TABLE OF CONTENTS
Needs of the Community
Participants/Population of Interest
Data Collection for Experimental Research
Conflicts of Interest
Benefit vs. Risk
Minority Group Membership and Treatment Distribution
Privacy and Confidentiality
RESULTS & DISCUSSION
Areas for Future Research
Recommendations and Discussions
Communication of Progress
APPENDIX A (Informed Consent Form)
APPENDIX B (Experimental Research Questionnaire)
APPENDIX C (Budget)
APPENDIX D (Event Chronology)
PROJECT OPEN ARMS
The goal of the Project Open Arms program is to address two main problems in the veteran community: unemployment and poor and unaddressed mental health. Site facilitators and volunteers will address this problem through the administration of the program. The implementation of the program will make sure that each participant gets the help that they need and will guide them through the optional experimental research that accompanies membership in the program. The goal of this program is primarily to address the above mentioned goals for all clients that come to the program from the veteran community. With the resources (both human and non-human) at the disposal of the program’s administration, mental health and unemployment issues will be issues that will be less of a plague to the veteran community.
Project Open Arms: How Mental Disorders and Unemployment affect Veterans (Program Development Initiative)
The chosen ARP is a program development for reintegrating war veterans back into society called Project Open Arms. The program was designed to benefit former war veterans returning from combat trying to cope with the civilian world again. The author also designed this program to benefit National Guardsmen who have returned from combat and will be reentering the civilian world most likely without jobs. This program will render job assistance, counseling services, etc. to the chosen audience.
The author became interested in this program when seeing several instances when members of the chosen audience would either return home to the civilian world jobless and helpless and after researching and finding that a lot of post combat veterans suffer from posttraumatic stress disorder (PTSD) and go untreated. These particular people are likely to commit acts of criminal nature and this program will be designed to deter this behavior through counseling and multiple other types of intervention.
This program is being proposed because there are issues that exist concerning America’s troops with regard to them becoming civilians again or battling post-traumatic stress disorder. The program will address several issues however the two main ones are PTSD and employment. The first reason the author decided to propose this program is because of employment. Many of the returning combat veterans, more specifically National Guardsmen, return home from war and have no idea how they will support their families or where to begin looking for help getting to work. Many employers will not hire National Guardsmen because they may get called to duty any time and the position they are filling will end up vacant if this is the case. This program is in place to specifically help these veterans find work tailored to their needs and to advocate on the soldier’s behalf in finding these jobs.
Another reason this program was developed was to offer counseling to combat veterans (regardless of branch of service) as long as they have had been overseas within the last 8 years. Research (outlined later in the report) dictates that soldiers that go untreated for PTSD are likely to commit acts of a criminal nature versus soldiers who are currently undergoing treatment for the disorder or one who has never been exposed to the disorder. This program will offer counseling on many different spectrums to treat soldiers who suffer from PTSD in order to deter them from not only criminal activity but from depression, suicide, and other situations that could surface as a result of untreated PTSD.
As mentioned earlier, soldiers who suffer from PTSD often commit acts of criminal nature. According to Elbogen (2012), a research survey conducted by the U.S. Department of Veterans Affair’s Environmental Epidemiological Service revealed that “ Factors associated with arrests in the final model included younger age, male gender, history of arrests, witnessing family violence, substance misuse, and PTSD with high anger/irritability; TBI with increased irritability approached, but did not achieve, statistical significance in this multivariate model. Combat exposure was significantly associated with arrest in bivariate analyses but failed to achieve significance in the multivariate protocol; post hoc analyses indicated the link between combat exposure and arrest was mediated by PTSD with high irritability. ” (p. 1099).
In other words, former combat veterans suffering from PTSD have a higher risk of committing acts of a criminal nature.
There are two problems this program aims to fix. The first problem is that these soldiers feel that they may be alone and there isn’t enough help available to them. A lot of the time, they do not know where to turn. Many soldiers to not even recognize they have a problem which is why PTSD often will go untreated. The program will specialize in counseling those who suffer from this disorder and work to provide awareness for the disorder to that more people get the help they need.
Another problem that exists that the program aims to address is the shortage of employment among National Guardsmen that are returning home from combat. This has been a problem for years even more so now that the economy isn’t as good as it used to be. As explained earlier, National Guardsmen who go overseas often come back with no job and little or no resources to turn to for help. This program aims to change that for these servicemen.
