Beneficial PTSD Initiatives and Making Veteran Patients More Aware of Resources

Ryan Rogers, MBA, DHS candidate, director of business management, PTSD Foundation of America, discusses the Foundation and its initiatives, including Camp Hope, how clinicians can help veterans with post traumatic stress disorder (PTSD) become more aware of various resources, and highlights how COVID-19 has impacted care. 

Mr Rogers is currently a doctoral candidate writing his dissertation on suicidality among veterans, military members, and the root causes.

Can you talk about how the life of a veteran compares with the Maslow Hierarchy of Needs pyramid?

I found that the pyramid coupled with the Clayton’s ERG mode really resonated with me because I oftentimes had to try to figure out what is that transition piece and why is that difficult for many veterans. Looking at that chart, along with the Clayton’s ERG model, the military is designed in such a way that it meets at least a minimum of four of the five of the hierarchy of needs.

That is how it is designed from the start, so that you are totally and completely self-reliant upon the military for many things that you do. It is designed that way. After that transition process, there is a possibility of being able to lose all or four of the five of those needs being met.

Can you talk about the PTSD Foundation of American and Camp Hope? What are the benefits and effectiveness of this program?

The PTSD Foundation of America’s niche is helping and healing the unseen wounds of war from combat PTSD. The reality of it is that we don’t stop with PTSD because oftentimes there are underlying conditions or issues that are directly connected or have correlations to PTSD.

We use the biopsychosocial spiritual model. It is a whole-person oriented type program. Let’s look at it from an outside perspective. We have Warrior Groups and Chapters that are located across the United States.

Those areas and chapters deal with the mild-to-moderate severity conditions. The Camp Hope facility, based in Houston, TX, is a residential treatment facility that treats patients with severe conditions.

If something has happened within a combat veteran’s life that has gotten them to the point to where they are utilizing destructive coping mechanisms to get through everyday life, we are going to look at that. We are going to pull it out. Then we are going to really work through the process and work with the families as well.

It is up to a 6-month period or maybe even longer, depending on the severity of the individual. It is unrealistic to expect a Vietnam era veteran who has been utilizing destructive coping mechanisms for 40+ years to face their issues and conditions and recover in a 30-day period.

It is more common that they have become accustomed to utilizing these destructive coping mechanisms for a very long time. Sometimes, it’s going to take longer than 6 months. What we are going to do as an organization is understand that however long it takes to get this individual to the level of functioning that they need to be, that’s how long it will take.

We have had individuals on campus for 13 or 14 months. That’s something that we are okay with because we don’t want them to just be alive. We want them to thrive.

We want them to, once they leave here—with a lot of the stuff that we have trained and taught them—to instill those productive coping mechanisms within them and give them a sense of hope and accomplishment throughout that process.

One of the things that we’re actively developing is how to measure effectiveness. Currently, all we have is the full 6 months at graduation as a level. We took 16 different measurements or conditions. We’re doing self-assessments on every individual that comes into the Camp Hope facility.

They’re self-assessing their level of severity in certain areas such as anxiety, depression, anger, self-worth, shame, guilt, betrayal, sleep, physical health, and suicidality, to name a few. After every 21 days, we take another measurement and say, “Where is this individual at in comparison to where they were 21 days
ago?”

After each 21-day period, we take another measurement to see where they are at. This does a couple of different things. One, it gives us, as an organization, a scale to say, “This individual is doing well. Some of the things that we have been working on with, say, anger or depression has improved under the program.

If they are not improving and we consistently get measurements that are showing we are not measuring reductive symptomology in anger or depression, we are going to reevaluate what we are delivering in the program. Then we will adjust the individual’s program to improve overall symptomology and lower those conditions and severity for that individual.
How has COVID-19 impacted PTSD initiatives? Has it delayed care?

We had put together a pretty extensive business development plan on what we were going to be doing as an organization and branching out, as well as doing a lot of process improvement and movement across the United States for potential expansion.

COVID-19 really derailed that and postponed implementing the plan. Now, on levels of care, it was an interesting experience. While other organizations were closing their doors, we were not. We put safety protocols in place to prevent the spread of COVID-19 on the campus.

We saw a major influx of intakes here at the Camp Hope facility in Houston. On average, we typically see about 10 to 15 intakes per month. In April, we did 32. In May, we did 27. In June, we did 26. We were at capacity and above capacity. Our normal capacity is 82 and we were at 92 in August.

Thankfully, we had an amazing organization called Cotton come out and provide additional housing. They brought two living trailers that gave us 12 more units. With all those influxes of individuals coming and the increase in our highest capacity, we only had two individuals, throughout this whole time, that have tested positive for COVID-19.

I think we have done pretty well regarding prevention while still meeting the community and these veterans’ needs because a lot of other entities were not accepting patients during this time because of COVID-19 restrictions.

Based on your experiences, what can health care professionals do to help their veteran patients with PTSD? How can they help this patient population become more aware of resources like Camp Hope?

I think a lot of it has to do with education and really just searching and seeking out. Then, the other part of it is that understanding the complexity of PTSD and that oftentimes moral injury itself will have a tendency to have an overlap and can sometimes mimic or have very similar symptom manifestations to PTSD.

You could actually have someone who looks like they are experiencing or showing PTSD signs, but they are actually displaying moral injury signs. There is often an overlap between the two.

I like to call PTSD an umbrella diagnosis. That means that in order for you to get a PTSD diagnosis, you have to have, after a trauma, a prolonged experience of negative reactions from that traumatic experience.

Typically, you have to have three of those underlying conditions that are associated with the trauma, like anger, depression, anxiety, to name three. One of the issues with the diagnosis within itself is that, and there is a tendency to happen with a lot of treatment is that, the diagnosis has those three conditions attached to it. Then the only three signs that get the attention are anger, depression, and anxiety because those are presenting as the highest at that specific time or when they were diagnosed.

The problem with that is if you are only focusing on these three pieces, what about your adverse childhood experience, if an individual has that. That may not necessarily be brought up. What about substance abuse? What about all the other pieces? What about family dynamic? 

The complexity within this realm is what makes it challenging. One person can present and have these issues and then another person can present, have basically the same or a similar combat experience or exposure to trauma and react totally and completely different than the other person.

I think one of the issues that the medical field is facing and one they are navigating away from is that there is no magic solution. There’s no catch all. There is no one size fits all. The complexities and the uniqueness of every single individual who has developed PTSD over time, it is just astronomical.

Part of it is looking at them individually and saying, “What are the complexities in which this individual is facing? How can we unpack those or just take you level by level and then look at those and then build positive attributes on top of those instead of the negative ones that they have done themselves?”

Is there anything you’d like to add?

I think the biggest part, as individuals who work in this field, paraprofessionals, clinicians, or whatnot, that we need to look outside the box and think outside the box when it comes to embracing and helping these individuals because the reality of it is that what we are doing is not working.

If you want to say, “Well, we have reduced the number of veteran suicides from 22 a day to 20,” the reality of it is that any suicides is one is too many. We need to come together collectively as a whole and look at this and say, “How can we better meet the needs of these veterans who are struggling, get to the roots of the causes, and then address them?”