August 5 Veterans News

August 5 Veterans News

Veterans news updateHow effective are PTSD treatments for veterans? (Time)
A new study published Tuesday suggests commonly used first-line treatments for PTSD in veterans may not work as well as medical experts once thought. The number of American veterans who suffer from PTSD continues to be a serious national public health problem. Recent data show that more than 200,000 Vietnam War veterans still have PTSD, and other research shows that around 13% of Iraq or Afghanistan veterans who experienced combat have PTSD. The numbers continue to climb. As TIME previously reported, PTSD diagnoses among deployed troops grew by 400% from 2004 to 2012. Now new research, published Tuesday in the Journal of the American Medical Association, reveals that go-to treatments for the disorder may not be as effective as many in the medical community may have believed or hoped. To reach their findings, researchers from the Steven and Alexandra Cohen Veterans Center for Post-Traumatic Stress and Traumatic Brain Injury at NYU Langone Medical Center reviewed 36 randomized control trials of psychotherapy treatments for veterans suffering from PTSD over a 35-year span. Two of the most commonly used treatments—and the most widely studied—are cognitive processing therapy (CPT) and prolonged exposure (PE) therapy. CPT is a treatment that focuses on changing dysfunctional thoughts, and exposure therapy is meant to help patients face what’s causing them stress and fear. The research showed that while up to 70% of the men and women who received CPT or PE experienced symptom improvements, around two-thirds of people receiving the treatments still met the criteria for a PTSD diagnosis after treatment. The researchers note that current veterans affairs policies emphasize the use of the two methods as treatments of choice. The researchers also argued that veterans with PTSD are likely to have worse outcomes from treatment compared to civilians with PTSD.

Why public service appeals to veterans (Task & Purpose)
Commentary: “Veterans are disproportionately represented in the public sector. There are good reasons why, and good effects from it. Any veteran who honorably finishes a term of military service, be that for four years or 20, has paid his or her dues to the country. In spite of this, many veterans, myself included, still find themselves in a public service job in some capacity. While many vets would prefer to never see the inside of a government building ever again, there are some compelling reasons to consider a job in government, be that federal, state, or local. First, there is the reward of having a sense of purpose. While that certainly isn’t unique to government jobs, many of them still provide that psychic payoff. That’s obviously more true of some jobs than others — a policeman, fireman, or teacher can often see the tangible results of his or her service more easily than a government office worker, though they often do important work, too. Having a larger purpose to your work can help ease the transition back to civilian life. Studies show that having a sense of purpose in one’s life leads to a longer and healthier life. While a second career in public service is by no means the only way for veterans to find a larger purpose again, it does give a head start towards finding one. In many government jobs, that transition is also eased by having a larger number of fellow veterans around. Vets are disproportionately represented in the public sector. Over half the people in my workplace are vets, and that makes a huge difference in terms of feeling like home, or in this case, much like my old squadron ready room. In a lot of ways it has the fellowship of the military, but without as many ridiculous rules. Part of the reason for that disproportionate representation is undoubtedly the preference veterans are given for government jobs. While the rules differ between federal, state, and local jobs, long story short, if two people are equally qualified for a position and one is a veteran, the veteran gets the job. That’s a pretty big deal. Disabled veterans get further advantages.”

VA getting out the word on successes, challenges (Stars & Stripes)
Department of Veterans Affairs stories will be popping up everywhere this week as the beleaguered agency rolls out a nationwide outreach effort to highlight reform efforts in the wake of a crisis in veterans’ health care. Roughly one year after former Procter & Gamble CEO Bob McDonald took over as VA secretary in the midst of a scandal, the VA has instructed directors of its medical centers, regional offices and cemeteries to reach out to local media to tell their stories. VA spokesman James Hutton said that facilities would be highlighting different issues, and that there is no specific topic for the outreach. “We told them to talk about their facility and we said, ‘Say some of your accomplishments, some of your challenges,’” he said. “There was no script.” At the Carl Vinson VA Medical Center, in Dublin, Ga., officials told local media they are hiring more health care professionals to get patients in sooner, but that average wait times are still well above their target of 30 days. “We still have long wait periods to get in,” Director Maryalice Morro told the Macon Telegraph. “While I see it getting better in the months ahead, we still struggle.” That’s a more conciliatory tone than VA central officials have sometimes struck in their frequent testimony to Congressional committees, perhaps signaling a different tack from the department. The defensiveness that VA officials have often shown over the systemic problems uncovered at the VA over the past year or so has enraged lawmakers, who have called for fundamental change at the federal government’s second largest department.