One of the initial approaches to the problems identified in this ARP is the use of traditional methods of treating mental disorders such as cognitive behavioral therapy, psychiatric drug, etc. Another approach is the use of more innovative treatments to treat mental disorders. Providing veterans with employment advocacy is a third approach for the problems stated in the problem statement of this ARP. All three of these solutions will be collectively used as the selected solution for the problems stated in the ARP.
There are some serious issues to address with post-war veterans. Two of these issues are the development of mental disorders from exposure to combat and the threat of possibly not having employment upon returning from active duty. One objective will be the treatment of mental disorders in post-war veterans. There is an issue with there not being enough treatment or reliable treatment available to veterans who experience post-traumatic stress disorder.
Another objective in the prevailing issue of post-war veterans with mental disorders is traumatic brain injury. There has been an increase in traumatic brain injuries in post-war veterans. According to Davis (2013), post-traumatic stress disorder and traumatic brain injuries are commonly encountered by clinicians treating veterans of war in both mental health and general health settings. Amongst the array of different types of mental disorders post-war veterans can suffer from, Schizophrenia is one of them. Schizophrenia can be the most serious of mental disorders to occur in post war veterans as it can sometimes be difficult to treat this disorder.
The second main issue with post war veterans is employment after active duty. Some veterans are all active duty military and therefore have nothing to worry about when they come from overseas; they go back to their post and resume their jobs as normal. Then there are the reservists and national guardsmen. When they are overseas they make active duty pay, however, when they come back, they don’t have posts to go to resume work. Some have jobs to go back to when they come back and some do not. Some reservists and national guardsmen can’t even find jobs, because some employers are afraid to hire such citizens because of the threat of them one day being called to go overseas. According to Dreisbach and Martin (2012), National Guard and Reserve components of the U.S. Armed Forces often face a unique challenge when it comes to finding employment because the model is predicated on their ability to move in and out of an employment situation as they're activated and deactivated.
There does not seem to be enough good quality programs to assist these veterans. Aside from the economic reasons this is a point of concern, is the crime rating. According to Phillips (2012), aggregate unemployment often has a negative effect on crime and most common in capitalist societies but generally anyway geographically. The research that will be reviewed here will support a plan that will offer mitigations for the two above mentioned main issues.
The program and research is related to the field of forensic psychology in a number of different ways. One of the ways is to decrease the amount of unemployed post war veterans. As the upcoming research will allude to, crime rate goes up when unemployment percentages go up. Another way this program could be of good to the forensic psychology community is that the program can offer involuntary counseling services as deemed necessary by law for the patient.
Every good research defense needs a hypothesis. The hypothesis for the defense of this program is stated as follows: Will veterans that receive the treatment they need for mental disorders they may be experiencing and the employment assistance (also if needed) commit less antisocial acts (such as crime, etc.)? As far as the research being gathered, there is research that has been gathered for this program thus far that dates back to 1998. In the beginning stages of research gathering for the defense of this program, there were foreseeable gaps in research. As of now, there are no known gaps in the research that has been gathered for the defense of this program.
Veterans have to experience a lot of things while at war. One of the things veterans have to go through or experience is the mind-gripping effect being away from their loved ones for an extended period of time. This can include family, friends, co-workers (if applies), etc. Veterans experience a lot of stress by not having familiar surroundings when they are abroad for long.
These veterans often experience the vision of having their fellow soldiers blown up right before their eyes. Others things veterans report experiencing is the sign of bloody corpses around the battlefield, hearing bombs go off with resounding noises that can remain with them in their minds long after they return from war. Veterans fighting in some countries are additionally exposed to chemical warfare, nuclear warfare, and other types of advanced weaponry and/or weapons of mass destruction. Last but certainly not least of the things veterans experience while overseas is that some of the veterans report that they have been held prisoners of war or POW.
In addition to the veterans, families also feel the soreness of having a loved one overseas for a long period of time. The number one thing families of veterans have to worry about is what could possibly happen to their loved ones while they are overseas. Families and loved ones often worry about, more commonly, if their loved one will return home and are around for their family’s growth and development.
Some times when veterans come back from war will they have physical limitations? If so, these limitations can make it hard for the affected veteran to work and support his/her family upon returning home. There are limitations besides physical ones. A veteran, upon returning home, could fall victim to a mental or psychological limitation.
When it comes to reintegrating post-war veterans back into society, one must think about the things that could possibly make it difficult to reintegrate them. Placing post-war veterans back into civilian society from the battlefield can be tough. Some of the veterans are often diagnosed with mental disorders or have these disorders and do not get proper treatment upon returning from war. The fact that some veterans go untreated can lead to them performing acts of criminal activity that are often seen as socially abnormal.
