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Department of Veterans Affairs Contribution to the Social & Treatment Stigma of Post-traumatic Stress Disorder

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Oral Arguments By Vietnam Veteran on the Organizational Structure and Strength of Department of Veterans Affairs Staff Militancy and Pathological Organizational Survival Strategy To Thwart Combat Veteran Post Traumatic Stress Recovery Research
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  Department of Veterans Affairs Contribution tothe Social & Treatment Stigma of Post-traumaticStress Disorder   FLASHBACKS of Organizational Deficiencies Leading to the Disintegration of Treatment  Routine of Recent Combat and Non Combat Forces: Internal Dynamics of Competition for Treatment in Health Care and Congressional Politics Synopsis: Oral Arguments By Vietnam Veteran on the OrganizationalStructure and Strength of Department of Veterans Affairs Staff Militancy and Pathological Organizational Survival Strategy To ThwartCombat Veteran Post Traumatic Stress Recovery Research Fall 2014  Robert Osenenko, Ed.D., LCSWMedicare Services US57 South Main Street #279 Neptune, New Jersey 07753  Invocation Joseph Campbell wrote in The Masks of God  , Vol. I – Primitive Mythology in 1991 “Whenever men havelooked for something solid on which to found their lives, they have chosen not the facts in which theworld abounds, but the myths of an immemorial imagination.” About The Author  Robert Osenenko lives in the New Jersey Pinelands Reserve area. Robert is a past member of the AmericanFolklore Society. He is considered an expert in social psychology and holds a New Jersey State Board Licensein Clinical Social Work. In 2013 he wrote, Family, Faith, Land and Mysticism an historical fiction account. Heis a recipient of ten military related service awards and trained at the Centers for Disease Control. He is adecorated infantry combat veteran. He went to the State University of New York and Goddard College. Hisdoctorate is in education. Preface to Argument One Visiting the Stockton State College campus in the Fall we ate at a nearby shack that was a former gas station.The owner made a great SOS of creamed beef and grapes were a side order. He stated that he became successful based on an old adage popular in the South, “I’m from Missouri. You gotta show me.” In these pages I hope todo that.The two theories surrounding higher rates of compensation claims for related post-traumatic stress disorder  payment focus on the reasons why non-combat and combat veterans make the claim. Rather than covering thesubject as “Over-reporting bias and the modified Stroop effect in Operation Enduring and Iraqi Freedomveterans with and without PTSD”, (Constans, Joseph I.; Kimbrell, Timothy A.; Nanney, John. T.; Marx, BrianP.; Jegley, Susan; Pyne, Jeffrey M. In Journal of Abnormal Psychology, Vol 123 (1), Feb 2014, 81-90.) I wouldlike to discuss the issue in another context.That is, most academic discussions do not address the role of the government in this process. What I mean isdoes the government encourage the veterans claims process. If we believe it does not, then our conclusiondenies the historical context of the governmental role to gain participation in its programs not only to cure theills of society, but to encourage the utilization of its services. Often, we learn later that the service duplicatesanother, then another well managed program bites the dust, and in place of it the duplication thrives at thefederal level. Is the public served well by a federal duplication of veteran service beyond the short term goal of agency survival?Department of Veterans Affairs (DVA) as it runs into public disrepute is the downfall of the once healthyhuman organization. DVA is a duplication of state and local priorities. To resolve duplication the PresidentRonald Reagan administration instituted Reaganomics. It did so without a strategic safety net and created adevastating gap among combat veteran services in the DVA versus what civilian services were available. Therewas a certain kind of carelessness that Vietnam combat veterans perceived was personally levied against them.Reaganomics was not logical either because at the time DVA hospitals were functioning as leaders in the healthcare field and regarded highly.In one of his famous cliché President Ronald Reagan remarked, “Government is the problem.” He acted and cut back DVA 160,000 staff making no friendships at DVA. Later, President William Jefferson Clinton cut another 160,000 and President Bush and Obama sliced more. Based on this history, we cannot conclude fiscal cuts werealong political party lines. No politician seemed to like DVA. All presidents followed essentially the same callfor corporatizing the DVA. We do not know whether President Reagan regarded knowledge and research,health care and wellness services purely as a private sector endeavor. There was nothing creative about these  cuts and they were brutal bringing credibility to Vietnam combat veterans to call for reform. Sometimes the callwas perceived as militancy.Had anyone in government realized that once you lay off the gatekeepers and kingpins of the internal DVAsystem, it could bust the entire organization at its seams. What becomes of the field offices nearby the leaders of Congress who wish to have more and more constituency services for all former service members and combatveterans to bring in the votes. Internal governance of the DVA did in fact crumble under the pressure of its ownweight corresponding to the well known decay of historic buildings that were ignored and robbed of new mortar and joint compound. It is the pragmatic result of what we did and shared as a nation. In a nutshell, we have theveterans' system we created and need to decide whether this is what we want, or get to be busy and replace thedecay with a well maintained structure. It's worthy of having a conversation about the largest influential healthcare organization serving defense veterans in the world.Most voters realize that the nation as a whole has entered a period in which all values need to be reevaluated. Inhealth care data needs to be examined on what the health care of war is. With the high incidence hearing loss,low incidence post-traumatic stress disorder, and intense physical wounds research can show us a light on whatneeds attention. It may be a justification to reallocate funds from one program to another and as important as theweapons firing protection gear. Before the researcher begins their enthusiasm to make such important findingstheir goal, let’s get into the weeds and part the grass while peaking in on two logical places for that new ageresearch to occur. Most likely researchers are interested doing their research collaboratively with theDepartment of Veterans Affairs (DVA) and the inpatient post-traumatic stress disorder program as well as theoutpatient side embodied in the Readjustment Counseling Service Vet Center Program.When characterizing Vet Centers, they are