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Creating individualized treatment plans for veterans is crucial as they may be experiencing symptoms from PTSD, TBI or other concussive injuries as well as moral injury. Often, soldiers enter a war in their late teens or early 20s when their brain has not yet reached full maturation. Providers must consider all of a veteran’s physical and psychological factors when tailoring treatment strategies.
If I could tell civilian providers working with veterans and service members with PTSD and other mental health challenges one thing, it would be that this population includes some of the most resilient people on the planet. I think we do a disservice to them by fragilizing them, treating them as if going through these intense therapies—cognitive behavioral therapy, prolonged exposure therapy, and discussions around moral injury and military sexual trauma among others—will break them. On the contrary, during Road Home's two-week intensive program, I have seen undue strength and resiliency demonstrated, which often lead to significant healing.
For many veterans and service members returning from deployment, not having their "team," their battle buddies around is very difficult. Everything seems to be about the individual. Capitalizing on this team unity mentality, providers at the Road Home Program understand that more healing will happen when people are working on individualized therapies as well as group therapies and activities. Once again, they have each other's backs.
A two-week program for veterans and services members who have PTSD and other mental health issues, Rush Medical Center's Road Home is intense, fast, and efficient. Through evidence-based studies and experience, providers have found that this two-week intensive is far more effective than traditional therapy to help with symptom remission and increases in resilience.
Treating service members and veterans with TBI and PTSD often includes complex and unique interventions and treatments. Based on their evidence-based guidelines and experiences working with thousands of people in their two-week immersive program, Home Base also focuses intentionally and systematically on assessing what the population needs once they leave the program and return to their communities. The more Home Base can help connect their participants with clusters of experts in their areas, the more long-term healing will occur.
The biggest and most nefarious misconception about TBI is that it doesn’t get better. That is simply not true. The vast majority of people with TBI do well over time and can be effectively treated to live functional and fulfilling lives. However, that does not counter the risk of behavioral, medical, and cognitive problems in the long term. With more research and experience, experts in the field are focusing on learning more to mitigate risk and improve the outcome of those with TBI in both the short and long term.
Does success translate into riding a horse again, returning to your pre-military job as an accountant, or coaching your kid’s Little League team? Staff at the Home Base Program understand that what success looks like for one military member with TBI and/or PTSD may look 180-degrees different from that of another. Using evidence-based guidelines to drive their therapeutic regimens as well as applying lessons learned from helping thousands of people in the program, Home Base providers are not only fine-tuning what they do each day but also learning and creating the next generation of effective therapies.
Staff at Home Base are awed—daily, hourly—by the resilience, determination, and dedication of the veterans and service members with whom they work during the two-week immersion program. Dr. Zafonte recalls one Special Forces member who was injured multiple times but whose focus, invariably and unblinkingly, was to restore himself so as to return to theater to continue to serve. Military members like this man exemplify a dedication to protect our country; something all of us should take time to better understand and appreciate.
Home Base’s two weeks of assessments and individualized therapies focused on treating veterans and services members with TBI and PTSD seems to be the “sweet spot” of time for this kind of immersive program. Staff in the program have seen lives changed, lives saved. They understand that the veteran experience is a unique one, hard for civilians to fully comprehend. Providing these men and women with the tailored interventions and therapies they need to enhance function in their day-to-day life is often as important as the bonding aspect of being with others who have had and continue to have similar experiences, challenges, and forward steps.
One of the most powerful aspects of the Home Base Program is the way it helps veterans and service members come together again with those who may have had similar experiences in combat and now back at home with issues around TBI and PTSD. Along with the comprehensive individualized treatment plans for each person, the program includes group therapies and events, which play a large role in the healing process.
The Home Base program, which includes comprehensive assessments and a two-week immersion into therapies and treatments for TBI, PTSD, and other conditions, is created anew for each veteran or service member who joins. Whether engaging in physical or cognitive therapeutic interventions, learning how better to communicate with family and friends, or delving into art therapies, each individual becomes part of a strong and supportive community of people who understand their experiences, though everyone’s experiences and issues are unique and treated as such.