Some veterans take in and harbor many elements of war. One of the elements of war, in relation to reintegrating war veterans, is watching a fellow soldier get injured or getting killed.
This particular element of war can lead to psychiatric disorders. Another element associated with war and being overseas is that of possibly unemployment upon returning home. This is particular of national guardsmen and reserves; they often have issues with employment upon returning home from active duty. Criminal justice involvement is one of the most significant problems for war veterans, especially Iraq and Afghanistan war veterans. Many veterans have returned home diagnosed with post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) which have been linked to aggression or violence among the veteran population (Elbogen, 2012).
According to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision or DSM-IV-TR (2000), Post-Traumatic Stress Disorder or PTSD is an anxiety disorder in which the essential characteristic is the development of symptoms following exposure to an extreme traumatic stressor; these stressors can include sexual trauma, threatened death, death of a loved one, and even war or combat. Any citizen can get post-traumatic stress disorder any age and any time in life. According to the National Institute of Mental Health (2010), anyone can get post-traumatic stress disorder (PTSD) at any age. People who typically get PTSD include: war veterans, survivors of physical and sexual assault, accidents, disasters, and several other serious events.
Veterans living with PTSD are living with an anxiety disorder, which means that they generally will elect not to be around someone or something that reminds them of the trauma in which is responsible for their horrible condition. People with PTSD and other anxiety disorders often plan every aspect of their day differently from someone who wasn’t affected by these disorders. Veterans with PTSD also may have difficulties with their families and/or relationships. According to the U.S. Department of Veterans Affairs (2014), the symptoms of PTSD can cause problems with closeness, trust, communication and problem solving skills. These problems could also have an effect on the way the affected person acts with other people. In turn, the way a loved one would respond the affected person can affect them. Often times, a circular pattern can develop that has the potential to harm relationships.
Veterans that may be living with PTSD, along with treatment can create and maintain good and prosperous relationships. One of the ways a veteran with PTSD can work on relationships with others is by building a personal support network to help cope with the disorder while working on family and friend relationships. Another way is by sharing feelings honestly and openly using respect and compassion. Finally, a veteran affected by PTSD can work on building skills in problem solving and connecting with others (U.S. Department of Veterans Affairs, 2014).
The research collected for the defense of this program will include traditional as well as innovative ways to treat PTSD. The main treatments for PTSD are psychotherapy and medications such as antidepressants. Better known as ‘talk therapy’, psychotherapy is one of the main ways to treat PTSD. Antidepressants are also another well-known way used to treat PTSD. Among the medications used are sertraline (Zoloft) and paroxetine (Paxil). Other methods of medicating for this disorder include the use of benzodiazepines and antipsychotics. Each person’s situation is different; therefore the same method will not always be used to treat all cases (National Institute of Mental Health, 2010).
There are also newer and more innovative ways to treat PTSD and other disorders like it. The use of innovative treatments is growing simply because psychologists, as well as their patients, are always on the hunt for methods that will better and perhaps less expensive for some methods. One of the new and innovative treatments for PTSD is the use of virtual reality treatment or VRT. VRT, according to McLay (2013): “ is similar to a video game, allowing the patient to feel as if they are in the traumatic scenario. Just as a pilot in a flight simulator might use virtual reality to learn how to safely land a plane without the risk of crashing, a patient with PTSD can learn how to confront painful reminders of trauma without facing any real danger. ” (Introduction, para. 3).
The technology levels for VRT programs varies a lot. The quality of these programs can vary from the best built programs with high end special effects down to a simple, standard headset with animated images. According to Cardenas-Lopez (2011), due to this socially relevant problem, and based on the efficacy treatments, it is important to design treatments involving the use of virtual reality, because it can help overcome some of the limitations of traditional therapy using exposure.
Although not listed in the DSM-IV-TR as a mental disorder, Traumatic Brain Injury or TBI can leave lasting effects and mental disease on those who sustain it. The brain is a very fragile and vulnerable body organ that can be damaged in a number of ways. One of the ways one can sustain TBI is by having an object penetrate the brain and cause almost irreparable damage to certain areas of the brain. TBI can result from sports injuries, automobile accident, intentional or accidental blow to the head, and TBI can even be caused by injuries sustained on the battlefield. Regardless of how one sustains TBI, is a brain injury s sustained, one should seek medical attention right away. Very little can be done to reverse the effects of TBI, however; getting prompt and effective medical treatment, this can prevent the injuries from becoming life- threatening.
