Written Statement of George S. Ake III, Ph.D.

Assistant Professor of Medical Psychology
Duke University Medical Center

Presented on behalf of the American Psychological Association

Before the U.S. House of Representatives Committee on Veterans’ Affairs Subcommittee on Health on Building Bridges between VA and Community Organizations to Support Veterans and Families

February 27, 2012

Good afternoon, Chairwoman Buerkle, Ranking Member Michaud, and Members of the Sub-committee. I wish to thank you for the opportunity to testify on behalf of the 154,000 members and affiliates of the American Psychological Association (APA) regarding collaboration between the Department of Veterans Affairs (VA) and community organizations to support Veterans and their families. As a child psychologist at Duke University Medical Center and with the National Child Traumatic Stress Network, my work focuses on assisting children and families who have experienced stressful and traumatic life events, including military deployment and its aftermath. I am honored to speak with you today about the collaborative work that I and my colleagues are engaged in with a variety of partners around the country in support of our nation’s military and Veteran families. 

Collaboration among all sectors of society is needed to support the health and well-being of Veterans and their families. This includes key partnerships with policymakers, government agencies, universities, the health care community, and the faith-based community. Scientific evidence continues to identify psychological and neurological disorders, including posttraumatic stress disorder (PTSD), depression, suicidal ideation, and traumatic brain injury (TBI), as some of the signature wounds of the conflicts in Iraq and Afghanistan. While psychologists and other health professionals play an essential role in helping Veterans and families to address these challenges, partnerships and collaborations with others sectors of society are also critical. 

Despite a proliferation of programs for Active Duty, National Guard, Reserve Component, and Veterans and their families, many families rely upon the support and counsel of faith-based providers as a first point of contact. In some communities, particularly small towns and rural areas, faith-based services are more prevalent and accessible than health care services. In theatre, on base or post, at the VA, and in local communities, Veterans and their families not only approach faith-based providers on spiritual, religious, and moral issues, but also issues of reintegration, spousal relationships, and parenting. Chaplains and other faith-based providers can play a key role in addressing concerns about stigma related to mental and behavioral health services and supports as well as providing linkages and referrals to appropriate community and professional resources.

I would like to express my deep appreciation to you, Chairwoman Buerkle, for your leadership in advancing collaboration between the mental health and faith-based communities with regard to military and Veteran families. The unique military and Veterans mental health workshop that you hosted for faith-based providers in your district in December served as a wonderful example of the collaboration and partnership that is possible across sectors. I was honored to join the distinguished panel of experts that you assembled, including Dr. David Rudd of the University of Utah’s National Center for Veterans Studies, Drs. Judy Hayman and Caitlin Thompson from the VA, Jason Hansman of the Iraq and Afghanistan Veterans of America, and Retired Air National Guard Chaplain Tim Bejian. Such events help to break down barriers and foster partnerships that benefit Veterans and their families. Replicating this training in other congressional districts could serve as a valuable resource. 

The importance of collaboration between military and community systems, and among health professionals and faith-based providers, is especially important as we consider data from the 2010 Department of Defense (DoD) Profile of the Military Community, which estimates that 44% of the 1.4 million Active Duty and National Guard/Reserve personnel, who have deployed to combat missions as part of Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and/or Operation New Dawn (OND), are parents. This same report noted that there are almost 2 million children in the U.S. who have parents in Active Duty or Reserve services. Many of these children and families have seen their military parents and spouses serve multiple combat deployments to Iraq and Afghanistan. A number contend with a parent who returns changed due to the wounds of war. Some of these families suffer financial hardship, homelessness, marital discord, violence, and other difficulties during their reintegration into civilian life. Still other families experience the grief and loss associated with their loved one’s fatal combat injury, or even suicide. Taken together, these findings highlight the necessity of considering the context and challenges for children and families of Veterans returning from combat, as well as the role of the family in facilitating a successful transition to stateside service or civilian life.

To support the Veteran and strengthen the family, Veteran families need easy connection to collaborative programs and supports through VA Medical Centers, Vet Centers, community mental health and faith-based services, and professionals from a variety of disciplines, such as psychologists, pediatricians, clergy, educators, and case managers who are familiar with the military/Veteran culture. 

As a member of the National Child Traumatic Stress Network (NCTSN), I would like to highlight some of our efforts to support such collaboration. The NCTSN is an initiative launched by Congress in 2000 with the goal of developing a national collaborative network to improve best practices and standards of care for children and families affected by traumatic stress. Since 2001, the NCTSN, which is administered by the Substance Abuse and Mental Health Services Administration, has delivered direct services to children and families who have experienced all forms of traumatic stress, including our nation’s military families. Between 2002 and 2009, NCTSN members reported serving over 320,000 children through direct clinical services, with many more reached through outreach efforts, community educational programs, and provider training and consultation. Our work is done in partnership with all child-serving systems, including military service branches, faith-based organizations, child welfare, and community mental health agencies. 