Baltimore VA cites faster, more accurate handling of disability claims (The Baltimore Sun)
The Baltimore office of the U.S. Department of Veterans Affairs, once the slowest and most error-prone in the country, has reduced its backlog of disability claims by nearly 60 percent and significantly improved its accuracy, officials said Tuesday. Antione Waller, named director of the office 11 months ago, said it has reduced its backlog from 6,000 claims in September to about 2,600. And while 26 percent of cases were found to be in error 30 months ago, the error rate has fallen to 16 percent, officials said. The office serves Maryland’s 450,000 veterans. “There’s no doubt that this organization has gone through a tremendous transformation,” Waller said. The goal, he said, is for veterans to “feel like when they greet us, we know who they are, we have all their information, and we can guide and direct them.” The office is working to “meet their expectation and not ours,” Waller said. The Baltimore Sun revealed in January 2013 that the local office was the slowest in the country in processing disability claims and the one that made the most mistakes. At the time, about 84 percent — or 16,800 of the 20,000 local claims — were at least four months old. The disability backlog has been one of two major problems plaguing the VA nationally. The agency also has been under fire for how long sick and injured service members must wait for treatment in its medical centers. At Baltimore’s disability benefits office, Waller said he has brought in more experienced management and hired 20 additional full-time employees, increasing the staff to 163 people. The office does most of its work by computer now, virtually eliminating paper claims, and has sent about 20 percent of its workload to other regions to speed the time it takes to approve or deny requests for benefits.

State veterans’ home worker lawsuit spills into Duckworth Senate bid (U.S. News & World Report)
A civil lawsuit alleging ethics violations nearly a decade ago has become an issue in a Democratic congresswoman’s bid to unseat first-term Republican U.S. Sen. Mark Kirk in what is expected to be one of the most competitive 2016 Senate races. The complaint alleging workplace retaliation was filed in 2008 by two employees of a southern Illinois veterans’ home against Tammy Duckworth, a Chicago area congresswoman who then led the Illinois Department of Veterans Affairs, and Patricia Simms, the home’s acting administrator in 2006 and 2007.  Christine Butler, a 21-year state employee, accuses Duckworth in the lawsuit of firing her for insubordination over complaints about Simms. Butler’s termination was reversed by Duckworth within days. Denise Goins, a human resources secretary, alleges that her complaints about Simms were also ignored and led to an unfavorable performance review that prevented her from receiving a raise. Goins says Duckworth urged her to “do your job and keep your mouth shut.” Goins and Butler also say they were punished for speaking out after Simms allowed unauthorized people to care for a resident of the home. The two state workers are seeking compensatory damages of at least $50,000, as well as other financial penalties. Duckworth, an Iraq War veteran who led the state agency from December 2006 until early 2009 before joining the federal Department of Veterans Affairs, deflected the allegations when she defeated an incumbent Republican for the state’s Eighth Congressional District seat in 2012.

Study: Veterans with severe PTSD may have weaker brain network connectivity (Physical Therapy Products)
Researchers at the VA Boston Healthcare System suggest in a new study that veterans with more severe PTSD may have weaker connectivity in two brain networks. The study was published in a recent issue of Biological Psychiatry, per a news release from Elsevier. The release notes that Jeffrey M. Spielberg, PhD, and his colleagues at the VA Boston Healthcare System examined brain networks in veterans with trauma exposure using functional magnetic resonance imaging (fMRI) and graph theory tools. Graph theory, the release explains, permits examination of the patterns of brain connections, as opposed to examining individual connections. In their study, the researchers recruited 208 veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn, all of whom had experienced a traumatic event. They found that veterans who had more severe PTSD re-experiencing symptoms (eg, flashbacks or reliving the event) showed weaker connectivity in two networks, the release explains. The first altered network includes the hippocampus and prefrontal cortex, and is involved in providing contextual information. This suggests that perhaps the hippocampus may be overgeneralizing trauma-related memories, and therefore, fails to correctly classify nonthreatening cues as “safe. The second network, which was identified only in veterans with comorbid mild TBI, includes the basal ganglia and prefrontal cortex, and plays a role in working memory, the release continues.

