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Psych Congress  

Residential Treatment for Combat Stress: A Comprehensive Approach

Angela Dinkins Smith, PhD
Marc Cooper, MD
Neil Page, MD
Moncrief Army Community Hospital

PURPOSE: In discussions with patients over a two year period, Moncrief Army Community Hospital (MACH) identified critical shortcomings in programs where Soldiers were receiving intensive psychiatric care. Medical co-morbidities were minimally addressed and Soldiers did not like having to “start over” upon completing intensive treatment. The Combat Stress and Addictions Recovery Program (CSARP) was created to fill these gaps. NATURE OF PROPOSED CHANGE DESCRIBING THE MODEL: Historically, inpatient psychiatric treatment at military treatment facilities has consisted solely of acute crisis stabilization with completely separate inpatient and outpatient treatment teams. The CSARP model incorporates outpatient therapists, who provide ongoing evidenced based treatment while the patient attends CSARP. Patients receive CPT, physical therapy, pain management, financial, spiritual, nutritional and family counseling, and pharmacotherapy. The CSARP model also includes a “work therapy” program to proactively address problems the Soldiers will face upon return to their units. The CSARP model is innovative because it is the Army’s first residential treatment program for post deployment issues incorporating evidence based treatments that patients continue after discharge without having to start over with new providers. Preliminary data on patients admitted since April 2011 demonstrate statistically significant findings on the PCL-M, t (30)=4.43, p=.000, the PTCI, t (26)=2.91, p =.007, and the BDI-II, t(18)=5.18, p =.000, indicating a significant decrease in reported symptoms of PTSD and depression. IMPLICATIONS: The demand for effective treatment of post-deployment stress continues to grow as troops return home. Research studies support the utilization of evidence based, interdisciplinary residential programs. The CSARP model offers a comprehensive approach to PTSD and medical co-morbidities, while maintaining treatment continuity. As CSARP patient outcomes continue to mirror the positive findings cited in previous studies, the program should look to become the AMEDD lead practice for residential treatment of PTSD.

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