A Caregiver s Guide to Unique Therapy Techniques for Women Veterans. July 30, 2015
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1 A Caregiver s Guide to Unique Therapy Techniques for Women Veterans July 30, 2015
2 A Caregiver s Guide to Unique Therapy Techniques for Women Veterans Welcome & overview of today s call Introduction & Message from: Sherri Kum, Easter Seals Dixon Center Thank-you to Partner Organizations Message from: Carol Harlow, Elizabeth Dole Foundation Caregiver welcome Caregiver, James Guest Speaker Dr. Alicia Rossiter Online Q & A Michelle Stefanelli, VA Caregiver Support Program Thank you and next steps Today s Agenda
3 Easter Seals Easter Seals Dixon Center is strengthening communities to enable our veterans and their families to thrive where they live by building partnerships, sharing innovations and connecting those who have served to supports and services.
4 Thank you to Our Partners! Atlas Research Caregiver Action Network Family Caregiver Alliance National Alliance for Caregiving Rosalynn Carter Institute for Caregiving USO Supported by Newman s Own Foundation Partner Organizations
5 Carol Lindamood Harlow Strategic Program Consultant, Former Executive Director The Elizabeth Dole Foundation
6 Carol Lindamood Harlow Carol Lindamood Harlow serves as a strategic program consultant to the Foundation, focusing on the Dole Caregiver Fellows Program. Carol is also president and CEO of Harlow Solutions, a firm she founded after her service as the Elizabeth Dole Foundation s inaugural Executive Director. Carol has a twenty-year fundraising and executive management career specializing in raising awareness and financial resources for military and veteran causes and institutions of higher education. Projects include the National Museum of the United States Army Capital Campaign and the National WWII Memorial Capital Campaign, where she raised more than $16 million. Prior to the Elizabeth Dole Foundation, Carol most recently served as Assistant Vice Chancellor for Pepperdine University School of Law and previously managed two simultaneous regional campaigns as part of a $1.5 billion capital campaign for Washington University in St. Louis. She also served as a legislative assistant to U.S. Representative Jerry Weller (IL-11) where she staffed him as a Member of the House Committee on Veterans Affairs.
7 The Elizabeth Dole Foundation Our Philosophy Five core principles guide the philosophy of our Foundation: Conduct evidence-based research on the needs of military and veteran caregivers Empower caregivers Promote collaboration Drive innovation Raise awareness
8 James Story James is Retired Navy (23 years) Hospital Corpsman cares for his wife Tita a Retired Navy (20 years) Second Class Living activities that require daily assistance are: Caregiver Support Showering Personal hygiene care Assistance getting up when sitting or lying down for an extended period of time (sofa/bed/car) Assistance getting dressed Properly applying orthopedic braces and splints Driving to and from medical appointments
9 James Story Caregiver Support continues Administering medications/pain management Memory Lapses--forgets where she puts things)(tbi) Comforting --Inability to go back to sleep after being startled by loud noises.(ptsd) Appointment scheduling
10 COLLEGE OF NURSING A Caregiver s Guide to Unique Therapy Techniques for Women Veterans COLLEGE OF PHARMACY Alicia Gill Rossiter Lt Col (ret), USAFR NC, DNP, FNP, PNP-BC, FAANP SCHOOL OF PHYSICAL THERAPY & REHABILITATION SCIENCES Transforming Healthcare Transforming Lives
11 Disclosure and Funding The views expressed herein are those of the author and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, the United States Air Force, the Department of Defense, or the United States Government. This EBP project was funded by the Jonas Center and supported by the University of South Florida College of Nursing. UNIVERSITY OF SOUTH FLORIDA COLLEGE OF PUBLIC HEALTH MCOL UNIVE COLLEGE OF NURSING Transforming Healthcare Transforming Lives CO UN
