Wednesday, June 24, 2009

VA domiciliary offers aid to troubled vets

VA domiciliary offers aid to troubled vets

by Janice Gibbs | Medical Writer
Published: June 22, 2009
The struggles of wounded warriors are well documented. There are veterans who carry their injuries on the outside, while others’ injuries are not readily apparent, but equally traumatic.

Many of those who carry their wounds internally turn to drugs and alcohol to quiet their inner turmoil, a way of life hard to sustain.

When the veteran is ready for help there are VA programs in place to assist. The domiciliary at the Olin E. Teague Veterans’ Center has several residential treatment programs to help the veteran who is trying to find his or her footing in a world turned upside down.

“There aren’t a lot of barriers that would exclude veterans from the programs, other than availability,” said Dr. Fred Willoughby, psychologist at the domiciliary. “Most of the programs have waiting lists. We can’t guarantee same-day access.”

Programs at the domiciliary include a Substance Treatment Employment Program that provides assessment and treatment services to veterans with substance abuse problems. The vocational aspect of the program works with the veteran to find employment, housing, transportation and reintegration into the community.

The Rehabilitation and Reintegration Treatment Program focuses on rehabilitation of medical and mental health problems, and reintegration into the community.

The Women’s Trauma Recovery Center provides residential treatment for the effects of military sexual trauma.

Domiciliary residents get into the treatment programs in a number of ways, including VA homeless social workers, the Waco VA psychiatric unit and VA hospitals. The residents come from across the country.

The domiciliary has 400 beds and is the second largest in the country.

The population of the domiciliary depends on the weather and the time of the year - winter being the busiest time, said Richard Tremaine, domiciliary administrator.

“We’ll prioritize those people who are waiting . . . do they have family they can stay with, versus someone who has nowhere to go,” Tremaine said.

Those who do participate in a program have to be mentally and medically stable and be able to take care of their living space, take showers and get to the cafeteria for meals.

The average age of the domiciliary resident is about 50, with the youngest probably 21 and the oldest 85.

The needs of the younger veterans are somewhat different from other residents, because they aren’t all that familiar with the VA, said Bobby Zimmerman, domiciliary administrative officer. Most assimilate well because the support system at the VA - the medical and professional staff and the older veterans - work to make the domiciliary the younger veteran’s home.

“Some, both men and women, are coming directly from a combat zone,” Zimmerman said. “They’re having problems adjusting and their world just spins out of control. They need all the support we can offer.”

Dr. Gerald Darnell, chief of psychology services, agrees younger veterans have different problems and issues.

“They’re at a different stage of life, wanting to return to family and understand what’s going on in their marriage and their relationships with their children,” Darnell said. “What’s great about the VA is that we have programming that meets that spectrum of needs.”

Even though the issues for post traumatic stress disorder are more out in the open, admitting one needs help is difficult, he said. However, since more information is out there, a spouse, girlfriend or boyfriend can more readily identify signs of a problem.

When the veteran leaves the domiciliary, the VA will make arrangements for aftercare, Willoughby said. Those with mental illness can enter the Mental Health Intensive Case Management program and will be introduced to their case manager before leaving the domiciliary.

“The veteran stays at the domiciliary until goals established in the treatment plan are reached . . . it’s individualized to the needs of the veteran,” Darnell said.

There is no magic number for length of stay, Willoughby said.

“If they relapse along the way we don’t kick them out,” he said. “If they develop some other mental health problems along the way that changes the length of stay.”

There are studies indicating veterans who stay four to six months in residential treatment programs are the most successful, with the veteran better able to maintain housing and jobs, Willoughby said. Those who stay less than that timeframe don’t do as well and those who stay longer don’t do significantly better and in some cases do worse.

The domiciliary programs are based on a more integrated model now, he said, addressing problems simultaneously - employment and substance abuse.

The VA offers job training in housekeeping and laundry, nutrition and food. There are outside contracts with Temple’s parks and recreation department.

The Compensated Work Therapy program offers jobs to veterans who mow the yards and maintain the shrubs on VA grounds.

“It gives the veterans work experience to use when they apply for jobs and gives them an advantage if they apply for a job at the VA,” Zimmerman said.

The program benefits the domiciliary resident in a number of ways, including offering work experience and the opportunity to save and learn budgeting skills, Darnell said. It also provides a boost to the resident’s self-esteem.


I don't know when or if the VA has changed their policy towards drug abuse or alcoholism, but unless the veteran has been clean they are not usually allowed into the domicillary. I am given prescription pain killers by the VA and I was denied a bed in the domicillary for the inpatient PTSD program, this was in 2003, I realize things change, but I have never heard of this change until this article, so pretend I am from Missouri and "show me" I know what the VA has been doing when did they change their policy?

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