The following information is presented with reference to developing a continuing discussion of the training necessary to effectively transition military veterans to civilian life. Characterized by Shari La Grange-Aulich as a “transition center,” this would be allied with the S.A.V.E. farm project. Those with interest in this initiative should contact Ms. La Grange-Aulich directly.
Transition Center
The purpose of the transition center is to facilitate mental and physical wellness as well as aid clients in issues related to the transition from military culture into the civilian world. The center will provide clients with an integrated team based holistic wellness treatment that includes psychological services, horticultural therapy, occupational therapy, physical therapy, and a fitness center. The center will also offer career services, vocational rehabilitation, volunteer and mentorship opportunities, spiritual guidance, tutoring, and on site work- study opportunities.
Psychological Services
The goal of the program is to reduce and minimalize the use of psychopharmacology for mental health treatment and utilize Empirically Supported Treatments (EST) that have been conducted in clinical trials and found to be effective. Psychological services will be provided to residents of the SAVE farm and to clients from the community who are dealing with combat related stress. Psychological services will be provided free of charge to any client desiring treatment. Clients who are residents of the SAVE farm will be able to attend psychological treatment concurrently while attending the educational program. Individual and group therapy will also be available for family members of veterans and service members and assessment and treatment plans will be individualized to meet the needs of each client.
Clients will receive feedback from a therapist following an initial intake utilizing Gold Standard and empirically supported assessments. A menu of treatment options will be provided and clients will participate in daily engagement in their treatment plan. Each client will collaborate with the EST trained and certified therapist to develop an individualized plan that includes attendance of a minimum one weekly 60- to 90-minute session of individual therapy, one weekly group therapy session, and additional wellness activities as desired. The EST will be based on the five principles of Posttraumatic Growth that include: 1) Personal strength, 2) Appreciation of life, 3) Relationships with others, 4) Spirituality, and 5) New possibilities. The menu of EST treatments will include:
Individual therapy
- Psychoeducational therapy (PTSD manuals)
- Interpersonal Process Therapy (IPT)
- Cognitive Behavior Therapy (CBT)
- Cognitive Processing Therapy (CPT)
- Cognitive Processing Therapy Cognitive Focus (CPT-C)
- Solution-Focused Therapy
- Moral Injury Treatment supplemental modules
- Posttraumatic Growth supplemental modules
- Marriage and Family counseling
- Anger Management
- CBT for Suicidality
Group therapy
- Interpersonal Relationship Process
- Mindfulness
- Cognitive Processing Therapy (CPT)
- Cognitive Processing Therapy Cognitive Focus (CPT-C)
- Psychoeducational therapy (PTSD manuals)
- Guided Imagery
- Mindfulness
- Distress Tolerance
- Emotional Regulation
- Anger Management
- Sleep Improvement
- Stress Management
Additional Programs (Non EST)
- Massage/Chiropractic
- Body Intelligence Therapy
- Equine Therapy
- Yoga
- Art
- Music
- Drama
- Horticultural/Nature Integration
- Mentor Program with Vietnam Vets (1:1 Mentorship for Game nights, off campus activities)
- Volunteering 1 hour a week in the community (community integration-altruism)
- Finding a Spiritual Growth mechanism (Church, Native American Groups, Prayer)
- Battle Buddy mentorship program to provide 1:1 assistance to incoming cohorts.
- Farm employment opportunities (kitchen, marketing, farm store, fundraising, event planning, etc.)
Assessment and Risk Management
Empirically validated measurements will be used upon intake and each client will receive an official diagnosis after receiving a clinical assessment that will include the Anxiety Disorders Interview Schedule (ADIS-5), Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Clinician Administered PTSD assessment (CAPS) and the Beck Scales for Suicidality and Hopelessness. Ongoing treatment progress will be monitored weekly using self-report measures such as the CAPS self-report, the Beck Depression Inventory and the Beck Anxiety Inventory. Ongoing assessment using the Beck assessments for suicidality and hopelessness will be conducted on an as-needed basis (daily, weekly) for individuals being treated for suicidal ideation. Prior to the last semester session, therapists will reassess and collaborate with the client in discussing treatment outcome and future planning in a termination session. Accredited University Psychology PhD candidate interns will track and research treatment outcomes to ensure efficiency and efficacy.
Clients with current substance use disorders will not be included in the SAVE farm and can apply after completing pertinent substance abuse programs. Clients who are actively suicidal will be referred to local hospitals/treatment centers/VA and may return for treatment on the farm after the period of active suicidality has passed. However, clients who are experiencing suicidal ideation may be still be treated at the SAVE farm while continuing their education. Future growth of the clinic may include a crisis center where suicidal clients can be monitored 24 hours a day and receive intensive treatment.
Occupational Therapy
Occupational therapy plays an important part in success of those transitioning to new life roles and those recovering in the community by facilitation participation in meaningful activities. Occupational therapy focuses on function and independence for obtaining/maintaining employment, going to school, or living independently while engaging in productive life roles.
