rates than their civilian counterparts [5]. Although the majority of student Veterans will complete their postsecondary programs, it has been estimated that about 30 to 40 percent will not [6], placing them at risk for adverse outcomes such as increased unemployment. This indicates a critical need to better understand and respond to the factors contributing to psychosocial difficulties among student Veterans that lead to poor academic outcomes. In this article, we will illustrate a replicable model that provides multifaceted Veterans Health Administration (VHA) healthcare, social work, and mental health services on the college campus and discuss ways in which clinicians and campus partners can promote wellness and academic success for student Veterans. Veteran students arrive on campus with a military background that includes unique experiences, knowledge, skills, and codes of behavior. Factors that can influence adjustment from military service to student life include the amount of time between discharge and entry into college, differences between military and civilian culture, balance between academic and other life responsibilities, and psychological consequences of combat or other trauma exposure. Military culture, which emphasizes service, respect, camaraderie, structure, discipline, and order, can differ from that of civilian or traditional college student life [7]. While military life can bring its own challenges and stressors, there are also significant benefits, such as having stable housing and income, healthcare, and support from superiors and/or peers, as well as generally more consolidated, centrally located or familiar resources. Loss of ones social network and need to obtain ones own housing, healthcare, and source of income can compound an often challenging cultural transition from the military to the college campus. Less than 10 percent of U.S. citizens serve in the military [8], and many civilian students may lack an understanding of the servicemembers experience. This disconnect is compounded by the often nontraditional status of student Veterans, who are typically older and often need to balance family (including parenting responsibilities), work, and academic demands. Indeed, nearly half (49.4%) of servicemembers and Veterans who have deployed to Iraq and Afghanistan are married [9]. In addition to general cultural or experiential differences, Veterans who have deployed to Iraq and Afghanistan are at higher risk for a number of adverse medical, psychiatric, and social outcomes. Milliken et al. reported exposure to deployment-related stressors in Reserve and Active Duty soldiers at rates of 69. …

Student veterans with posttraumatic stress symptoms: Perceived preferences for on-campus psychoeducation.

INTRODUCTION The purpose of this study is to examine the feasibility and acceptability of incorporating a mobile application, Stay Quit Coach, into an integrated care smoking-cessation treatment protocol for veterans with posttraumatic stress disorder (PTSD). METHODS Participants included veteran smokers aged 18-69 years with PTSD. The integrated care protocol includes eight weekly PTSD-informed cognitive behavioral therapy sessions for smoking cessation, followed by monthly booster sessions and a prescription for standard smoking-cessation medications if desired. Participants used Stay Quit Coach as desired. Outcome measures at 3-month follow-up included: adherence (sessions attended), 30-day point-prevalence abstinence bioverified with carbon monoxide <6 parts per million, past-30 day mean daily cigarette use, exhaled carbon monoxide, nicotine dependence, and PTSD symptom severity. Repeated outcomes were analyzed with random-intercept linear mixed models. Data were collected in 2015-2016 and analyses were conducted in 2016-2017. RESULTS Participants (n=20) were 95% male and 5% female; mean age 41.4 (SD=16.2) years. Thirteen participants (65%) attended all scheduled sessions, four (20%) did not adhere to the protocol on schedule, and three (15%) were lost to follow-up. At 3-month follow-up, six of 17 completers (35.3%) had bioverified 30-day point-prevalence abstinence. Nicotine dependence, carbon monoxide levels, and past 30-day cigarette use significantly decreased and PTSD symptoms were unchanged from baseline to follow-up. Participants self-reported using Stay Quit Coach 2.5 (SD=2.2) days/week; 15 of 17 (88.2%) reported using Stay Quit Coach <30 minutes/week; two of 17 (11.8%) reported using Stay Quit Coach 30-60 minutes/week. CONCLUSIONS Although results must be interpreted with caution given the lack of control group and small sample size, findings indicate that integrating Stay Quit Coach into integrated care was feasible and acceptable.

Deployment Anxiety Reduction Training: A Pilot Study of Acceptability and Feasibility in Current or Recent Active Duty Service Members

Objective: This investigation aimed to better understand perceived barriers to academic success and preferences for a veteran-specific psychosocial course among veterans with symptoms of posttraumatic stress (PTS). Method: Ninety-three veterans participated in this investigation as part of a larger study examining psychosocial functioning among veterans with PTS symptoms. Participants completed a self-report survey focused on perceived barriers to academic success and psychoeducational preferences related to health and well-being. Results: Perceived barriers to academic success reported as most problematic were sleep difficulties, stress, depression, and financial concerns. Results indicated that veterans would be interested in attending an on-campus course focusing on these areas. Conclusions and Implications for Practice: These findings contribute to the understanding of student veterans with PTS symptoms’ perceived needs and inform the development of campus programs for this population.

