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Historic Opportunities Abound in the Quest to Improve Veterans Healthcare

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A number of recent activities indicate that there is a unique opportunity to substantially improve the provision of healthcare services to veterans through the Veterans Administration (VA) System. This improvement will only occur, however, if bold and innovative thinking and action is pursued. Simply throwing more money and resources at the inherent structural, and at times, fraudulent activities of the VA system (i.e. fabricated health services record keeping), will likely result in little meaningful change.

Just a few days ago, the Senate approved a $16 billion bill to overhaul the department of Veterans Affairs system, a measure that also won overwhelming House approval a day earlier (a rare legislative success these days). This measure awaits signature from President Obama. Couple this with the recent appointment of Bob McDonald, former CEO of Proctor Gamble, to head the department of Veterans Affairs, and the elements appear to be in place for meaningful change. As a welcomed "outsider," Mr. McDonald has promised to swiftly implement reforms to substantially reduce veterans' wait times for health care services, and to abolish the fabricated record keeping at some VA facilities.

There are also laudable efforts to provide veterans with access to "alternative" health care outside of the VA system, particularly when in the midst of intolerable delays. In late June, Florida Congressman Gus Bilirakis, Vice-Chairman of the House Committee on Veterans Affairs, introduced the Creating Options for Veterans' Expedited Recovery (COVER) Act. The COVER ACT is a bipartisan piece of legislation that will establish a commission to examine VA's current therapy model and the potential benefits of incorporating complementary alternative therapies. Representative Bilirakis stated "Veterans need to have a range of options for mental health treatments, such as outdoor sports therapy, hyperbaric oxygen therapy, Accelerated Resolution Therapy, and service dog therapy." At present, these options fall outside conventional mental health services typically provided within the VA system.

One critical concern is that without a true commitment for innovative change and an overhaul of the VA system, money alone will have little appreciable impact. To illustrate, the U.S. Department of Defense and the U.S. Department of Veterans Affairs recently agreed to provide approximately $45 million over five years for post-traumatic stress disorder (PTSD) research to advance PTSD diagnosis, prevention, and treatment for service members and veterans. This effort is under the auspices of the new Consortium to Alleviate PTSD (CAP) which aims to implement an array of clinical treatment trials and biological studies for active military and veterans with PTSD and related conditions. The signature question is whether this type of effort, which fundamentally involves the same "players" and past approaches to treatment of PTSD, will yield significant innovations. In perusing the recently disseminated Request for Proposals (RFPs) solicited from the CAP, there appears to be little interest in examining the types of alternative therapies that Representative Bilirakis articulated with the COVER Act.

Indeed, a closer look at the newly formed CAP reveals that its leadership and mission is essentially an evolution of the previously established South Texas Research Organizational Network Guiding Studies on Trauma and Resilience (STRONG STAR) consortium, funded by the Department of Defense in 2008 in the amount of $35 million with the goal of developing and evaluating effective early interventions possible for the detection, prevention, and treatment of combat-related PTSD in active-duty military personnel and recently discharged veterans. Examination of the STRONG STAR research portfolio shows a very heavy past emphasis on studying two therapies for treatment of PTSD known as prolonged exposure therapy and cognitive processing therapy, both of which have been around for decades and are not innovative. The peer review publication record from STRONG STAR appears thin, and thus with the establishment of CAP, a major concern is whether this well-funded effort will represent "business as usual," and not true innovation is science that leads to provision of timely and effective health care for our veterans.

The recently appointed Bob McDonald as Secretary of Veterans Affairs will hopefully arrive with an unbiased and fresh perspective. As stated by Representative Bilirakis, credible alternative models of therapy must be examined and made available to service members and veterans, as warranted. Recently, investigators from the University of South Florida have published compelling trial results on the use of an emerging therapy known as Accelerated Resolution Therapy (ART) for symptoms of combat-related PTSD. In the December 2013 issue of the journal Military Medicine, effective treatment of symptoms of PTSD with ART was reported in just 1-5 sessions and without homework or medications, much shorter and cheaper than current first-line therapies being used within the VA system and those being studied largely by groups such as STRONG STAR and CAP. A new international organization known as the International Society of Accelerated Resolution Therapy (IS-ART), located at www.is-art.org, has been established to help promulgate ART as a very brief treatment alternative for PTSD (i.e. outside of the current VA system).

The timing is ripe for meaningful and historic changes in the provision of timely and effective treatment of health care for our service members and veterans. Such progress, however, will be stifled if new leadership and funding associated with the VA system fail to completely reboot and instead attempt patchwork fixes to a system that by the majority of accounts, including independent examinations, indicates the need for a major overhaul. Our service members and veterans deserve nothing less.

Marcus Bright, Ph.D. is the Executive Director of Education for a Better America and an Adjunct Professor in the School of Public Administration at Florida International University and Florida Atlantic University