Recommendation: the Committee consider a supplemental appropriation for a National Center for PTSD, regional treatment and training centers and enhanced specialized PTSD treatment units addressing the multiple PTSD needs of the VA Medical Centers.

OFFICE OF ASSOCIATE DIRECTOR FOR PTSD

There is no question that there is a need for coordination and planning as well as opportunity for Central Office initiative in the issue of PTSD. Therefore I endorse the intent of the legislation advocating the creation of such an Office. As an outsider to VA Central Office, it seemed to me that the creation of a seperate Readjustment Counseling Service apart from the Mental Health and Behavioral Science Service was initiated within the VA to address certain concerns and maximize effective management and control. I find myself in the position of wishing to support those efforts of the VA which enhance the effective assessment and treatment of PTSD and to leave to the Administrator the details of what can best effect that effort in Central Office at any single point in time. Consequently I have no specific comment on this issue.

DRAFT PROPOSAL

FOR A

REGIONAL

COMPREHENSIVE CENTER FOR THE STUDY & TREATMENT

OF POST TRAUMATIC STRESS

VETERANS ADMINISTRATION MEDICAL CENTER

CLEVELAND, OHIO

1. INTRODUCTION

This proposal describes the organization and resources required for a comprehensive center for the study and treatment of Post Traumatic Stress Disorder (PTSD). Sincre relatively little is known about the diagnosis and treatment of PTSD this Center is designed to advance knowledge about of PTSD as well as serve as an educational site. This proposal recognizes that PTSD is not confined to Vietnam Veterans alone; female veterans, combat veterans of other eras and in particular POWs are also affected. It also acknowledges that the impact of PTSD is not confined to specialized PTSD units but affects the entire Medical Center and the community at large. Innovative approaches included in this proposal are (1) the integration of a variety of effective therapeutic strategies, (2) greater involvement of the vet centers with the medical center, and (3) provision for the development of training, evaluation and research for the Medical Center and Region.

2. GOALS AND OBJECTIVES

To develop a comprehensive regional center for the study and treatment of post traumatic stress.

To study the relative efficacy of existing and innovative treatments.

To develop a working partnership with existing community resources, particulary the Vet Centers, to provide additional vocational, social and readjustinent services to patients with PTSD.

To provide both consultation and treatment for the Medical Center and Region on assessment and treatment of stress disorders.

To facilitate research in acute and chronic reactions to stress.

To develop an educational program in the assessment and treatment of PTSD as a resource for the training of staff thoughout the Department of Medicine and Surgery.

To develop an ambulatory care program (1) to provide continuing care and (2) for patients who need treatment but who do not require hospitalization.

3. ORGANIZATION OF THE CENTER

The overall orzanization of the Center is presented graphically in the enclosed organization charts. Summary narrative descriptions of each unit and program within the center follow below.

OFFICE OF ASSOCIATE DIRECTOR FOR CLINICAL SERVICES.

Outreach and Community Liaison Unit:

The personnel assigned to the unit will coordinate existing community resources, assist in the development of complementary veteran vocational and readjustment services, and provide direct crisis intervention services to veterans in the community in consultation with community and public safety agencies. The unit will provide a direct link with local Vet Centers and provide liaison with other Vet Centers throughout the region. Staff in this unit will serve as an initial contact point in order to facilitate entry into the program and develop follow up options for veterans returning to home communities throughout the region.

Inpatient Treatment Units:

(a) Vietnam Veteran Treatment Unit

This

inpatient unit is a structured treatment program for the assessment, stabilization and initial resolution of stress disorders as well as an orientation to community reentry. This unit contains a concentration of readjustment counselors since it will be a 24 hour/ 7 day a week therapeutic program to insure clinical staff on hand whenever needed and to obviate difficulties encountered by other inpatient units. This unit also provides beds for immediate crisis readmissions.

Target population: Vietnam veterans with PTSD problems without major psychiatric disorder or substance abuse problems which would impair ability to benefit from the structured residential treatment program.

(b) Specialized PTSD Treatment Unit This inpatient treatment unit will consist of a structured treatment program which utilizes treatment protocols targeted at specific symptom clusters (for example, intensive sleep distrubances, intrusive thoughts and flashbacks, impulse control problems).

This unit will provide important data about the variability of PTSD inpatients with different backgrounds and with different stressors. Individualized treatment and the development of specialized treatment protocols will be a primary goal of this program.

Target population: Veterans of any era who meet the critiera for any ongoing specialized treatment protocol. WW II, Korean veterans, POWs from several eras as well as male and female Vietnam veterans will be sought for this unit.

Ambulatory Care Unit:

This unit provides followup for patients discharged from the inpatient units who live within commuting distance of the medical center or satellite units at the local vet centers and the Canton outpatient clinic. The unit will also provide a cost efficient treatment option for patients whose clinical condition does not necessitate inpatient care. The objective of direct admissions to ambulatory care