Occupational therapy services for clients of the SAVE farm will include individualized comprehensive evaluations of the client’s needs for their home, workplace recommendations for adaptive equipment and training in its use, and guidance and education for family members and caregivers. The Occupational therapy practitioner will use a holistic perspective, in which the focus is on adapting the environment to fit the person, and the person is an integral part of the therapy team.
Occupational therapy assessments will determine necessary intervention in the areas of education, work, skills training, health and wellness, and cognitive remediation and adaptation. Payment for services will be similar to psychological services. Examples of occupational therapy interventions include:
- Evaluating and adapting the environment at home, work, school, and other environments to promote an individual’s optimal functioning
- Providing educational programs, experiential learning, and treatment groups or classes to address assertiveness, self-awareness, interpersonal and social skills, stress management, and role development (e.g., parenting)
- Working with clients to develop leisure or avocational interests and pursuits
- Facilitating the development of skills needed for independent living such as using community resources, managing one’s home, managing time, managing medication, and being safe at home and in the community
- Providing training in activities of daily living (e.g., hygiene and grooming) and instrumental activities of daily living (e.g., managing finances and utilizing communication/technology aids)
- Consulting with employers regarding appropriate accommodations as required by the Americans with Disabilities Act
- Conducting functional evaluations and ongoing monitoring for successful job placement to include activity analyses of specific job tasks (e.g., lifting and carrying with a back injury)
Assessment and Risk Management
Occupational therapy services will be conducted by a therapist who is credentialed from the National Board for Certification of Occupational Therapist and licensed in the state of Kansas. This individual will comply with OT standards for continuing education requirements and abide by American Occupational Therapy Association (AOTA) code of ethics and scope of practice. Selected assessment tools will follow AOTAs guidance for reporting outpatient functional data. Most ADL and functional performance outcomes will be gathered from interview and observation of the skill.
Physical Therapy
Physical therapists are health care professionals who help individuals maintain, restore, and improve movement, activity, and functioning, thereby enabling optimal performance and enhancing health, well-being, and quality of life. Their services prevent, minimize, or eliminate impairments of body functions and structures, activity limitations, and participation restrictions. Physical therapy is provided for individuals of all ages who have or may develop impairments, activity limitations, and participation restrictions related to (1) conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems or (2) the negative effects attributable to unique personal and environmental factors as they relate to human performance.
Physical therapy will be provided for residents of the SAVE farm to improve health and well-being. Specific therapy could include: enhancing functional strength and mobility as the clients ambulate over different terrains, educating clients how to use their joints and muscles for work tasks given an injury, testing client’s cardiovascular systems during long work hours and environmental exposures, and teaching strategies on how to perform work skills without acquiring a secondary injury.
Assessment and Risk Management
Physical therapy services will be conducted by a therapist who is credentialed from the National Physical Therapy Examination and licensed in the state of Kansas. This individual will comply with PT standards for continuing education requirements and abide by American Physical Therapy Association (APTA) code of ethics and scope of practice. Appropriate assessments will be used to determine physical function and billing and coding will follow APTAs guidance.
Art Therapy
The practice of art therapy combines the knowledge of visual arts ( painting, sculpting, printmaking, drawing, jewelry making, pottery, etc.) and the creative process with expertise in human development, psychological theories, and counseling techniques. Research encourages the use of art therapy within a professional relationship for the therapeutic benefits gained through artistic self-expression and reflection for individuals who experience illness, trauma, and mental health challenges, as well as those seeking personal growth. Art therapy is currently utilized in VA centers and by many military-related treatment providers to support rehabilitation, often as a complementary technique to other therapies. Art therapy services for clients at the SAVE farm would improve or restore a client’s confidence in daily functioning and his or her sense of personal well-being through individual and group sessions. The adaptability of art therapy is especially beneficial when serving veterans who may face physical challenges in terms of communicating or using traditional art materials. Art therapists are trained in a variety of modalities to adapt the art making experience to meet the specific needs of the client.
Art therapy can provide a depth of insight into client needs less accessible by other therapies as clients may either hesitate or be unable to participate in a dialog regarding their thoughts, emotions or experiences. Art therapy provides the opportunity to express oneself in a safe way. As explained in a recent National Geographic feature article on the power of art to heal the wounds of war, art therapy can give “invisible wounds a visible voice.” By assessing both the process of making art and the final creative product, an art therapist can contribute to the development of a holistic treatment plan, supporting therapists in identifying clinically relevant information that is essential to client care.
The art therapist will work in conjunction with other professionals to reach therapeutic goals. This can be achieved through either clinical art directives or an open art studio, as both approaches are beneficial to the veteran’s journey in healing. In each case, veterans utilize and explore art materials and processes in order to express themselves freely. Art therapy can also be used to build community through collaborative or shared art experiences. In a group setting, a peer-to-peer model can be employed to encourage communication and understanding across collective events or emotions, thereby utilizing art making activities and review of final products to establish or enhance a sense of community among clients.
