July 2019
Spotlight
This month’s spotlight highlights mental and behavioral health apps, specifically self-management and treatment companion apps that address the physical, mental, and behavioral health among military veterans and service members. Treatment companion apps are designed to be used with a provider in conjunction with evidence-based treatment, while self-management apps are designed to be used independently or even in addition to or as an extension of traditional care.

The US Department of Veterans Affairs (VA) has developed a variety of apps accessible on the VA App Store . These treatment companion and self-management apps can be downloaded and used on mobile devices. In 2018, 81% of Americans   owned a smartphone, and 52% owned a tablet. The ubiquity, in both ownership and presence, of mobile devices make them useful tools for those working to overcome the challenges in addressing behavioral and mental health needs.

While many of these apps can be helpful tools in treatment and management, clinicians and users should be knowledgeable about their purpose and scope, aware of current and emerging research regarding these apps, and careful not overstate potential benefits.

Research has begun to examine the, feasibility, usability, efficacy, acceptability, and effectiveness of these apps, as well as attitudes toward them and cultural considerations in their use. I encourage you to increase your app awareness and knowledge by exploring the articles below.

Jason E. Owen, Eric Kuhn, Beth K. Jaworski, Pearl McGee-Vincent, Katherine Juhasz, Julia E. Hoffman, and Craig Rosen
This article discusses the purpose of 15 physical and mental health-related apps and explains how the VA conducts research on their effectiveness.

Christine E. Gould, Brian C. Kok, Vanessa K. Ma, Aimee Marie L. Zapata, Jason E. Owen, and Eric Kuhn
This systematic review summarizes the “feasibility, usability, efficacy, and effectiveness” of eight VA mental healthcare apps. With most current research focusing on feasibility and acceptability rather than effectiveness, clinicians are urged to use caution in stating the benefits of apps to clients.

Daniel M. Blonigren, Brooke Harris-Olenak, Jon Randolph Haber, Eric Kuhn, Christine Timko, Keith Humphreys, and Patrick L. Dulin
As an estimated 15-30 percent of Veterans Health Administration patients are hazardous drinkers, this article discusses how the app Step Away can help reduce hazardous drinking when used with telephone support from a VHA peer support specialist. Its key benefit may be the ability to reach a group who would not ordinarily seek help for a drinking problem due to stigma.

Christina M. Armstrong, Kile M. Ortigo, Sarah N. Avery-Leaf, and Tim Hoyt
In addition to considering racial, gender, religious, age, income, and orientation within the military culture, one must also consider veterans’ and clinicians’ perceptions of technological competence. Understanding attitudes towards using technology in healthcare and its efficacy in the field is necessary for improving patient care.

Dr. Julie Baldwin
Associate Director of Research
Justice Programs Office, American University
Research
Bo Kim, Megan B. McCullough, Molly M. Simmons, Rendelle E. Bolton, Justeen Hyde, Mari-Lynn Drainoni, B. Graeme Fincke, and D. Keith McInnes
Using interviews with staff from organizations providing reentry support to veterans, the researchers created a process map that determined gaps in service provision, which included difficulties in identifying soon-to-be released veterans and a lack of awareness about available services among released veterans.

Benjamin Pomerance
This article focuses on the adherence to the Equal Protections Clause in veterans treatment courts (VTCs) in terms of eligibility criteria. Indicating that courts must, at the least, pass a Rational Basis Review, the author determines that some courts do not pass this standard and calls for greater uniformity in eligibility criteria, as well as stronger adherence this standard.

Robert D. Shura, Sarra Nazem, Holly M. Miskey, Trisha A. Hostetter, Jared A. Rowland, Lisa A. Brenner, Katherine H. Taber, and VA Mid-Atlantic MIRECC Workgroup
This study tested whether or not a history of traumatic brain injuries (TBIs) was associated with increased levels of suicidal ideation. Sustaining multiple TBIs in a lifetime was significantly associated with increased recent suicidal ideation as compared to no history of TBI, and current depression and poor sleep quality were consistent risk factors for recent suicide ideation. 

Adam G. Horwitz, Lynsey Miron, and Kelly P. Maieritsch
This study aimed to determine if reductions in specific PTSD symptom clusters had greater effects on reductions in suicidal ideation than other symptom clusters. In a sample of 160 veterans who completed an evidence-based trauma-focused treatment program at the VA, reductions in the cognitive/mood alteration cluster significantly predicted decreases in suicidal ideation at program discharge.

Caitlin A. Goodin, Daniel M. Prendergast, Larry D. Pruitt, Derek J. Smolenski, Naomi Y. Wilson, Nancy Skopp, and Tim Hoyt
Using data from the Department of Defense, these researchers analyzed whether financial distress had a significant impact on suicide attempts. Financial distress appeared to be an indirect risk factor for suicide and a less substantial risk factor than mood disorder diagnosis, substance abuse history, and relationship difficulties. 
Practitioner Publications
National Center for Medical-Legal Partnership at the George Washington University
Updated in June 2019, this booklet details how to implement a medical-legal partnership aimed at helping veterans resolve legal needs that may affect their health and includes an assessment guide for determining what combination of services a veteran may need.

US Department of Veterans Affairs
This fact sheet explains the basics of the VA’s Mobile Health Provider Program, which equips VA team members with tablets, phones, or laptops capable of bringing VA healthcare to remote areas. Devices come equipped with the VA’s apps, secured logins, educational resources, and immediate access to up-to-date client records.

US Department of Veterans Affairs
This one-page infographic depicts statistics on memorial benefits and the number of deaths during wartime military service and after military service by conflict, ranging from the American Revolution to current conflicts.