Supporting Veteran Transitions to the Academic Setting: VA on Campus

Objectives The Deployment Anxiety Reduction Training (DART) is a manualized tool that was developed and piloted with active duty service members and recently deployed veterans regarding their response to potential and experienced acute combat stress reactions. DART is low risk and has high potential to be beneficial. It is a brief, one-session, non-pharmacological approach designed to reduce symptoms of peritraumatic panic and increase resilience in the face of a potentially traumatic stressor. Methods This study was a mixed-methods pilot study to assess the utility and acceptability of DART during deployment. Results Self-report and interview responses indicated that participants generally found the DART techniques acceptable and easy to understand. Overall, the techniques were perceived as likely to be helpful with high utility, although there was variation in perceived helpfulness among the different techniques. Participants overwhelmingly positively endorsed delivery of the DART protocol through use of smartphone technology. Conclusions Results indicate that the DART components were considered highly acceptable and feasible for use in the deployed environment.

Impact of Engagement in Exercise on Sleep Quality Among Veterans With Posttraumatic Stress Disorder Symptoms

ABSTRACT In this case study, we assessed academic functioning, service satisfaction, and needs of student veterans at a community college who had accessed the Veterans Health Administration (VHA) Student Veteran Health Program (SVHP) (n = 36). The SVHP provides outreach and behavioral health services directly on a large community college campus to overcome common barriers to engagement in mental health care (e.g., distance from a VA medical center). Academic difficulties that were most commonly reported were in the areas of retention of information, meeting deadlines, and cooperation with other students. Overall, the majority of student veterans who received services in the SVHP were satisfied (76.5%). Services targeting attention and concentration and utilization of educational benefits were highlighted as important by student veterans. This case study of VA services delivered within the community college setting provides important insights into how to design VA services to target the needs of student veterans. Specific recommendations for supporting student veterans on a community college campus are discussed.

Topiramate Treatment of Alcohol Use Disorder in Veterans with Posttraumatic Stress Disorder: A Randomized Controlled Pilot Trial

BACKGROUND Exercise has beneficial effects for physical health outcomes and has also been shown to reduce the severity of psychological health symptoms. Recent studies have shown a potentially positive impact of exercise on posttraumatic stress disorder (PTSD). Prominent among those with PTSD, sleep disturbance and nightmares are among the top three PTSD symptoms commonly reported by treatment-seeking Veterans. Regular physical exercise has been consistently associated with better sleep. This study utilized a longitudinal design to explore the relationship between exercise and sleep among Veterans with PTSD symptoms at baseline and one-year follow-up. MATERIALS AND METHODS Veterans (n = 76) who served in support of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn were recruited for this study. Correlations were assessed between PTSD symptoms, sleep, and engagement in exercise at each time point (baseline, one-year follow-up). Regression analyses were conducted to examine the relationship between engagement in exercise at baseline and PTSD symptoms at one-year follow-up, as well as sleep quality at one-year follow-up. Regression models controlled for demographic variables (age and gender), alcohol use, baseline PTSD symptoms, and baseline sleep quality. RESULTS Multiple regression analyses demonstrated that engagement in exercise at baseline was significantly associated with better sleep quality at one-year follow-up while controlling for age, gender, alcohol use, baseline PTSD symptoms, and baseline sleep quality (β = -0.128, p < 0.05). Multiple regression analyses examining the relationship between engagement in exercise at baseline and PTSD symptoms at one-year follow-up (controlling for age, gender, alcohol use, baseline PTSD symptoms, and baseline sleep quality) did not yield statistically significant results (β = 0.053, p = 0.57). CONCLUSION Results from the present study found that engagement in exercise at baseline was associated with better sleep quality at one-year follow-up. These findings were consistent with the current literature suggesting exercise can have a positive impact on sleep quality. Furthermore, our findings suggest that exercise could be considered as an adjunctive intervention for individuals with PTSD-particularly for those patients whose difficulties with sleep are predominant. Given that exercise is highly accessible and is embedded in the military culture, future research should examine the way in which exercise can be leveraged in PTSD treatment, specifically in ameliorating sleep difficulties. Exercise may also reap demonstrable public health benefits in multiple psychological and physical domains and reduce the psychiatric and medical morbidity and mortality associated with PTSD.