Clinical Topics

Program Helps Reduce Domestic Violence Involving Returning Servicemembers

by Stephen Spotswood

December 19, 2018

WACO, TX—While intimate partner violence in the military population has been found to occur at about the same rate as the civilian population, servicemembers and veterans face unique challenges: a lack of separation between home and work life, long separations from family and repeated exposure to combat and other traumatic situations.

When the team behind Strength At Home began developing their ground-breaking IPV treatment program nearly a decade ago, there was little in the way of effective therapeutic response to the issue.

“At the time that Strength At Home was initially developed, and still to this day, what happens when someone is charged with domestic violence by the justice system is that they are referred to some kind of treatment program. Unfortunately, in almost every state, that program is punitive and costly and is not associated with reductions in the use of aggression,” explained Suzannah Creech, PhD, MS, a research psychologist in the Behavioral Sciences Core at the VISN 17 Center of Excellence for Research on Returning War Veterans and one of the team that developed Strength At Home. “Most people are sent to a program that is not very effective. And that wasn’t good enough when we were talking about our veterans and servicemembers.”

The program began with Casey Taft, PhD, a staff psychologist at the National Center for PTSD in Boston. In his research, he found correlations between veterans diagnosed with PTSD and those at risk for IPV. It was not that veterans with PTSD were more prone to violence than the average person but that the symptoms of PTSD were the same issues that made it difficult for returning veterans to reengage with domestic life. Symptoms such as hyperarousal and emotional numbing—developed to emotionally and physically protect a servicemember while they were deployed—can lead to unwanted consequences back home. “When someone is deployed and they’re in combat, it’s very useful for them to see ambiguous situations as hostile or threatening. That protects their life and safety,” explained Creech. “But when someone comes back stateside, if that kind of tendency to view the world as threatening continues, then that can translate into their intimate relationships.”

However, Taft’s research suggested that, just as PTSD can be treated using cognitive therapy, the symptoms that led to an incident of domestic violence also could be treated. Which is how the Strength At Home program was born. A trauma-informed, 12-week long group therapy course, Strength At Home is designed to look at every aspect of a patient’s life and how it’s been impacted by trauma.

“We work to consider trauma on all levels—in the treatment rooms, in the assessments and in the therapy itself,” Creech said. “We ask group members to track their thoughts and to work on changing the way they think about situations. In the meantime, they’re learning new skills. Sometimes people just never had a chance to learn relationships skills. We talk about communication, intimacy and expressing feelings in addition to changing these thought patterns.”

Patients come into the program through veterans courts, through clinicians and through self-referrals. “We want this treatment to be available to any veterans that receives VA care who wants to improve relationships, who might be concerned about their relationship or who is involved in the justice system because there’s been some intimate partner violence and they’re wanting to learn new ways to function.”

Clinical tests have shown a greater reduction in aggression in patients who went through Strength At Home compared to previous treatment programs. They also saw PTSD symptoms decrease and alcohol misuse go down. “If you improve someone’s relationship, it cascades into improving other aspects of their lives,” Creech declared.

For the last few years, the Strength At Home team has been in teaching mode, spreading the program to as many VA hospitals as they can. Currently it’s available at 39 hospitals, and they hope to have it at every VA hospital in the next five years. Taft and others travel to hospitals to help train staff on the program, while Creech does phone consultations with leaders at each site.

Like any new program being stood up at a hospital, it takes considerable planning, training and developed infrastructure. Each Strength At Home program requires a program coordinator, as well as four to six licensed clinicians who can deliver the group treatment and deliver assessments. “I provide a lot of consultations with site leads: How do you start something new? What do you need to think about? How do you get referrals?” Creech explained. “When the site is committed and enthusiastic, we don’t have any problems getting clinicians to sign up.”

The benefits of Strength At Home don’t stop at the veteran. For every veteran enrolled, the program makes an outreach call to his or her partner, whether they’re still in a relationship or it’s a relationship that’s ended. The partner is offered hotline numbers and access to other IPV resources.

“It could be somebody out there who’s unknown to the system, and, as mental health providers, we may be the only people who know something has happened. We feel obligated to try and get them the resources they might need,” Creech said.

“Now we’re looking at new ways to deliver the material. How can we harness technology better? And we definitely want to spread the program into DoD. That’s our biggest goal. We want Strength At Home available to active duty servicemembers. And we want to expand the program to civilians to make sure that all of those affected by domestic violence have access to this program. We really want to change the landscape of what people receive when they have a domestic violence charge.”

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