12 Women Veterans Fastest growing segment of the veteran population 360,000 women veterans currently utilizing VA medical services 280,000 served in OEF/OIF/OND 14.6% active duty; 19.5% reserves; 15.5% national guard UNIVERSITY OF SOUTH FLORIDA COLLEGE OF PUBLIC HEALTH MCOL UNIVE COLLEGE OF NURSING Transforming Healthcare Transforming Lives CO UN
13 Challenges Facing Women Veterans
14 Challenges Facing Women Veterans UNIVERSITY OF SOUTH FLORIDA COLLEGE OF PUBLIC HEALTH MCOL UNIVE COLLEGE OF NURSING Transforming Healthcare Transforming Lives CO UN
15 Challenges Facing Women Veterans MST Nationwide, approximately 12 million women have a lifetime history of PTSD secondary to rape and in the U.S., rape victims may constitute the greatest number of PTSD sufferers Upwards to 80% of women in the military have experienced some form of sexual harassment or sexual assault leading to multiple psychological comorbidities UNIVERSITY OF SOUTH FLORIDA COLLEGE OF PUBLIC HEALTH According to the FY 2013 SAPR report, 5,061 reports of sexual assault were filed in 2013 these numbers have increased steadily since FY2007 when 2688 sexual assaults were reported Due to the fact that most women do not disclose their history of sexual assault, it is estimated that the number of sexual assaults are six times higher that approximately 30,366 sexual assaults occurred in fiscal year 2013 MCOL UNIVE COLLEGE OF NURSING Transforming Healthcare Transforming Lives CO UN
16 What is MST? U.S. Code (1720D of Title 38): 1) Psychological trauma, which in the judgment of a VA mental health professional, resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the Veteran was serving on active duty or active duty for training. 2) Sexual harassment is further defined as "repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character." UNIVERSITY OF SOUTH FLORIDA COLLEGE OF PUBLIC HEALTH MCOL UNIVE COLLEGE OF NURSING Transforming Healthcare Transforming Lives CO UN
17 Many Never Tell Live with, work with, and rely on perpetrators Fear of losing career Fear of letting unit down Fear of reprisal Potential effects on unit cohesiveness Impact on mission No one will believe her Blame Fear of getting in trouble if alcohol of fraternization Stigma UNIVERSITY OF SOUTH FLORIDA COLLEGE OF PUBLIC HEALTH MCOL UNIVE COLLEGE OF NURSING Transforming Healthcare Transforming Lives CO UN
18 MST Associated Conditions Physical Health Comorbidities Psychological Stress Unemployment Disordered Sleep MST Depression UNIVERSITY OF SOUTH FLORIDA Social Isolation COLLEGE OF PUBLIC HEALTH Anxiety Homelessness MCOL UNIVE COLLEGE OF NURSING Transforming Healthcare Transforming Lives Rossiter, 2015 CO UN
19 Mental and Physical Health Conditions Associated with MST Mental Health PTSD Depression Anxiety Anger Sleep disturbances Disordered eating Binge drinking Substance abuse Suicidal ideation Physical Health Chronic pain Gynecological Urological Neurological Endocrine Gastrointestinal Pulmonary Cardiovascular
20 Effect of MST on the Caregiver Emotional Stress UNIVERSITY OF SOUTH FLORIDA Increased stress and anxiety Depression Feeling of hopelessness Marital and family strain Physical stress Sleep deprivation Change in exercise habits Poor eating habits COLLEGE OF PUBLIC HEALTH Increased COLLEGE blood OF MEDICINE pressure or other health problems Missing appointments MCOL UNIVE COLLEGE OF NURSING Transforming Healthcare Transforming Lives CO UN
21 Women Veterans UNIVERSITY OF SOUTH FLORIDA COLLEGE OF PUBLIC HEALTH MCOL UNIVE COLLEGE OF NURSING Transforming Healthcare Transforming Lives CO UN
22 The Challenge Veterans 26 Million UNIVERSITY OF SOUTH FLORIDA Civilian Sector 18 Million VA Healthcare System 8 Million COLLEGE OF PUBLIC HEALTH MCOL UNIVE COLLEGE OF NURSING Transforming Healthcare Transforming Lives CO UN
