Alisha Desai, PhDa; Ryan Holliday, PhDa,b; Matthew Stimmel, PhDc; Lauren M. Borges, PhDa,b Correspondence: Alisha Desai (alisha.desai@va.gov)
aRocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
bUniversity of Colorado Anschutz Medical Campus, AuroracUS Department of Veterans Affairs Veterans Justice Programs, Washington DC
Author disclosures
The authors report no actual or potential conflicts of interest or outside sources of funding with regard to this article.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.
Ethics
This qualitative improvement program was exempt from institutional review board approval.
This educational program aimed to (1) provide psychoeducation on trauma exposure, PTSD, and existing evidence-based treatments; (2) present clinical considerations for justice-involved veterans related to trauma exposure and/or PTSD; and (3) introduce skills to facilitate effective communication and trauma-informed care practices among professionals working with veterans in a treatment court.
Prior to piloting the program, we conducted a needs assessment with VTC professionals and identified relevant theoretical constructs and brief interventions for inclusion in the training. Additionally, given the dearth of prior research on mental health education for VTCs, the team consulted with the developers of PTSD 101, a VHA workshop for veterans’ families that promotes psychoeducation, support, and effective communication.11 Doing so informed approaches to delivering education to nonclinical audiences that interact with veterans with histories of trauma exposure. As this was a program development project, it was determined to be exempt from institutional review board review.
Needs Assessment
In the initial stages of development, local VJO specialists identified regional VTCs and facilitated introductions to these courts. Two of the 3 Rocky Mountain region VTCs that were contacted expressed interest in receiving trauma-informed training. Based on preliminary interest, the facilitators conducted a needs assessment with VJO and VTC staff from these 2 courts to capture requests for specific content and past experiences with other mental health trainings.
Guided by the focus group model, the needs assessments took place during three 1-hour meetings with VJO specialists and a 1-hour meeting with VJO specialists, VTC professionals, and community-based clinical partners.12 Additionally, attending a VTC graduation and court session allowed for observations of court practices and interactions with veterans. A total of 13 professionals (judges, court coordinators, case managers, peer mentors, VJO specialists, and clinicians who specialize in substance use disorder and intimate partner violence) participated in the needs assessments.
The most critical need identified by court professionals was a focus on how to apply knowledge about trauma and PTSD to interactions with justice-involved veterans. This was reportedly absent from prior training sessions the courts had received. Both Rocky Mountain region VTCs expressed a strong interest in and openness to adapting practices based on research and practice recommendations. Additional requests that emerged included a refresher on psychoeducation related to trauma and how to address the personal impact of working with this population (eg, compassion fatigue).
Training Components
Based on the needs identified by VTC professionals and informed by consultation with the developers of PTSD 101,
the training consisted of 3 components: psychoeducation, skills training, and consultation (Table 1).
Psychoeducation. The initial portion of the training consisted of psychoeducation to increase VTC staff familiarity with the distinctions between trauma exposure and a formal diagnosis of PTSD, mechanisms underlying PTSD, and evidence-based treatment. To deepen conceptual understanding of trauma and PTSD beyond an overview of criteria set forth in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), psychoeducation centered on the drivers of avoidance (eg, short-term benefit vs long-term consequences), behaviors that often facilitate avoidance (eg, substance use), functions underlying these behaviors (eg, distress reduction), and structure and mechanisms of change in evidence-based treatments for PTSD, including cognitive processing therapy and prolonged exposure.13,14