In 2008, the National Center for Child Traumatic Stress (NCCTS), the NCTSN coordinating center co-located at Duke University and the University of California Los Angeles (UCLA), embarked on a partnership with the Center for the Study of Traumatic Stress of the Uniformed Services University of the Health Sciences, to expand and enhance the level of support provided to military children and their families. Other major government partners include the VA, the DoD, and the National Guard. Civilian partners include the American Psychological Association, the National Association of Social Workers, and other community health care providers.

Of the more than 100 NCTSN funded and affiliate member sites in 40 states, more than 60% serve military children and families. The NCTSN Military Families Program brings together high-level experts from multiple disciplines (i.e., mental health, military, and public health) to address the challenges facing military children, their families, and the providers who serve them. The NCTSN has modified interventions to meet the unique needs of military families, has conducted outreach to them in a variety of settings, and has produced educational and informational materials designed especially for their needs. Using Web-based, interactive media (e.g., podcasts, speakers series, and teleconferencing), the NCTSN Military Families Program offers more than a dozen educational presentations developed by key experts on psychological trauma and military issues. The NCTSN has developed a useful curriculum for civilian providers, called Essentials for Those Who Care for Military Children and Families, which addresses subjects such as military culture, the impact of combat on families, the needs of children, programs and services for Veterans and National Guard and Reserve members and their families, behavioral health services, frameworks for interventions, and family violence. Further, we created a web-based Master Speaker Series cosponsored by the NCTSN and Zero to Three, which provides an opportunity for leading authorities from the VA, DoD, and university settings to discuss military culture, mental health issues, resilience, and wellness. In fact, tomorrow, the topic of our monthly webinar will be Expanding Services to Veteran Families and includes panelists from the VA and Zero to Three. These resources are available on the NCTSN website.

In addition to providing evidence-based, trauma-informed treatment, the 27 sites of the NCTSN Military Families Program are actively engaged in research, community outreach, and partnerships with state and local agencies that serve Active Duty military, Guard, Reserve, and Veterans. My colleagues at Duke University are implementing a Welcome Back Veterans program, which is an initiative of the McCormick Foundation, Major League Baseball, and the Entertainment Industry Foundation. This national program is intended to develop models for training community clinicians to offer accessible and effective mental health services to military and Veteran families in local communities.

Other colleagues with the Duke Evidence Based Implementation Center have been leading quality improvement collaboratives with VA teams. One of these collaboratives is based at the Durham VA Medical Center with teams focused on improving coordination between mental health services and Veteran-centered care to improve access to services. The other collaborative based out of VISN 6 with Community Based Outpatient Clinic teams focuses on increasing patient access to services and enhancing workflow efficiencies.

Our NCTSN partners at UCLA developed and disseminated a program called Families OverComing Under Stress (FOCUS). The FOCUS program is designed to enhance the inherent resiliency of military families. The program has addressed family adjustment to parental deployment at more than 20 U.S. military installations, including Camp Lejeune, for which I provided consultation to their resiliency trainers on the implementation of FOCUS. The NCTSN has also collaborated with the VA’s National Center for PTSD to train military and civilian providers on acute stress interventions such as Combat Operational Stress First Aid that address principles of safety, connectedness, hope, calming, and self-efficacy. Our NCTSN and VA colleagues have provided trainings specifically to military chaplains as the training has embedded components relevant to the work of clergy working with service members and Veterans.

Further, other NCTSN colleagues at Allegheny General Hospital in Pennsylvania have partnered with the Tragedy Assistance Program for Survivors (TAPS), the National Military Family Association, Zero to Three, the Center for the Study of Traumatic Stress, and the Center for Health and Health Care in Schools to educate professionals about the most appropriate resources for aiding families coping with the death of a loved one in the military. Resources from this program have been widely disseminated and are available on the NCTSN website for faith-based organizations to use or adapt when working with military and Veteran families in the aftermath of loss.

The NCTSN also has a strong program in support of military families through the Ambit Network at the University of Minnesota, which has developed the ADAPT (After Deployment, Adaptive Parenting Tools) program. This groundbreaking initiative specifically meets the needs of Reserve Component service members and their families. The 14-week, web-enhanced group parenting program addresses key challenges faced by deployed parents and their partners, including dealing with the transitions of deployment, responding to emotional challenges of deployment and reintegration, and enjoying children during stressful times. The program is now being tested in a National Institutes of Health-funded randomized controlled trial of 400 families with children ages 4-12.

Finally, Catholic Charities of Hawaii, an NCTSN Community Treatment Services Center, has reached out to military partners at Tripler Army Medical Center and Schofield Barracks to provide training on evidence-based treatments for children experiencing traumatic stress.

In conclusion, we have seen that collaborative efforts between partners such as chaplains and faith-based providers, mental health professionals, physicians, educators, and the military and Veterans community have resulted in a growing evidence base and increasingly high quality services for our military and Veteran families. The American Psychological Association, Duke University Medical Center, and the National Child Traumatic Stress Network all stand ready to continue our collaborative efforts with this Subcommittee, the VA and DoD, our community-based partners, and the military and Veterans community to address these important issues.

Thank you for the opportunity to speak with you today and for your leadership and commitment to our nation’s Veterans and their families.