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One such program, called the Veterans Transition program (VTP), is a group-based program designed to assist the transition of
military personnel back into civilian life. It is a Canadian residential group-based program that helps veterans with their personal and
career readjustment. Exposure therapy, trauma focused group therapy, social skills training, family involvement, peer counseling are
components of VTP. The programs main goals are
(a) creating a safe, cohesive environment where soldiers can experience mutual support, understanding from others who have been
there and process their reactions (b) normalizing of the soldiers military experiences overseas and the difficulties with re-entry back to
civilian life (c) offering critical knowledge to understand trauma and its origins, symptoms, impact on self and others along with
provision of specific relational and self-regulation strategies for trauma symptom management (d) reducing the symptoms of the stressrelated issues arising from their military experiences; (e) teaching of interpersonal communication skills to help manage difficult
interactions or enhance relationships with others (e.g., spouses, friends, co workers)(f) generating life goals and learning how to initiate
career exploration; and (g) involving spouses and other family members in family awareness sessions (Westwood, McLean, Cave,
Borgen, & Slakov, 2010, p. 47-48).
There would be a para-professional soldier that has previously participated in the VTP and have received additional training; they assist
by modeling caring and supportive behavior and by engaging in the expected behavioral outcomes of the program.
There are 21 steps in the VTP program that are broken into 5-stage model. The first stage is assessment and preparation which
focuses on establishing a solid working group, which is prepared by the professionals. The second stage is called group building. The
counselors assist veterans to address symptoms and begin the work of trauma repair. The veterans share life-narratives through a groupbased life review process. Enactment is the third stage and the activity for the veterans is to enact specific trauma narratives. Through
the enactment process group members are able to learn about their triggers, stressors, and patterns of activation, relapse and regression.
The fourth stage is called Sharing, Reconnection, Closure; it integrates what the veterans have learned and create new clear and
achievable goals. The final stage, Integration and Transfer, helps veterans reconnect with their community (family, friends etc.). Followups by the clinicians are done after six months of the program. Then a year later after the six-month follows up.
Method
The proposed program is designed to integrate both therapeutic aspects as well as vocational rehabilitation. The program is
preventative in nature. The goal is to minimize PTSD symptoms, while incorporating vocational rehabilitation. This two-pronged
approach can help reduce hospitalizations and co-occurring conditions (such as depression and substance abuse). Furthermore, it can
increase job retention. Therefore, the program is designed to be cost and time effective.
Participants
The program would be in the United States and focused in New York State. New York state has a high density of veterans,
between 650,001- 950,000 (Veteran Affairs, 2014). There will be a total of 20 veterans, consisting of both men and women. The veterans
must meet certain criteria in order to participate. Each veteran must be referred to the program by the Bronx VA Medical Center and,
therefore, have a documented diagnosis of PTSD. The veteran must have been discharged in the past 10 years. The discharge time frame
was decided based on a study that compared therapy dropout rates of OIF/OEF veterans and Vietnam veterans. The results showed that
OIF/OEF veterans were attending sessions significantly less than Vietnam veterans. Furthermore, dropout rates all together were higher
than Vietnam veterans (Erbes, Curry, & Leskela, 2009). These results show that it is important to focus on more recently discharged
veterans. Veterans cannot be homeless and must show proof of suitable housing. Lastly, veterans must start the program from the
beginning; no participants will be allowed to begin after the first session.
Program Specifications
The VTP will be 3 hours long every Saturday for 16 weeks from 12 to 3pm. It will be held at the Bronx VA Medical Center in
New York. Two facilitators, one with military background and one mental health counselor, will run the sessions. The program will
follow the stages of Westwood et al, group-based approach.
Throughout the 16 weeks, VTP will focus on minimizing PTSD symptoms using exposure therapy with the group-based approach
of Westwood et al. Creating a support system for the veterans is needed in order to have a successful transition to civilian life.
Additionally, a vocational component to the program is added in order to help veterans understand and effectively navigate the current
job market.The vocational component will include translating military skill sets to a civilian job, resume building and interview skills.
The counselor with the military background will lead the vocational component.The last part of the vocational component will be career
assessing.This involves asking the veterans what career interests they have and assigning the veterans to research the requirements of the
career(s).
In order to evaluate the veterans, the PTSD CheckList Civilian Version (PCL-C) will be handed out at Assessment and
Preparation stage of the program and also at the conclusion of the program. Doing a pretest and posttest evaluation like the PCL-C is a
requirement of the VA hospital in order to see if PTSD symptoms were minimized. Furthermore, a follow up will be conducted 6 months
and 12 months after the program. This is to assess the long-term effectiveness of the interventions. The follow up will be a phone
conversation with the veteran, where the counselor will note how the veteran has been managing his/her PTSD symptoms. Job
placement, retention, housing and no recurring hospitalization will be indicators of progress.
Limitations
This program aims to alleviate veteran PTSD symptoms, while helping them transition into civilian life by finding a job. This
complicated process has various limitations. Insurance may not cover the program, so funding will be essential. The program is based on
individual studies done on therapy and vocational rehabilitation separately. No research has been done on the combination of the two
with the use of group counseling as the main form of therapy. Therefore, there are no previous trials the program can build on and
prevent mistakes. Since veterans must be referred to us by the VA hospital, the program excludes all those who do not have access to
health care. The veterans participating in the program will come from the same referral source. They might know each other and already
have relationships in place. This can be a hindrance to group therapy and progress. Follow up might be difficult because the counselors
might not be able to get in touch with the veterans (who might have moved or changed their contact information). In addition, counselors
will be assessing progress solely on the testimony of the veterans. This testimony is very important, but can also be misleading since the
veteran might not divulge accurate information.
Funding
For a pilot program of this type, funding is inherent due to the likely possibility that health care will not cover the 16 sessions
for the veterans. The websites used to find funding were Grants.gov, foundationcenter.org/newyork and google.com searches for grants.
The Department of Labor (DOL) provided grants under programs like Veterans Workforce Investment Program and Stand Down.
JPMorgan Chase also offer grants through programs called Veterans for Hire and Wounded Warriors. The Veterans Affairs website lists
grants as well. Fundraising and donations will be included in the process.
Prolonged Exposure Therapy - PTSD: National Center for PTSD. (2014, January 1). Retrieved
http://www.ptsd.va.gov/public/treatment/therapymed/
prolonged-exposure-therapy.asp
Strachan, M., Gros, D. F., Ruggiero, K. J., Lejuez, C. W., & Acierno, R. (2012). An Integrated Approach to Delivering
Exposure-Based Treatment for Symptoms of PTSD and
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569. doi:10.1016/j.beth.2011.03.003
Westwood, M. J., McLean, H., Cave, D., Borgen, W., & Slakov, P. (2010). Coming Home: A Group-Based Approach for
Assisting Military Veterans in Transition. The Journal for Specialists in Group Work.
doi:10.1080/01933920903466059