23 Why is this important? UNIVERSITY OF SOUTH FLORIDA 18 M veterans receiving care in civilian sector Most veterans do not self identify Military status unknown to healthcare providers Many women veterans do not identify themselves as veterans and do not know they are eligible for VA services Lack of knowledge regarding military and military culture Lack of knowledge regarding services available to veterans in our community Effects of military service impact: Mental health Physical health COLLEGE OF PUBLIC HEALTH MCOL UNIVE COLLEGE OF NURSING Transforming Healthcare Transforming Lives CO UN
24 Current Evidence-Based Treatments Cognitive Processing Therapy (CPT) 12 sessions (60-90 minutes) w/practice of skills outside of sessions Prolonged Exposure Therapy (PE) 10 sessions (~90 minutes each) with homework assignments UNIVERSITY OF SOUTH FLORIDA Eye Movement Desensitization Reprocessing (EMDR) 8 to 12 weekly 90-minute sessions COLLEGE OF PUBLIC HEALTH MCOL UNIVE COLLEGE OF NURSING Transforming Healthcare Transforming Lives CO UN
25 Accelerated Resolution Therapy Emerging, brief exposure therapy grounded in theory Similar to EMDR however uses a directed treatment approach without free association Treatment is focused on calming the trauma associated physiologic symptoms initially while incorporating Imaginal Exposure (IE) and Imaginal Rescripting (IR), and the use right to left eye movements UNIVERSITY OF SOUTH FLORIDA COLLEGE OF PUBLIC HEALTH MCOL UNIVE COLLEGE OF NURSING Transforming Healthcare Transforming Lives CO UN
26 Intervention ART Imaginal Exposure (IE) Recall (verbally or nonverbally) the traumatic event Focus on associated physiological sensations, thoughts, and emotions
27 Intervention ART Imagery Rescripting (IR) Visualize the traumatic event Replace negative images and sensations with a positive image of the patient s choice After substituting, review until only the replacement scene is recalled. Conclude with crossing the bridge
28 ART Results Improvements in: UNIVERSITY OF SOUTH FLORIDA 1. PTSD* 2. Psychological Stress* 3. Sleep 4. Depression 5. Anxiety 6. Trauma Related Guilt Hopelessness* Sustained at 3 month follow up COLLEGE OF PUBLIC HEALTH Additional studies warranted Pain MCOL UNIVE COLLEGE OF NURSING Transforming Healthcare Transforming Lives CO UN
29 Quotes It (ART) was an amazing experience. I initially went in with the money as a motivator (as I didn t think after years of military therapy anything would help) and after three sessions it s amazing how much better I feel. THANK YOU! I only wish I had found something like this earlier on. However, I know this study will help to further others and improve their quality of life, so it worked out. UNIVERSITY OF SOUTH FLORIDA COLLEGE OF PUBLIC HEALTH MCOL UNIVE COLLEGE OF NURSING Transforming Healthcare Transforming Lives CO UN
30 What Can You Do As A Caregiver? Become knowledgeable regarding issues facing veterans Encourage the veteran to seek services at the VA Seek additional resources in the community Do your homework UNIVERSITY OF SOUTH FLORIDA COLLEGE OF PUBLIC HEALTH Support group for caregivers Take care of yourself MCOL UNIVE COLLEGE OF NURSING Transforming Healthcare Transforming Lives CO UN
31 Resources International Society of Accelerated Resolution Therapy Rosenzweig Center for Rapid Recovery (RCRR) erapy.com/web/ Veteran Alternative Center, Holiday, FL e.org/ Camaraderie Foundation dation.org/ VA Caregiver Support Military One Source Veteran Crisis Line Make the Connection Vet Center Programs
32 Women Veteran, their Spouses, Caregivers & Family Members Resource List For additional resources please visit:
33 A Caregiver s Guide to Unique Therapy Techniques for Women Veterans Questions Comments Answers
34 VA Caregiver Support Program (855)
35 Community OneSourceSM Community OneSourceSM provides information, resources and assistance to all service members, veterans and their families at no cost. We re here to help: (866)
36 Military Caregivers Webinar Series Stay tuned next webinar scheduled for August 27 th on the topic of Parents as Caregivers. Handouts, additional resources, recording, & transcript to be posted to Contact: with any questions Will keep you apprised of future webinars and new partner resources
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