2010 VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress: How Busy Clinicians Can Best Adopt Updated Recommendations
Bernardy, Nancy C., Friedman, Matthew J., Journal of Rehabilitation Research & Development
The continued wars in Iraq and Afghanistan have brought an increased focus on posttraumatic stress disorder (PTSD) and have made PTSD a part of a national conversation. Since the first edition of the Department of Veterans Affairs (VA)/Department of Defense (DOD) Clinical Practice Guideline (CPG) for PTSD was issued in 2004 at the beginning of these conflicts, more than 750,000 returning new Veterans have sought mental health care in the VA. It is anticipated that this number will climb dramatically as more than 1 million Veterans will leave the military in the next 5 years. This makes it all the more important that VA and DOD healthcare providers have clear guidance on best management practices for PTSD and an understanding of how they can best use the revised VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress issued in the fall of 2010. As coeditors, our goal with the production of this special issue of JRRD is to publish a series of articles that go beyond the recommendations in the new CPG by providing, in addition to a comprehensive overview of the latest scientific evidence, practical guidance for busy clinicians who wish to adopt the CPG recommendations within their various clinical settings.
The Veterans Health Administration (VHA) has taken significant steps to meet the needs of returning Veterans. In the guest editorials that follow, leadership in VHA's Office of Mental Health Services outlines the transformation that has occurred in the effectiveness of mental health care in the VA. For the first time, a standard for providing mental health treatments across VHA was established in the Uniform Mental Health Services Handbook that defines the clinical services any Veteran can expect from any VA facility. Foremost among available treatments are very effective evidence-based psychotherapies for PTSD. As reviewed in the guest editorials, large numbers of clinicians have been trained in PTSD first-line psychotherapy treatments, such as prolonged exposure and cognitive processing therapies. In addition, substance use disorder (SUD)/PTSD specialists have been hired to manage the common co-occurring disorders. Post-deployment clinics have been created to address specific reintegration needs of returning Veterans. Primary Care Mental Health Integration Teams have been established to assess and offer brief mental health treatments in an interdisciplinary, coordinated primary care environment. PTSD residential treatment settings have gone through significant system redesigns to meet the needs of returning Veterans, and their treatments have significantly improved outcomes. Perhaps the biggest paradigm shift has been the emphasis on a recovery-oriented model in which individually-focused treatment plans, services that go well beyond symptom management, are developed that also address the unique needs of the Veteran and his or her family.
The National Center for PTSD (NCPTSD) has worked within the VA's Office of Mental Health Services to meet the demands of increasingly complex clinical presentations in which PTSD is often accompanied by comorbid diagnoses (such as depression, SUD, and traumatic brain injury [TBI]) and co-occurring problems (such as insomnia, pain, and aggressive behavior). Specifically, NCPTSD has developed new programs, such as the PTSD Mentoring Program and the PTSD Consultation Program. …