There is a broad array of drugs and treatments that can be used to treat TBI. Among the available treatments, medications like diuretics and anti-seizure drugs may be used by a doctor to help treat TBI. Depending on the severity and while under the appropriate care, doctors may propose the use of coma-inducing drugs to treat severe cases of TBI where blood vessels have collapsed and cannot deliver the required amount of oxygen to the brain. Fractures of the skull, blood clots and immense pressure can result from TBI, thus surgery may be proposed in order to alleviate these somatic symptoms resulting from TBI. In many severe cases of TBI, rehabilitation may be required in effort to closely achieve the best brain functioning possibly. According to the Centers for Disease Control and Prevention (2013):
“ Every year, at least 1.7 million TBI related injuries occur and research also shows that TBI contributes to about 30.5% of all injury related deaths in the United States. Clinicians play a key role in the identification, diagnosis and management of TBI. Early management, appropriate referral and rehabilitation can improve patient outcomes. ” (Traumatic brain injury, para. 1).
TBI rehabilitation includes a psychiatrist (who oversees the rehabilitation), a speech therapy, occupational therapy, and recreational therapy.
As previously stated, another main mental disorder that can affect post-war veterans is Schizophrenia. In most people, this is a mental disorder that can have catastrophic side effects. According to the DSM-IV-TR (2000), Schizophrenia is a mental disorder involving a range of cognitive and emotional abnormalities including abnormalities in perception, thought, communication, language, behavior, affect, etc.
According to the National Institute of Mental Health (2010), Schizophrenia affects men and women alike and some of the major symptoms of Schizophrenia (i.e. hallucinations and delusions) tend to develop between the ages of 16 and 30 but not after age 45. People can also develop Schizophrenia after traumatic events such as sexual abuse and after being exposed to combat. The research collected for the defense of this program will include traditional as well as innovative ways to treat symptoms. Some of the main treatments available to post-war veterans for the treatment of Schizophrenia are cognitive behavioral therapy (CBT), psychosocial treatment, and the use of antipsychotic medications such as Thorazine. In addition to conventional methods, there are some must more innovative ways being created in order to treat the disorder. According to Garrido (2013), cognitive remediation therapy is emerging as a psychological intervention that targets cognitive impairment, however; a newer, more innovative treatment is available to manage Schizophrenia, and it is known as computer-assisted cognitive remediation.
Cognitive remediation therapy or CRT is not a new therapy, however; it is a new way to treat Schizophrenia. The primary aim of CRT is to reduce cognitive defects in patients for which the treatment is used on. According to Favrod (2014):
“ When considering remediation tools that are currently in practice, one could compare it to brain training. However, in contrast to cognitive remediation, brain training is aimed at healthy subjects wishing to prevent aging-related cognitive deficits before they occur. Brain training programs (in addition to possible medical indications) employ evidence-based techniques to prevent cognitive aging. ” (Definition of cognitive remediation/cognitive rehabilitation, para. 1).
People with Schizophrenia can lead very difficult lives to say the very least. Their lives can be very socially isolated, upon development; occupational growth can be stunted, it can be hard for them to become productive members of society and most schizophrenics never get married or have meaningful relationships. People with this disorder can have a hard time but there are things that can be done (along with getting the necessary treatment) to make things easier for the ones who have to live with this disorder. According to McGrath (2012):
“ People suffering from schizophrenia struggle to set goals for themselves, therefore; other people can help guide them through it. By setting small, reachable goals, loved ones can help their affected family member slowly and steadily grow more independent. For friends and family of schizophrenia patients, responding to the delusions and hallucinations schizophrenics can have can prove to be difficult at times. For this situation, it is recommended to not try to dispute nor play along with the schizophrenic's false notions. Instead, be nice and tell them that people are entitled to their own opinions, but that you disagree. ” (Living with schizophrenia, para. 2).
In addition to gathering research, facts and statistics to defend the medical standpoint of the program, research has been collected for the unemployment standpoint. According to research, the relationship between the state of the economy and crime has a long history in criminology research dating as far back as the mid-1930s to mid-1940s. There are two independent and counteracting effects from unemployment that affect crime: motivation and guardianship (Andersen, 2012). There are three types of crimes that are often associated with unemployed veterans: violent crime, property crime, and nuisance crime.
Generally when post-war veterans come home from the combat zone, especially if they are guardsmen or reservists, it is not uncommon for them to be a little confused about how they are going to support their families (as some of them may not have jobs when they return).