Examples of art therapy activities include:
Maybe one related to TBI?
And another to PTSD?
A situation in which someone is unable to speak?
Something related to children?
Or complementary to family therapy
Assessment and Risk Management
Art therapy services would be provided by a practitioner who holds a master’s degree in art therapy from an institution of higher education accredited by the Council for Higher Education Accreditation (CHEA) and credentials from the American Art Therapy Board (AATB). The art therapy practitioner will work closely with psychological services, and PT and OT services in assessment.
Horticultural Therapy
Horticultural therapists use gardening and other horticulture-based activities to promote health and well-being. Through individual and group sessions, therapists work with clients to develop across physical, cognitive, social and emotional health domains. Many VA facilities incorporate horticultural therapy into patient programs today, making many positive impacts on patients. Horticultural therapy services for clients of SAVE farm will supplement and complement psychological, occupational, and physical therapy services to help clients reach their therapeutic goals.
The horticultural therapy practitioner will also develop intentional landscape designs with specific therapeutic results in mind. Based on the clinical needs of the clients, the gardens will benefit individuals as they seek to restore their overall health. Healing gardens have been shown to lessen symptoms of depression, alleviate stress, and reduce anxiety.
Specific therapy could include: developing clients’ practical or social skills, confidence or self-esteem; helping clients to learn or re-learn basic skills; provide supportive outdoor activity and exercise to restore strength and mobility; working with clients to develop leisure or vocational interests. Passive garden areas will provide areas for meditation, contemplation, and group sessions and elements to strengthen the client’s connection to nature. Exercise stations and rehabilitation elements such as handrails and a variety of walking surfaces will be incorporated in the gardens for physical therapy. Other landscapes will be designed to create serene, tranquil environments for clients to prepare for meditation and mindfulness exercises.
The horticultural therapy programs and healing gardens will also serve as a center for study and research. This is essential to the success of this program and for future programs and gardens that want to serve this client group.
Assessment and Risk Management
Horticultural therapy services will be coordinated by a practitioner that meets the American Horticultural Therapy Association (AHTA) professional registration requirements. This individual will comply with AHTA code of ethics and standards of practice. The HT practitioner will work closely with psychological services, and PT and OT services in assessment.
Marriage & Family Therapy
A certified marriage & Family Counselor will be on staff to provide counseling for those in need. This counselor will also develop and execute programs that will enrich marriages and strengthen families.
Psychiatric Nurse
Residents of the S.A.V.E farm will be provided access to a Psychiatric Registered Nurse. The psychiatric nurse combines biopsychosocial knowledge, psychopharmacologic competency and physical and psychiatric assessment skills with an intrinsic perspective of patient advocacy. In the Care Manager Role they are trained to manage client’s needs and identify resources. The psychiatric nurse will partner with the integrated team to provide a holistic wellness treatment plan focused on recovery. For those clients being prescribed psychotropic medications by an outside provider, the psychiatric nurse will provide ongoing assessment and education related to medication management.
Fitness Center
A small fitness center for student and family use will be available in the physical therapy area. The center will serve the dual purpose of providing the physical therapist with necessary equipment and as a fitness center.
Clinic Schedule
The clinic will operate on a semester schedule to allow new service members/veterans to enter the program with minimal wait times (maximum 3 months) for admittance to the program. Clients will receive treatment during their apprentice, journeyman, and master farm cycle education semesters with Kansas State University instructors. The proposed schedule accompanies Kansas State University course schedules to allow for consistency for instructors. For example, spring semester will be from January-May, summer semester from May-September and fall semester from September-December. There will be a two-week break in between semesters in that one week would be used at the employee’s discretion and the second week to prepare for the next semester.
Methodology for SAVE Wellness Clinic Cost Estimate
Many different resources and avenues were approached when collecting budget estimates for the SAVE Transition Center. The biggest costs in maintaining the center are the salary and benefits for the employees. The estimate for each salary is based upon averages for that particular discipline at the VA, Ft. Riley, and surrounding areas. Salaries are based to be competitive, but not out of range, in order to recruit highly qualified candidates. The benefit packages, to include FICA, Medicare, Social Security, and Healthcare costs, were computed at a 33% rate of the employee’s salary. This information was taken from the Veteran’s Administration Fiscal and Accounting Offices. The budget also includes other related employee costs to ensure staff are safely practicing under their licensure. Psychology administration costs are based upon cost to purchase and administer adequate screening tools. Lastly, the psychology budget also includes costs for printing and distribution of correct treatment manuals/books for the residents of the farm. Furnishings and breakroom costs were compiled using VA Interior Design resources. IT and computer record budget costs were estimated using both VA resources as well as outside wholesale retailers. Occupational therapy and physical therapy equipment were again resourced through the VA and Ft. Riley occupational therapists.
