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PPP Final Report

Topic: PTSD in Veterans
HPEB 300 - 006
Molly Haggerty, Cicely Brunt, Kabreea Howell, Mara Falter

Program Rationale

After returning home from combat, veterans face a significant amount of adversity
reintegrating into civilian lifestyle. One of the biggest and perhaps underestimated issues faced
by thousands of veterans annually is the effect of PTSD. This highly detrimental mental disorder
almost always makes a significant impact on the lives of veterans struggling with it, but because
of its stigmatized nature within the military, many never seek treatment or methods to cope.
Despite the role stigma plays in this lack of seeking help, there are also multiple barriers to care
that veterans face, which results in not receiving treatment. A recent Military Psychology study
found that, “up to 30% of veterans returning home from combat operations report suffering from
psychological problems,” but only about ~8% actually seek help for treatment (Britt et al., 2011).
They found that this lack of receiving treatment was primarily due to the stigma surrounding the
mental disorder and barriers to care including not having time for treatment, not knowing the
resources around them, and the perceived belief that problems with PTSD can be handled
oneself.
The important note to make is that PTSD does not go away with time. Symptoms will not
diminish and fade away, and ignoring them will only cause greater damage to the individual
suffering. Providing veterans with ample information about PTSD and the severity and impact of
its symptoms will raise the awareness of the importance of receiving treatment. Increasing
knowledge about local resources and ways of coping will encourage veterans to reach out and
seek help. Additionally, this information will help break down the stigma surrounding PTSD,
and allow veterans to realize the seriousness of its effects and significance of its treatment.
Our program will target veterans who reside in Charleston County, SC that have returned
from combat within 2 years. We will include both male and female veterans, and want to
specifically target those who live in both rural and urban areas. According to the U.S. Census
Bureau (2015), approximately 30,000 veterans live in Charleston County, ~24% of which
reported suffering from a service-connected disability.
A lack of knowledge of resources in the area is one of the most common barriers to
receiving treatment for PTSD. Although Charleston has a large support system for veterans,
many do not know where to find specific centers that support those with PTSD and provide help.
Our program focuses on reducing this barrier by providing veterans with a number of resources
throughout 3 information sessions, for example different projects like the Wounded Warrior
project that is an established resource in Charleston County. We also would like to work on
breaking down the stigma surrounding PTSD by having a veteran that is suffering from PTSD
and who is receiving treatment come talk to the target group of veterans.
Targeting veterans suffering with PTSD is especially important because it affects so
many more lives than just the individual. Often times the families of veterans struggling with
PTSD either do not know their loved one is in need of help or they simply do not know how to
go about helping them. To get our program up and running, we will advertise our information
sessions to the resources already existing in Charleston County and use their contacts to reach as
many veterans as possible. We would like to achieve “program ownership” by advertising to the
Veterans Association, who receives a yearly budget dedicated to funding and supporting ways to
increase the accessibility to benefits and services for those who served our nation. We will also
ask for donations from current establishments dedicated to supporting the needs of veterans.

