Helping Heroes Come Home

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1 Helping Heroes Come Home Harris County Veterans Court May 30, 2012

2 Honorable Discharge, on active duty or in reserves Have pending eligible felony offense Be a legal resident of/or citizen of the United States of America Be a resident of Harris and/or surrounding Counties Have mental health, TBI, and/or substance use diagnoses Criminal offense must be related to the diagnosis First felony offender and/or have served in combat or on hazardous duty

3 Pending case is either; Sexual offenses, drug delivery or all 3G offenses with the exception of aggravated assault. Prior conviction or deferred adjudication for sexual assault or 3G offense with the exception of aggravated assault. Is seriously and persistently mentally ill and cannot participate Has previously been terminated or graduated from Veterans Court

4 Judge Program Director Probation Clinical Legal Benefits

5 Community Veterans Court Team Judge Veteran

6 Integrated, comprehensive care Integrated electronic medical record Housing support Vocational support Availability of evidence-based treatment for mental health and substance use disorders Case management (VJO)

7 Comprehensive psychiatric evaluation to establish diagnoses Violence history Assessment of the mental state of defendant at the time of the alleged offense and analysis of the relationship between the illness and the offense behavior Available services and treatment amenability

8 PTSD Criterion D : Persistent symptoms of increased arousal as indicated by two (or more) of the following: Difficulty falling or staying asleep Irritability or outbursts of anger Difficulty concentrating Hypervigilance Exaggerated startle response SUD: disinhibition of intoxication; perpetuation & exacerbation of symptoms DSM-IV-TR

9 Abstinence from substances often makes PTSD symptoms worse initially Poorer treatment outcomes for PTSD/SUD patients More severe substance use (e.g., type of substance and quantity) if PTSD diagnosis Patients want integrated treatment for both conditions Charity Hammond, PhD, MEDVAMC

10 Developed in 1990s by Dr. Lisa M. Najavits, Professor of Psychiatry, Boston University School of Medicine; Lecturer, Harvard Medical School; clinical psychologist at VA Boston; and clinical associate, McLean Hospital. First integrated PTSD/SUD treatment with published outcomes Studied in women, men & special populations: homeless and incarcerated, veterans, soldiers, Iraq and Afghanistan veterans

11 Safety as the overarching goal (relationships, thinking, behavior, emotions) Integrated treatment (working on both PTSD and substance abuse at the same time) A focus on ideals to counteract the loss of ideals in both PTSD and substance abuse Four content areas: cognitive, behavioral, interpersonal, case management Attention to clinician processes (countertransference, self-care, and other issues)

12 Originally developed by Drs. Patricia Resick and Monika Schnicke as a group treatment for rape survivors in 1988 Dr.Resick, Director of the Women s Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System. Based on a cognitive therapy model Modified by Drs. Resick, Candace Monson, and Kathleen Chard for veteran/military populations in 2006

13 Educating about PTSD and its symptoms Helping patients explore how traumatic events have affected their lives Learning about connections between traumarelated thoughts, feelings, and behaviors Remembering the traumatic event and experiencing the emotions associated with it https://cpt.musc.edu/introduction

14 Increasing patient s ability to challenge maladaptive thoughts about the trauma Help patients increase their understanding of unhelpful thinking patterns and learn new, healthier ways of thinking; and Facilitating patients' exploration of how each of 5 core themes have been affected by their traumatic experiences https://cpt.musc.edu/introduction

15 Substance Abuse Treatment Program Residential treatment Outpatient: coping skills, relapse prevention, anger management, mood management Trauma Recovery Program Inpatient: acute care and ROVER Outpatient: individual and group therapies, Health Care for the Homeless Vocational Rehabilitation

16 Evaluation: Legal Judicial Psychiatric Teamwork Resources

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