in non-traditional medical facility office locations. These offices andvisible locations have not removed them from ties to the medical mission of the DVA organization. They havea clinical responsibility to tie themselves into the DVA medical center and make any continuity of care possiblewhile extending it to civilian health care mental health practitioners. Argument One Treatment approaches used in the diagnostic process of post-traumatic stress disorder resulting from combat aredevised outside of organizational models and function by the American Psychiatric Association. All treatmentmodels get defined this way until once tried on the site of the intervention. Then, during this phase, they runtrials and are refined or abandoned. It is no small task to find the correct juncture of the trial, then ultimately puta diagnostic theory into practice. The process could take years, if it involves medication. In the age of fiscalresponsibility these traditional approaches may need to be altered by a preliminary consideration of theorganizational response to new theory and its implementation by outside entities. Spending time toiling on thefront lines at treatment locations, interviewing staff, and gaining some knowledge about how their current processes work, are invaluable for development of appropriate theory and can provide a framework of limitations.An accurate diagnosis of combat post-traumatic stress disorder should include where the patient is treated.During the diagnostic theory phase the military, DVA post-traumatic stress disorder program, and civiliantreating counterparts of combat veterans' data should come together to create a picture of the diagnosis. But as positive as these considerations are, researchers may not always be welcomed in the organizationalenvironment. Barriers to performing preliminary research may include the surreptitious resistance. It may comein the form of rumor which are potentially devastating to the credibility of the data.Taking such consideration to account the following argument is offered. It comes in the form of a nonfiction participant observation of the difficulty one can expect researching and working with the Department of Veterans Affairs (DVA). Organizational history buffs will recognize the various internal changes as theDepartment has altered itself to correspond with changing demands inherent in working with the public. It begins with this opening statement to the audience:I appreciate your time as I seize the opportunity to address the activities of the Department of Veterans Affairs  (DVA) and Vet Center program and the role it plays in providing outreach and mental health care for veteransreturning from combat operations. I ask that you read this narrative on your desk from the point of view as amental health provider. It is my contention that this content may be useful when considering the proposedchanges by the President to meet the mental health need of the combat force, and the needs of those retirees andothers departing the combat force. The key point is to look for the healthiest part of DVA where you mayenvision research can be conducted in all of its phases without disruption and resistance.To the communities and military bases in the Continental United States (CONUS) this return will betransformative for the nation. Twenty combat veterans will die today from suicide. In all probability thisnumber could have been reduced by an effective DVA plan of continuity of care not more DVA Vet Center’s.There must be a deliberate and forceful drive away from the DVA culture and club mentality which preventsDVA and Vet Center operations from becoming as sophisticated and effective as the military. They havemanaged to integrate some medical and psychiatric function into primary care. Civilian mental health care isseeing combat veterans through Medicare. These may be data collection sites less complicated than DVA.Time to time there have been many i DVA Office of The Inspector General reviews about the Vet Center  program. In all  of this critique one theme consistently emerges. The Vet Center program in 1979 is much thesame as it is today in failing to curb the suicide rate. This may be because the DVA location of facilities is not being vetted by the state government establishment.It has been ii questioned, whether relocation of, Vet Center and DVA Community Clinics have been free of  political interference. So it is that on the state level a health care facility must go through consumer scrutiny tolocate in our communities through the “certificate of need process”. The process may be far from perfect, but itrelies on need without particular preference given to a specific politician. Assuming it is by coincidence, aformer Congressional chair of the House Veterans Committee has several DVA facilities in his district. It can beassumed that because these facilities did not pass the process afforded to the state requirement no particular consensus was necessary and no continuity of care strategy planned and written for.To the point, most Vet Centers are still permitted to operate primarily in the proximity of a DVA medical andcommunity based facility. So when the Vet Center program is called outreach  it is a mythical description of itsfunction to further assume it gets outside this geographic bubble. Due to its physical proximity to large DVAmedical centers more accurately Vet Centers are a nearby less threatening office space . Naturally, theseclustering services have contributed in leaving other geographic and service areas neglected. There can be asmany as two Vet Centers and two community clinics, one DVA medical center in close proximity, butorganizationally tied to another DVA medical center sixty miles away. When researching Vet Center data it isimportant to realize that one recorded visit may be almost simultaneously (that day or month) be recorded byanother site at the same city using another diagnosis. On the surface the data may be reported as several visits if it occurred the same day when actually it was one visit to the DVA. All aggregate data from the DVA should bescrutinized and validated as on first appearance, it might seem like there are more patients but are the same patient having more visits. There is a substantial need for community based coordination of health care and clinical services, but theneed may far outweigh the qualification of DVA Vet Center staff. Caution should be exercised whenconsidering staff as ‘experts’. DVA continues to be a self-contained organization much like a fraternity,not an agent accustomed to collaborating with the professional equivalent in their communities except toenhance productivity. The 1979 personnel hiring standard use the job title “Readjustment Counseling Therapist”. The term “Veteransand Health Affairs qualified” (VHA) does not correspond to any state license classification, state licenseacademic preparation, and is a purely mystical array, and jumbled requirement that is impossible to measure. In
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