Evaluation of the Veteran Resilience Project Shon Powell Antioch University Seattle

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Antioch University AURA - Antioch University Repository and Archive Student & Alumni Scholarship, including Dissertations & Theses Dissertations & Theses 2019 Evaluation of the Veteran Resilience Project Shon Powell Antioch University Seattle Follow this and additional works at: https://aura.antioch.edu/etds Part of the Psychology Commons Recommended Citation Powell, Shon, "Evaluation of the Veteran Resilience Project" (2019). Dissertations & Theses. 491. https://aura.antioch.edu/etds/491 This Dissertation is brought to you for free and open access by the Student & Alumni Scholarship, including Dissertations & Theses at AURA - Antioch University Repository and Archive. It has been accepted for inclusion in Dissertations & Theses by an authorized administrator of AURA - Antioch University Repository and Archive. For more information, please contact [email protected], [email protected]. EVALUATION OF THE VETERAN RESILIENCE PROJECT A Dissertation Presented to the faculty of Antioch University Seattle Seattle, WA In Partial Fulfillment of the Requirements of the Degree Doctor of Psychology By Shon Powell May 2019 EVALUATION OF THE VETERAN RESILIENCE PROJECT This dissertation, by Shon Powell, has been approved by the committee members signed below who recommend that it be accepted by the faculty of the Antioch University Seattle at Seattle, WA in partial fulfillment of the requirements for the degree of DOCTOR OF PSYCHOLOGY ii © Copyright by Shon Powell, 2018 All Rights Reserved iii 1 ABSTRACT EVALUATION OF THE VETERAN RESILIENCE PROJECT Shon Powell Antioch University Seattle Seattle, WA Posttraumatic Stress Disorder (PTSD) is a daunting concern among the majority of organizations with diverse, or tangential, affiliations to the United States Military and/or its personnel. Unquestionably, the 21 million service-connected individuals, at the time of this writing, (i.e., Active-Duty, Reserve, National Guard, and Veterans) afflicted with this disorder are the catalyst for the intense public and private sector interest and involvement in eradication of this disorder. Prevalence rates of PTSD among this complex classification of persons vary across the relevant literature. Some estimates suggest anywhere from 11 to 20 percent, while other sources indicate that upwards of 40 percent of some military service-connected populations (i.e., those who served in Operation Enduring Freedom [OEF], Operation Iraqi Freedom [OIF], and Operation New Dawn as well as less publicized military actions which have taken place within the same timeframe) demonstrate PTSD or other related mental health disorders. Given the high PTSD prevalence demonstrated among service-connected populations, effective, practical, and accessible treatment of PTSD among this contingent is a primary and salient area of exploration both clinically and empirically. Relevant to this, the Veteran Resilience Project (VRP) of Minnesota utilizes Eye Movement Desensitization and Reprocessing (EMDR) as an intervention to treat veterans with PTSD. Thus, the organization contracted this program evaluator to undertake a program evaluation of their nonprofit organization. The association utilizes Eye Movement Desensitization and Reprocessing (EMDR) as a therapeutic intervention due to their 2 belief that it is the most efficacious treatment for PTSD. Along with the comprehensive evaluation of their program and the establishment of proof of efficacy for their interventions of choice, EMDR, the VRP seeks to increase their capacity through the recruitment of military service-connected clients and retention of treating therapists. Therefore, the achievement of these objects occurs through an implementation program evaluation dissertation, based on both qualitative (i.e., using survey and interview methodologies) and quantitative data (i.e., analyzing accessible collected data from a sample of service-connected clients who had previously utilized services at the VRP). As a part of the program evaluation, the data were used to inform specific recommendations thus refining ameliorative procedures. This dissertation is available in open access at AURA, http://aura.antioch.edu/ and Ohio Link ETD Center, https://etd.ohiolink.edu/etd. Keywords: PTSD, EMDR, veterans, program evaluation Dedication To my father, who has always put his role of protector above all things. vi Acknowledgments Over the past eight years, I have received support and encouragement from a great number of individuals; however, I would like to acknowledge the following individuals in particular. Katherine Weissbourd, Ph.D., has been a mentor and friend. Her presence has helped to form a thoughtful and rewarding doctoral journey. I would also like to thank my editor. A special