Needs Assessment
Post-traumatic Stress disorder is a mental health problem that affects about 7-8% of the
current U.S. population (U.S. Department of Veterans Affairs, 2016). After experiencing a
trauma, one can develop symptoms that become debilitating and interfering in life and remain
long after the traumatic event occurred. Symptoms include re-experiencing the trauma,
hyperarousal, nightmares or terrors, negative alterations in cognition and mood, and several
more. PTSD is especially common in veterans who experienced combat and can be extremely
intrusive and hindering when they return to civilian life. Not only does the existence of PTSD
affect the veterans themselves, but their family members and friends around them. The target
group for our program include veterans residing in Charleston, SC. This target population
especially experiences a variety of barriers preventing them from accessing resources for
treatment and support for PTSD, which we feel needs to be addressed. Through our research,
environmental risk factors that we have found to present issues for veterans include lower
socioeconomic status, lower education levels, family instability, and prior exposure to a trauma
or chronic stress at an earlier age (National Center for PTSD, 2000). Risk factors that cannot be
changed include gender, level of severity of trauma, biological predisposition to mental illness,
and age at exposure to trauma.
Predisposing factors relating to health behaviors include the belief that PTSD affects
someone directly after the trauma and stigma surrounding the disorder. Symptoms of PTSD tend
to occur within 3 months of the traumatic experience, but it is not uncommon for them to display
years later. This makes PTSD very hard to detect in some cases and can convince people that
they do not have the disorder, which leads them to not get treatment. Stigma surrounding the
disorder also influences people’s choice to reach out or seek treatment. This has especially
affected the veteran population because they do not want to ruin their reputation as strong,
independent, healthy individuals. Several enabling factors include workplace environment,
accessibility to resources and treatment centers, and family support. Supportive and
understanding workplace environments allow veterans returning to civilian lifestyles to have the
opportunity to reintegrate at their own pace while satisfying their needs, especially if they are
dealing with PTSD. Accessibility to resources and treatment centers make the behavioral change
of acknowledging and addressing the prevalence of PTSD in veterans’ lives easier and more
manageable. Additionally, family support enables veterans to explore the opportunity to initially
seek help and continue to do so if they are struggling with PTSD. Finally, key reinforcing factors
like symptom withdrawal and social support are likely to relate to health behavior changes in
veterans struggling with PTSD. By receiving treatment and addressing the disorder, some
symptoms will alleviate and become less debilitating. Also, strong support from one’s
community helps to validate one’s efforts and encourages veterans to continue seeking treatment
(American Psychological Association, 2000).

Mission Statement

The mission statement for this project is as follows: To educate and assist veterans,
specifically in the the Charleston area, with Post Traumatic Stress Disorder about the disorder
and to provide the resources to cope with PTSD.

Goals
The first goal of our project is to increase veteran’s knowledge of post traumatic stress
disorder prevalence and symptoms. The second goal is to break down barriers that prevent these
veterans from receiving care and or treatment. The final goal of this project is to reduce stigma

and belief that receiving help for PTSD is a sign of weakness. Increase veteran’

Objectives

The objectives of this program are specific, measurable, achievable, realistic and time-
bound. These are known as SMART objectives and they are designed provide the foundation for
our program and will help determine the impact of the results at the closing of the program. ***
The process objectives are:
● By the end of the program, planners will have provided resources to all the veterans
currently living in Charleston, SC as well as their immediate family members
● During the next 6 months, half of families of veterans with PTSD will be enrolled in one
of the provided resources (Wounded Warrior, therapy, etc.)

The learning objectives are:
● Upon the completion of this program (after 6 months), veterans and their family
members will know at least three methods to help alleviate some PTSD symptoms.
● By the end of the program, veterans with PTSD will have learned at least three benefits
to counseling/therapy services and will have obtained a brochure containing information.

The behavioral objective is:
● By six months after the completion of this program at least 60% of veterans will have
attended at least one therapy or counseling sessions
Intervention
The intervention strategy for this project is the Theory of planned behavior. This strategy
consists of three main concepts that all build upon one another, the first one is that a person’s
behavior and their attitude of said behavior enhances the individual's intentions when a favorable
attitude is fostered (McKenzie et al., 2013). The second component relates closely to the first, it
is that normative beliefs also play a large role in behavioral change on an individual level. As an
individual's attitude becomes more favorable to these aspects so does their perceived behavioral
control. Perceived behavioral control is the third aspect of this intervention strategy and also the
one that separates it from other strategies. When an individual takes responsibility in their health
and understands that they have control over many different aspects they are more likely to
perform or change a specific behavior (McKenzie et al., 2013).
Currently only 7.6 % of veterans that are experiencing some sort of mental health
disorder are seeking treatment (Brit, et al.,2011). Stigma plays a major role in determining why
the majority of veterans do not seek help. By using the theory of planned behavior to use
knowledge to influence a favorable attitude and change the norms of society this stigma can be
minimized. To achieve this a health education intervention strategy will be used. This includes
providing information from different credible sources and utilizing their materials such as
brochures. Once the stigma surrounding mental disorders is gone the individual can use
resources that are readily available for them to take some control of their health behavior.
Applying TPB to our program by influencing the veteran’s beliefs and the support they receive
from their social network leads to an increase in the belief that an individual has control over
their behavior of seeking needed treatment and consequently will engage in this behavioral
change (Brit, et al.,2011). The process of helping the individual become comfortable in their
environment, or by creating a comfortable and safe environment is accomplished by an
environmental change strategy as well as a health-related community service strategy.

