Readjustment Counseling Services Physically Disabled Veterans Working Group
By Alfonso Batres, Ph.D.
NCP Clinical Quarterly 2(2): Spring, 1992
The core mission of the Department of Veterans Affairs is to heal the physical trauma warriors' incur in combat, and to heal the psychological trauma that follows them and their families after combat. Services to physically disabled veterans with PTSD represents the core of the Deparmtment of Veterans Affairs mission in the treatment of combat related readjustment problems.
To address readjustment needs, and enhance services to disabled Vietnam veterans, a Working Group on Physically Disabled Veterans was formed in 1984 by Readjustment Counseling Service (RCS). The Working Group, currently chaired by Ray Pearson, is composed of RCS personnel who are physically disabled combat veterans that have extensive experience counseling physically disabled Vietnam veterans.
The co-occurance of service-connected physical disability (SCPD) and PTSD is not uncommon. The National Vietnam Veterans Readjustment Study (NVVRS, 1988) reported that 346,000 (11%) of Vietnam theater veterans have a current SCPD. Among it's findings, the study reported that SCPD veterans were significantly more likely to have current PTSD than Vietnam veterans without a SCPD. Specifically, more than 74,000 SCPD veterans have current PTSD.
Other NVVRS findings indicated that SCPD veterans are likely to have a history of generalized anxiety disorder, symptoms of non-specific psychological distress, and are likely to be generally dissatisfied with current life circumstances. However, the study found that SCPD veterans are no more likely to suffer from other major psychological disorders than veterans without a SCPD.
In 1985 and 1989, the Working Group (Tice, et al.) produced reports outlining critical issues regarding services to physically disabled Vietnam veterans. These reports chart out key issues effecting clinical service delivery, including the role of outreach, physical accessibility to services, personnel attitude, and assessment considerations. In addition, the reports addressed specific clinical problems concerning loss, grieving, substance abuse, and family problems, as well as addressing employment benefits. An abstract of the the report follows:
Outreach: There are numerous ways in which to outreach the disabled veteran. The most important may be within the DVA system itself. It is essential that the services of the RCS, VAMC, and VARO be coordinated. Services such as vocational rehabilitation, prosthetics, medical administration, benefits, social work, nursing, physicans, and personnel can be invaluable in establishing contact with the disabled veteran. In addition to the DVA system, veteran service organizations such as the Disabled American Veterans, the American Legion, Paralyzed Veterans of America, Veterans of Foreign Wars, AMVETS, Vietnam Veterans of America and others offer ample opportunities for outreach efforts. Networking with service organizations and specialized recreation programs is an effective means to overcome disabled veterans' reluctance to receive readjustment services.
Accessbility and Accomodation: Accessibility to services is critical to the provision of services to physically disabled veterans. The Department of Veterans Affairs serves more handicapped individuals than any other government entity. The department published a handbook on barrier-free design for its health facilities. It also contains a check list which can be used to assess your own service's accessibility. This handbook may be purchased from the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402.
Assessment Guide: To become disabled or wounded is to have one's body violated. For the disabled individual, the event causing the disability, the aftermath of treatment, expectations for recovery, the course of rehabilitation, the level of adjustment, the reactions of family, friends, and others, are just a few of many deeply personal experiences. Discussing these experiences sensitively, may help the disabled veteran to acquire new ways of coping and or understanding. In addition, exploring the veteran's aspirations and inspirations, furhter serve to acknowledge the veteran's strengths.
Attitudinal Issues: Even though the disabled individual has become more visible in our society, many non-disabled people feel somewhat awkward when having a personal interaction with a disabled person. The following guidelines may be helpful in establishing a positive relationship with the disabled client.
Always treat the disabled person with respect and dignity, seeing the person first and not the disability. Allow the disabled person to initiate humor to gauge his or her sensitivity. Disabled persons do not want special consideration or privileges and generally do not require the clinician to over-compensate. Treat items that serve as aids (wheelchairs, crutches, canes, etc.) with care and do not separate the person from these aids without permission. Be aware of your own feelings. Recognition of your own feelings of discomfort is helpful as the disabled person most likley will have recognized your discomfort. Generally, disabled individuals will allow and accept your discomfort, as you are not the first person to react this way. Being empathic, treating the person with respect, and providing a service are the most important factors during initial contact. Once the relationship forms, feelings of discomfort may be addressed with therapeutic sensitivity. Avoid ungenuine empathic statements such as "I know how you feel," or 'I understand what you are dealing with." Instead, make inquiries about how the client is feeling or coping. Take responsibility for educating yourself about the client's disability.
The Working Group presents annually to RCS Regional Trainings, the International Society for Traumatic Stress, and the PTSD Clinical Teams training. The group is currently working on a paper that addresses treatment issues of physically disabled veterans and their family and/or significant others. For a copy of the Working Group's 1988 Report on the Physically Disabled Veteran, please contact the national office of Readjustment Counseling Service, address here, Washington, D.C.
Alfonso Batres, Ph.D., is Regional Mangaer, Western Mountain Region 4A, for Readjustment Counseling Service.
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