Trauma experiences change brain even in those without PTSD (MedicalXpress)
Trauma may cause distinct and long-lasting effects even in people who do not develop PTSD (post-traumatic stress disorder), according to research by scientists working at the University of Oxford’s Department of Psychiatry. It is already known that stress affects brain function and may lead to PTSD, but until now the underlying brain networks have proven elusive. Led by Prof. Morten Kringelbach, the Oxford team’s systematic meta-analysis of all brain research on PTSD is published in the journal Neuroscience and Biobehavioural Reviews. The research is part of a larger program on PTSD in British war veterans run by the Scars of War Foundation based at The Queen’s College, University of Oxford. The foundation uses neuroscience to advance understanding of the effects of war and disaster. The research team’s initial survey of the scientific literature for all the published studies reporting brain activity in individuals with a diagnosis of PTSD yielded over 2000 records. This number was then reduced using stringent criteria to ensure the highest possible data quality for processing with meta-analytic tools. The team separated studies by type of control group: trauma-exposed (those who had experienced trauma but did not have a diagnosis of PTSD) and trauma-naïve (those who had not experienced trauma), and compared the individuals with PTSD to both groups. This yielded an insight into how the abnormalities in functional brain activity in PTSD comprise a whole-brain network. The analysis showed that there were differences between the brain activity of individuals with PTSD and that of the groups of both trauma-exposed and trauma-naïve participants. This suggests that even in the absence of symptoms, trauma may have an enduring effect on brain function. Critically, the research found that in parts of a region of the brain called the basal ganglia, brain activity was different when comparing people with PTSD to the trauma-exposed group.

Mindfulness-based therapy eases veterans’ PTSD symptoms (Reuters)
Some veterans may experience a sharper decline in symptoms of post-traumatic stress disorder (PTSD) with mindfulness-based stress reduction therapy than with other forms of group treatment, a study suggests. Researchers gave one group of veterans with PTSD eight weekly 2.5-hour sessions focused on mindfulness and meditation, as well as a day-long retreat, and compared their progress to their peers who received nine weekly 1.5-hour group sessions designed to address specific problems stemming from PTSD in daily life. With mindfulness-based therapy, 49 percent of veterans reported a dramatic reduction in PTSD symptoms, compared with just 28 percent of their peers who didn’t receive this type of treatment. “Overall, the evidence from this study suggests mindfulness-based stress reduction therapy may be a promising treatment for PTSD,” lead study author Melissa Polusny, of the Minneapolis Veterans Affairs Health Care System, said by email.  Roughly one in four veterans returning from deployments in Afghanistan and Iraq suffer from PTSD, Polusny and colleagues report in JAMA, the journal of the American Medical Association. Mindfulness-based group sessions help veterans learn meditation techniques they can use at home to cultivate awareness of the present moment during ordinary daily activities such as driving or eating, she said. Breathing exercises and practices such as yoga are also used to help encourage body awareness and focus on the present. The other treatment used in the study, known as present-centered group therapy, fosters concentration on the impact of trauma and PTSD symptoms on daily life, with an emphasis on problem-solving and coping mechanisms, she said.

VA launches cyber squad (Federal Computer Weekly)
LaVerne Council, the new CIO at the Department of Veterans Affairs, has assembled a team charged with coming up with an overall cybersecurity plan for the agency. The new Enterprise Cybersecurity Strategy Team will be led by Susan McHugh-Polley, a senior executive program manager at VA. The team includes executives and subject matter experts from across the VA’s Office of Information and Technology. “The team’s scope includes management of current cybersecurity efforts as well as development and review of VA’s cybersecurity requirements and operations holistically — from desktop to software to network protection,” a VA spokesperson told FCW. The plan will be made public once it is completed and presented to Congress, per the spokesperson. The plan is due to be completed in 45 days, according to an article in FedScoop, which first reported on the VA’s new cyber effort. Stephen Warren, who served as acting CIO at VA for more than two years and is currently Council’s deputy, published monthly reports on intrusion detection under Einstein 3, as well as potential data loss as a result of mishandled files and lost or stolen computer equipment. According to a July fact sheet released just before Council was sworn in as VA’s top tech official, the department has encrypted all of the more than 438,000 laptops and desktops on its network, and decreased its critical or high vulnerabilities by 71 percent between November 2014 and May 2015. Despite some gains, VA’s inspector general gave the agency a failing grade on information security in the most recent security audit because of multiple outstanding recommendations going unfulfilled over several years. The most recent public report for June 2015 said there were 2,076 veterans affected as a result of mishandled information, such as incidents in which printouts of patient information were displayed openly in public settings. None of the potential data loss incidents were the result of cyber attacks, according to the VA report.