The program being implemented consists of three sessions each spaced two months apart.
The first session will be held towards the beginning of April so that the majority of the program
occurs over the summer. The first session will be the kick off to our program and will be a large
event that is open to a broad group of people. The session will be open to all veterans, not just
those with PTSD, as well as family members, friends, supporters, and community members.
Each session will be held at a community center in Charleston, South Carolina. Tables and small
tents will be set up along the perimeter of the room that will be reserved for different
organizations to set up their materials and information. Tables will be reserved for the following:
a volunteer for a crisis line, a representative from the veterans hospital, a local therapist, a
member from Wounded Warrior Project, a merchandise, a donation station, tables will also be
reserved for program sponsors, a representative from the VA , and a table for a veteran that is an
advocate for the program. The first session has a main objective to provide information to the
public and to raise support and funds for the continuation of the program. The second session
will be more specific to the needs of the priority population. Only veterans who are or have
suffered from PTSD and their immediate family members will attend, specifically veterans who
have returned from combat within the last six months to a year. The second session will have a
member from Wounded Warrior Project, a nonprofit organization created to help injured
veterans in a multitude of ways. The representative member will give a short
presentation,distribute materials and answer questions that the target population may have. The
third session will hopefully be the largest and will include a high percentage of the original
priority population. The third and final session will have either a therapist or a counselor from
the area so talk to veterans and their family members and to give a short presentation with their
own materials. At each session when people are checking in and registering for the event all
veterans will be required to fill out a short survey. The survey is a vital part of this program to
determine the effects the program has had on the priority population. The fee that veterans pay
will only be five dollars upon entrance and will help pay for materials needed throughout the
completion of the program.
Resources
We will need and use a variety of resources such as supplies, personnel, equipment and
space. For personnel we plan on relying on volunteers but also hiring outside guest speakers
from organizations such as the Wounded Warrior Project. We will need a space large enough to
accommodate up to 200 people, most likely we will use a community center room or small
auditorium. For equipment we will need a projector and screen for presentations and chairs if the
space does not provide them already, and some incentive materials such as shirts to hand out
when continuing on with the program. We will also be using materials created and already
provided by the Veteran’s Association such as brochures and various treatment options and
information that will be informative for the families as well.

Marketing
By the third session near the closing of the program we hope to have an upwards of 200
participants. The first session will be held in April so the beginning of the year will be spent
advertising the program. The main advertising tool being used is a large billboard that will be put
up in a urban area in Charleston, SC. This will allow families and veterans so get curious and
inquire more about the program. Along with using the billboard as method of marketing we will
also have volunteers hand out fliers on the streets and even make personal door-to-door sales
pitches with families located in a heavily military based housing area. With making door-to-door
house calls with the families we will be able to see and meet with them first hand a get a feel
ahead of time the best way to present the program to them.
Budget

