PTSD the COMPACT Act and the Portland VA with Cynthia Tanner & Kristine O’Brien
Kristine and Cindy stop by the chat to talk PTSD, the COMPACT Act, CBOC’s, PCL-5’s, and other varied acronymed topics that give Melissa and Staci the insider’s peek into mental health care in the Portland VA (Veterans Affairs) Healthcare System. They’re on a mission to spread the word about the VA’s whole health approach, build community coalitions, explain how the VA is trying to broaden the reach into more rural communities, and what treatment and benefits are like at the VA.
Welcome Kristine and Cindy! Let’s chat!
If you or a Veteran you know is having a suicidal crisis, or you’d like to get advice on how to talk to a Veteran you care about, call the National Suicide Crisis Line at 988 and Press 1 to be connected to the Veterans Crisis Line.
Defining PTSD:
In addition to military combat, PTSD can result from the experience or witnessing of a terrorist attack, violent crime and abuse, natural disasters, serious accidents, or violent personal assaults.
In 2013, the American Psychiatric Association moved PTSD from the class of “anxiety disorders” into a new class of “trauma and stressor-related disorders.” DSM-5 categorizes the symptoms that accompany PTSD into four “clusters”:
Intrusion—spontaneous memories of the traumatic event, recurrent dreams related to it, flashbacks, or other intense or prolonged psychological distress
Avoidance—distressing memories, thoughts, feelings, or external reminders of the event
Negative cognitions and mood—myriad feelings including a distorted sense of blame of self or others, persistent negative emotions (e.g., fear, guilt, shame), feelings of detachment or alienation, and constricted affect (e.g., inability to experience positive emotions)
Arousal—aggressive, reckless, or self-destructive behavior; sleep disturbances; hypervigilance or related problems.
Diagnosis Screening Tools
The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) is considered the gold standard for PTSD assessment in both veterans and civilians. The detailed 30-item interview has proven useful across a wide variety of settings and takes approximately 30 to 60 minutes to administer.
The well-validated PTSD Checklist for DSM-5 (PCL-5) is one of the most commonly used self-report measures of PTSD. Administration of the 20-item questionnaire is required by the VA for veterans being treated for PTSD as part of a national effort to establish PTSD outcome measures. The PCL-5 can be completed in five to seven minutes.
Therapies Mentioned in this episode:
Cognitive Processing Therapy (not Cognitive Behavioral Therapy - CBT)
Structured 12 week process
Socratic questions to identify automatic thoughts, blaming (self or others) thoughts, maladaptive strategies
Where are you stuck - examining the stuck points and looking to enact a skill change & recognize cognitive distortions
In the service more black and white thinking exists to help keep people safe, but in civilian life - those strategies may not serve you anymore, looking at those strategies and determining what is no longer helpful.
Exposure Therapy
EMDR: Eye Movement Desensitization and Reprocessing - our interview with Arabeth Mashek, EMDR practicioner
VA mental health benefits can take many personalized forms:
Taking personal health inventories and building relationship skills
Keeping Safe
The Center for Integrated Pain Management (and some self -referral groups at the VA) and getting out emotions stuck in the body
Acupuncture
Chiropractic
Massage
Yoga
Tai chi
Mindfulness Training
Healing energy / reiki work
EMDR
CPT
Prolonged Exposure Therapy
Full Spectrum Bulbs (Happy Lights)
PTSD Symptom Management Group
Financial Support
Cheaper co-pays and prescription coverage that in civilian plans
Service connected disabilities - no copays
Some things that didn’t make it into the edited version of this interview:
It’s estimated that 20-30% of Veterans have PTSD
60% of veterans who have completed suicide have *not* used VA healthcare.
Veterans Justice Outreach - diversion program from the criminal justice system.
Connect with our Guests (please let them know you heard their interview!):
Kristine O’Brien, Ed.S, M.S, LMHC (photo left)
Community Engagement & Partnerships Coordinator (CEPC) PTSD
Kristine O’Brien is a licensed mental health counselor (LMHC) working to build community coalitions as a Community Engagement & Partnerships Coordinator which is a position housed in the Suicide Prevention office in the Portland VA Health care System. With her Ed.S degree (Education Specialist post Bac degree) she focuses her work primarily with coalitions out in the community working towards suicide prevention with veterans, military and their families.
Kristine is also in Private Practice at Built for Better Counseling.
Cindy Tanner, LCSW (photo right)
COMPACT ACT Coordinator, detail position & Suicide Prevention Coordinator
Suicide Prevention Team Line (503) 402-2857
Cynthia Tanner is a Licensed Clinical Social Worker (LCSW), working in the VA Portland Health Care System. In her previous roles with the Portland VA, she has assisted with Veteran care coordination and stabilization for those experiencing houselessness, and provided services for Veterans seeking recovery from substance use disorders, helping them reconnect to who they wanted to be, without substances. Currently she works with the Suicide Prevention Team as the COMPACT ACT Coordinator, providing consultation, education, and supportive resources for Veterans who are at high risk for suicide. The overall theme in her work has been creating safe spaces for individuals where they can experience being heard and valued, so they may begin the process of building a life they want to live.
Related Internal Chatter Episodes
Go on a deeper dive into EMDR with Arabeth Mashkek and safety plans with Angela Perry both referenced in this episode. Also, if you would like to know more about 988 and what happens when you call, please listen to our episode with Debbie Dedrickson, Director of Clinical Operations at Lines for Life. The Taylor Made Retreat offers a non-insurance based 30, 60, 90 day stay, recovery house (and a sliding scale for payment) in Beaverton for those struggling with Substance Abuse issues.