Vet’s overdose while in custody spurs VA probe (Tampa Tribune)
The Department of Veterans Affairs Sunshine Healthcare Network is conducting an internal review of how a veteran in the custody of the Bay Pines VA Police Department was able to overdose on drugs, said Bay Pines spokesman Jason Dangel. The veteran, Carl Giordano, 61, of St. Petersburg, was charged with possession of a controlled substance with intent to sell, a second degree felony and possession of a controlled substance, a third degree felony, according to Pinellas County Jail Records. It is unclear from court records when Giordano overdosed and Dangel didn’t have that information Tuesday evening. Citing an ongoing investigation among other reasons, the Department of Veterans Affairs on July 28 denied a Freedom of Information Act request filed by The Tribune two weeks earlier seeking police records for the arrest of Giordano and another veteran, Thomas Stewart, who was charged with one count of possession of hydrocodone and one count of possession of a controlled substance. Stewart, 54, was booked on July 9. The review is being conducted by the VA Sunshine Healthcare Network, which oversees VA healthcare in Florida, southern Georgia, Puerto Rico and the Virgin Islands, said Dangel, who offered no more details about the review or when it might be completed. The review “takes a look at how we could have prevented something like that from happening,” said Dangel. A common practice, “they are used as an opportunity to learn, improve and validate our business practices in accordance with local and national policy and regulations,” he said in an email last week. Giordano, in both a video visitation at the Pinellas County Jail and via telephone, has declined comment. Giordano was released last week after posting $6,000 bond, according to court records. Stewart, in a video visitation from the jail, said that he has known Giordano for about three years, but that the hydrocodone in his possession was his own prescription and that VA police placed a different hydrocodone pill in his bag when he refused to inform on Giordano.

VA permanently closes acute care center at Fort Harrison (Stars & Stripes)
VA Montana has dissolved its urgent mental health unit in favor of additional long-term beds at Fort Harrison west of Helena. The Veterans Affairs hospital had called the closure temporary when it shuttered the acute inpatient psychiatric service in February. The services were permanently ended on July 20 because of a lack of demand. The eight-bed crisis unit was consistently under capacity because about half of veterans who require short-term care seek it closer to home, Chief of Behavioral Health Chris Childers said. “With review of the demand for residential and lack of demand for acute psychiatry, it was clear that VA Montana could serve more veterans and not have empty beds if the acute beds were converted to treating those wanting residential treatment,” Childers said. Fort Harrison’s Residential Rehabilitation and Treatment Program absorbed the acute-care resources after minimal construction. VA Montana spokesman Brandon Freitas said the cost of labor and materials was about $25,000. The eight beds were added to the program’s existing 16 beds dedicated to treating post-traumatic stress disorder and substance abuse. The residential program has been at 90 percent capacity since the expansion was completed two weeks ago, Childers said. Patients at the program build camaraderie, reflect and learn techniques to relax during treatment that typically lasts six weeks, Childers said. Fort Harrison operates Montana’s only outpatient facility that treats PTSD and substance abuse, Childers said.

Tampa VA hospital to get 2nd Fisher House for patient families (Tampa Tribune)
The first Fisher House at Tampa’s James A. Haley Veterans’ Hospital has been so successful that plans have been approved to build a second facility to house family members of patients. The plans were recently accepted by Department of Veterans Affairs Secretary Bob McDonald and construction will be helped with a $7,500 donation from Amazon, according to hospital spokeswoman Karen Collins. The hospital is planning a news conference for Wednesday to announce specifics. Fisher House II will be a 16-suite facility “that will complement the existing 20-suite house, giving us the ability to accommodate up to 36 families each night at no cost to them,” Collins said in a statement. The Fisher House at Haley, one of more than 40 across the nation, opened in 2007. It has individual rooms and a shared kitchen that allow families of those receiving treatment to avoid paying for lodging and the expense of dining out. As a result, the average family saves about $900 by staying at Fisher House, Collins said. Last year, the Fisher House accommodated more than 1,000 families, said Collins. The new facility will be one building away from the existing one, Collins said. Site preparations will begin in the fall with the goal of completion by summer or fall of 2016. The house will be built by the Fisher House Foundation and donated to Haley, which assumes responsibility for operation, maintenance, upkeep and staffing, Collins said. “Creature comfort needs” of the guests, such as food and toiletries, are provided through monetary or in-kind support of the local community, Collins said.