Budget Item Unit Cost Number of Total Cost
Units

Personnel

Guest Speakers $150 3 $450

Professional Counselors $300 2 $1800

Equipment and Supplies

Brochures $5 200 $1000

Billboard $500 2 $1000

Other

Building/Location $1500 1 $4500

Total Budget $8750

Evaluation
While there are already PTSD programs in Charleston, SC. Our program is one of the
few that focuses on raising the awareness and getting families with a PTSD member the
resources they need to reach out for treatment. The objective of our program is to remove the
barriers that the priority population faces in seeking help, in a matter of 6 months of them
returning from combat. In the baseline data that was collected it showed that many of our
participants were not aware of the resources that are available to them. Along with not being
aware of resources, they also did not understand the status and behaviors of their health.
Comparing this pretest to our posttest at the end, will determine if our program was a success and
to what extent. We as stakeholders want at least 50% of our participants and their family
members after the 6 months to enroll in some sort of therapy or counseling treatment.
Throughout the 6 months we held three informational sessions.
The first session was when the pretest was conducted. The second session, surveys were
handed out to get a general feel of how the participants thought the intervention was going since
the last meeting. The survey consisted of questions such as: How would you rate this program?,
How would you rate the guest speakers?, What do you like most about the program? What do
you like least?, How likely are they to get treatment? How can we get more families and veterans
to participate?, What treatment are you likely to get and the type? . The results of that survey
showed 35 out 75 people thought that this intervention was on the right track in connecting them
to the treatments they may need. That’s 46%, in our second session we are almost to our goal of
half the veterans and families looking to maybe enroll themselves in some sort of counseling or
treatment for PTSD.
In the last session, another survey was handed out featuring some of the same questions
as the first with the exception of what treatments would you likely get and type?. Questions that
were added were What materials and treatment did you end up using? Those were great
questions to sum up our intervention to get an answer of if we reached our goal of at least 50-
60% of participants enrolling or going to a therapy or counseling session. Also from the last
session, there were some changes that were made. Our participant count went from 75 to 125.
After taking all that into consideration, 85 out of the 125 participants said they enrolled and
attended a treatment session for PTSD. Looking at that in a percentage, that’s 68%! We reached
our goal. From the beginning session to the end we saw tremendous change in our participants,
they went from kick-off not knowing anything about PTSD and the available resources to
enrolling themselves into treatment sessions. After reviewing all the results, we have concluded
that we have reached our goal and mission of educating and limiting the obstacles that our
population faces.

References
American Psychological Association. (2000). Meta-analysis of risk factors for posttraumatic
stress disorder in trauma-exposed adults. Retrieved from
http://psycnet.apa.org/journals/ccp/68/5/748/

Britt, T. W., Bennett, E. A., Crabtree, M., Haugh, C., Oliver, K., Mcfadden, A., & Pury, C.
(2011). The theory of planned behavior and reserve component veteran treatment seeking.
Military Psychology, 23(1), 82-96. doi: 10.1080/08995605.2011.534417

McKenzie, J., Neiger, B., & Thackeray, R. (2013). Planning, Implementing & Evaluating Health
Promotion Programs. Boston:Pearson.

National Center for Post-Traumatic Stress Disorder. (2000). Risk Factors for PTSD 11(3).
Retrieved from https://www.ptsd.va.gov/professional/newsletters/research-quarterly/v11n3.pdf

Richardson, L., Frueh, C., & Acierno, R. (2010). Prevalence estimates of combat-related ptsd: A
critical review. The Australian and New Zealand Journal of Psychiatry, 44(1), 4-19. doi:
10.3109/00048670903393597

Thomas J., Wilk J., Riviere L., McGurk D, Castro C., Hoge C. (2010). Prevalence of mental
health problems and functional impairment among active component and national guard soldiers
3 and 12 months following combat in iraq. Arch Gen Psychiatry, 67(6). 614-623.
doi:10.1001/archgenpsychiatry.2010.54

United States Census Bureau. (2015). Service-connected disability-rating status and ratings for
civilian veterans 18 years and over. Retrieved from
https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=CF

U.S. Department of Veterans Affairs. (2016). PTSD: National center for PTSD. Retrieved from
https://www.ptsd.va.gov/public/ptsd-overview/basics/how-common-is-ptsd.asp