Home Base, a free Red Sox Foundation and Mass General Hospital program, started small, but then and now—as it has grown to help 1,000s of veterans and service members nationwide—it remains a passion for many. The program focuses on treating the invisible wounds of war like TBI and PTSD. With evidence-based treatments in all domains like behavioral therapy, physical therapy, health and wellness, and medications, providers help these warriors with issues that run the gamut from sleep apnea and cognitive function to depression and physical pain.
The jury is still out on the exact ways that repeated blast injuries affect the brain. Some believe that the blast waves travel through the organs, producing a change in the gray-white matter of the brain. Others believe that blast-related injuries produce a unique pathology while others still think that the pathological signals from these injuries result in behavioral disturbance. But all researchers seem to agree that repeated blast-related injuries affect a person’s brain in the short-term as well as in the long-term with the risk of neurodegenerative disease.
For many service members and veterans, traumatic brain injury and PTSD often go hand in hand, with some of the symptoms of these conditions being co-morbid. By using evidence-based treatments, providers work with their patients with the goal of getting them as symptomless as possible.
A family member or support person at home plays a key role as part of the treatment plan for a service member or veteran. An adjunct in their loved one’s care, the family member collaborates with the team of providers to help their loved one follow through with appointments, medications, and health regimens. They often serve as the more impartial eyes and ears to their loved one’s challenges and improvements.
Changes don’t happen 0-60 mph, rather they occur incrementally. Providers know that barriers can impede improvement to healing, but by setting a series of step-by-step goals—whether treatments for better sleep, pain relief, or relationship strategies— service members and veterans can see improvements to their physical, behavioral, and emotional issues and build on them from there.
Two-week intensive outpatient programs that implement a comprehensive, holistic approach to treatment, The Road Home Program includes two treatment arms for veterans and their families—one for veterans who experience battlefield PTSD, the other for survivors of military sexual trauma. Their data reveal high success rates during the program and in the long-term, post-program.
After intensive treatment programs like Home Base, often veterans and service members need to rely on their local providers who have not been specifically trained to work with people who have military-related TBI and/or PTSD. But there are lots of resources out there, like Home Base, that can help civilian providers learn more to successfully understand and help this large, unique population in their cities and towns.
Originally, the Home Base program focused primarily on the brain injury, itself, of service members and veterans. With time, experience, and research, the program now approaches treating brain injury from a holistic method as other issues affect brain health—neurological, cognitive, and psychological functions—like sleep deprivation, chronic pain, or co-occurring substance abuse. Treating the whole person with an individually tailored plan has provided far better outcome.
Often feelings of lost connection with family members—whether with a spouse, children, parents, or siblings—is what finally catalyzes a veteran or service member to seek treatment for TBI and/or PTSD. For example, a Special Ops veteran who had deployed 10 times during a 35-year military career finally sought treatment through the Home Base program because his child told his wife that he was afraid of him. He did not want the effects of TBI and/or PTSD to create irreparable damage to his whole, multigenerational family.
There are several misconceptions around brain injury and it is important to dispel them. One is that someone with a TBI cannot get better. Not true; in fact, many, many people with TBI who are engaged in treatment get better and return to full lives. The second issue is the wishful thinking that there is one pill or technology that can cure a TBI. Not true; rather engaging in a series of evidence-based treatments and sticking to one’s treatment regimen is what helps people heal.
Home Base has been offering outpatient programs for 10 years and intensive programs for the last five, during which time they have learned two main lessons. The first is the importance of designing individual treatment plans for each person based on their biomarkers of injury, symptoms, and needs. Secondly, they learned the importance of follow through post-program—whether helping a service member or veteran learn the tools for self-management when ready or educating local practitioners to better help the military population with TBI and/or PTSD.
Researchers and doctors are learning more about how blast injuries, especially if repetitive and sustained close together, can affect the brain far more significantly than a singular blow to the head as from football, boxing, or a car crash. When treating veterans and service members, clinicians in the Home Base program start by taking an in-depth TBI history starting from childhood to the present. The more they understand the mechanism, frequency, and interval between any sustained injuries, the more pointed their treatment can be.
Oftentimes, a family member is the first to recognize symptoms of TBI and/or PTSD in their loved one who has returned from military service. At the Home Base program, veterans and service members are accompanied by a family member for part of the two-week intensive so upon returning home, the family knows better how to help their loved one understand their symptoms and aid with and ongoing treatments, interventions, medications, and general support.