TRICARE
In this fact sheet, TRICARE presents more than a dozen resources designed to help servicemembers and veterans quit smoking. While most of the resources are specifically tailored towards veterans, general resources for quitting tobacco are also included.
Multimedia Resources
(Webinars, Podcasts, Online Resources)
Justice Programs Office at American University
This recently archived webinar examines the various aspects of VTCs. The expert panel discusses the VTC concept and delves into the variation in the implementation across the United States, addressing target populations, stakeholders, services available, program requirements, and military culture. Implications are explored in conjunction with lessons learned and recommendations for future VTC policy, practice, and research.

Center for Deployment Psychology
This two-day online workshop for clinicians and healthcare providers addresses dealing with deployment-related sleep problems. Covered techniques include stimulus control, sleep restriction, and imagery rehearsal therapy, which are taught using traditional methods, case studies, and role-playing.

Mental Health Technology Transfer Center Network (Funded by SAMHSA)
This recently archived webinar aims to inform health professionals in how to deal with potentially violent clients. Viewers will learn about the boundaries of confidentiality, mandatory reporting, the use risk assessments to determine risk status, and the duty to warn or protect potential victims.

HomeBase
This archived training informs clinicians and practitioners how to use VetChange, an online addition to any clinical practice supporting veterans or servicemembers. The training describes how to inform clients about the training, create treatment plans that involve VetChange, and help veterans get the most out of their experience with the intervention.

US Department of Defense
That Guy is a website designed to help military service members and veterans understand responsible drinking, providing multiple resources such as helpful facts, explanations of how drinking responsibly or not drinking at all can improve the social, financial, professional, and physical health, and a quiz on drinking habits.

The Veterans Consortium Pro Bono Program and the Legal Services Corporation
Stateside Legal is a “one-stop shop” for individuals  looking to understand the complex systems of laws and benefits unique to those with military service. This resource provides the public with tools and resources such as the  Veterans Legal Help Navigator , an online national directory that allows users to find low-cost legal service providers that can help enforce the legal rights and benefits of veterans. Their collection of specialized information on topics including money and debt, child support and guardianship, housing, military benefits, and employment is a great resource for advocates and attorneys who want to help veterans, servicemembers, and their families.
Policy
Arizona House Concurrent Memorial 2001 – Enacted May 21, 2019
As deported veterans have historically been denied the benefits associated with their service in the US military, this legislation urges the US Congress to enact laws requiring the Veterans Health Administration to provide healthcare and other benefits to veterans who have been deported from the US.

Colorado Senate Bill 8 – Enacted May 23, 2019
This act requires the Colorado Commission on Criminal and Juvenile Justice to seal records of drug convictions, find alternatives to charging individuals with drug-related crimes, and investigate opioid distribution in the State; creates a harm-reduction grant program; and improves medication-assisted treatment delivery methods for incarcerated individuals.

Colorado House Bill 1275 – Enacted May 28, 2019
This act increases the eligibility of unsupervised individuals to have their criminal records sealed and states that the completion of a VTC in the selected case must be seen as a point in favor of having that record sealed.

Connecticut Senate Joint Resolution 3 – Enacted June 5, 2019
This resolution petitions the US Congress to amend current legislation and recognize the women who served in World War II in the Cadet Nurse Corps as veterans with all associated care and benefits.

Florida Senate Bill 910 – Enacted June 7, 2019
This act allows the chief judge of each judicial circuit to establish a Military Veterans and Servicemembers Court Program. Veterans of the US military and the veterans of foreign allies are eligible for these programs which may include treatment for mental health disorders, substance abuse disorders, posttraumatic stress disorder, and/or traumatic brain injuries.

Nevada Assembly Bill 222 – Enacted June 7, 2019
This act withdraws the requirement that veterans seeking to enter a specialty court must have the stipulation of the prosecuting attorney to do so. The Nevada Supreme Court has found this to be a violation of the separation of powers.

Texas House Bill 714 – Enacted June 2, 2019
This act provides for a reemployment program to be made available to supervised veterans convicted of misdemeanors. If a veteran successfully completes the program and all other supervision conditions, the court may enter on order of nondisclosure concerning the preceding misdemeanor.

Texas Senate Bill 1180 – Enacted June 7, 2019
This act requires the Texas State Veterans Commission to report the basic statistics of VTCs within the state, including the number of participants in each program, completing each program, terminating from each program, as well as the amount of grant funding acquired by each program. 
In the News
Events Calendar
Make Plans! Upcoming Events Notice

August 3-6 – Orlando, FL: DAV National Convention
August 30-31 – San Diego, CA: Paralyzed Veterans of America Fencing Clinic
September 15-20 – San Diego, CA: National Veterans Summer Sports Clinic
October 11-13 – Monterey, CA: 2019 Women Veterans Alliance UnConference
October 23-24 – San Antonio, TX: Combat PTSD Conference
October 28-November 3 – Kalamazoo, MI: National Veterans Creative Arts Competition

July Events

July 22 – East Rochester, NY: 2019 Veterans Outreach Center Golf Tournament
July 22-24 – Washington, DC: 2019 National Conference on Ending Homelessness
July 26 – Vail, CO: Gore Range Backpacking

July 24, 2019 – White City, OR
July 25, 2019 – Hastings, NE
July 26 - 28, 2019 – Ventura, CA
July 27, 2019 – Newport, WA
July 29, 2019 – Port Townsend, WA
July 31, 2019 – Cincinnati, OH
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