thank you to my dissertation committee, comprised of Jude Bergkamp, Psy.D., Bill Heusler, Psy.D., and Joseph Graca, Ph.D. for their support over the past four years as I have moved from a concept to a completed exposition. In addition, I would like to give a naval salute to Mark Russell, Ph.D. (CDR retired) for connecting me with the subject of my dissertation and CDR John Petrescu, my friend who kept me afloat in rough seas. Thank you all for sharing this experience with me and for your understanding. I would also like to acknowledge the involvement of the Veteran Resilience Project in this program evaluation and dissertation. Qualitative and quantitative data were collected on treatment participants from the Veteran Resilience Project in Minnesota. Additionally, partial funding for the program evaluation and dissertation was provided through a research grant via the Veteran Resilience Project. vii Table of Contents Page Dedication………………………………………………………………………………... vi Acknowledgments……………………………………………………………………….. vii List of Tables……………………………………………………………………………... x List of Figures……………………………………………………………………………. xi Executive Summary……………………………………………………………………… 1 Dissertation Overview…………………………………………………………………… 1 Chapter I: Introduction…………………………………………………………………… 4 Diagnostic Classification for Posttraumatic Stress Disorder…………………………. 4 PTSD Among Military Personnel and Veterans……………………………………… 4 Treatment Structure within the Veterans Affairs and Military: Current Systems of Care……………………………………………………………………………............ 12 Recent Delivery Innovations in Expanding Capacity………………………………… 21 Providing Mental Health Services in Primary Care…………………………………… 24 Expanding Access to Community Sources of Care…………………………………… 26 Posttraumatic Stress Disorder Treatment Modalities…………………………………. 27 Eye Movement Desensitization and Reprocessing…………………………………… 30 Clinical Practice Guidelines for EMDR……………………………………………… 39 Obstructions to Treatment within Military and Veteran Populations………………… 48 The PTSD Problem in Minnesota…………………………………………………….. 52 Veteran Resilience Project……………………………………………………………. 54 Program Evaluation…………………………………………………………………… 56 Structure of the Program Evaluation for the VRP……………………………………. 57 Chapter II: Literature Review……………………………………………………………. 58 Literature Review Procedure…………………………………………………………. 60 Program Evaluation Question 1: Approaches to Recruitment………………………… 64 Program Evaluation Question 2: Retention Strategies for Therapists………………… 89 Program Evaluation Question 3: Treatment Efficacy…………………………………. 108 Chapter III: Methodology ………………………………………………………………... 122 Veteran Resilience Project Intervention Methodology………………………………... 123 viii Program Evaluation Data Collection………………………………………………….. 127 Chapter IV: Results………………………………………………………………………. 131 Chapter V: Discussion……………………………………………………………………. 151 Recommendations for the Veteran Resilience Project………………………………… 153 Strengths and Limitations……………………………………………………………... 170 Future Research………………………………………………………………………. 173 Conclusion……………………………………………………………………………. 176 References……………………………………………………………………………....... 177 Appendix A: Supplemental Materials and Footnotes……………………………………. 205 Appendix B: Tables and Figures…………………………………………………………. 214 Appendix C: Measures and Materials……………………………………………………. 227 Appendix D: Supplemental Materials from the Veteran Resilience Project……………... 236 Appendix E: Results……………………………………………………………………… 238 Appendix F: Permissions…………………………………………………………………. 248 ix List of Tables Page B1. Questions for the program evaluation…………………………………………… 215 B2. Diagnostic criteria for PTSD as per the DSM 5………………………………… 220 B3. TRICARE structure and descriptions…………………………………………… 221 B4. Program evaluation types and descriptions……………………………………… 222 B5. CFIR Domains…………………………………………………………………... 223 B6. Factors affecting burnout as per Ozturkcu et. al (2018) ………………………... 224 B7. Evidence-Based Practice Evaluation Criteria as per the APA Presidential Task Force………………………………………………………………....................... 225 B8. Guidelines for Outcome Research………………………………………………. 226 E1. Reasons for seeking treatment…………………………………………………… 239 E2. IES-R Data………………………………………………………………………. 246 E3. PTGI Data……………………………………………………………………….. 247 x EVALUATION OF THE VETERAN RESILIENCE PROJECT List of Figures Page A1. Footnotes for Chapter I in order of appearance………………………………… 206 A2. Footnotes for Chapter II in order of appearance………………………………… 209 A3. Footnotes for Chapter III in order of appearance………………………………… 211 A4. Footnotes for Chapter IV in order of appearance……………………………….. 212 A5. Footnotes for Chapter V in order of appearance………………………………… 213 B1. Logic model of the VRP…………………………………………………………. 216 B2. Master Plan for the VRP, Evaluation Question 1………………………………… 217 B3. Master Plan for the VRP, Evaluation Question 2…………………………………
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