Before the wars in Iraq and Afghanistan, there was little research on effective treatments and not much pressure to add to what existed, said Army Brig. Gen. (Dr.) Loree Sutton, director of the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury.
Sutton, at a Warrior Resilience Conference here, said her office has been working with the services to develop treatment programs and is researching best medical practices. But the effort isn’t a simple matter of an open checkbook; results count.
“Everyone has good intentions,” she said during an interview. “But as I’m fond of saying, ‘In God we trust. All others bring data.’ We continue to add to our data.”
The center has sponsored a number of promising initiatives to combat the signature psychological wounds of the wars in Iraq and Afghanistan, as a result of funding that flowed in to military medicine after revelations of substandard care at Walter Reed Army Medical Center in Washington.
The initiatives provide a chance to standardize the hundreds of disjointed programs around the country, Sutton said. “Some are pilot programs, some we added to established programs, and with some we have ventured in to completely new kinds of approaches,” she said.
The initiatives are just approaching maturity now, the general said. “We are putting outcome metrics against the programs to see what works [and] what doesn’t,” she said. “The services and everyone involved knows that we will go where the evidence leads.”
Sutton explained some successful initiatives. The first is the publishing of a clinical practice guideline for concussion or mild traumatic brain injury. “It’s the first that has been signed off on,” she said. “We’re in the process of taking the guideline and transforming it into a mandatory, event-driven protocol.”
The protocol mandates that if a vehicle is struck by a roadside bomb, everyone in that vehicle must go through a standardized treatment. “There is no choice,” she said. “It’s a partnership between the line leadership and the medical leadership. It gets past the stigma and the ‘suck-it-up’ leadership. No excuses, no exceptions, this is what happens.”
The tools have been implemented and have ripened, The medical community is ready to link up with line partners, and the whole process can now be implemented in units, Sutton said.
The office also stepped in to look at cognitive rehabilitation programs. This is a concern throughout the country, Sutton said, acknowledging that confusion exists about what it involves and whether it should it be reimbursed by the Tricare military health plan.
Much like rehabilitation after a stroke, she explained, cognitive rehabilitation is a series of treatments designed to re-teach those suffering from traumatic brain injury the skills they lost. Sutton’s office brought together a group of nationally known experts to determine where things stand. “This will put the foundation under our research efforts and the way ahead,” she said.
Another initiative is the “Real Warriors” campaign, which uses public service announcements to tell the stories of servicemembers who are dealing with psychological trauma. It is an attempt to get servicemembers to get past the stigma associated with these ailments.
“The power of this campaign comes from the fact that these are real warriors,” Sutton said. “It’s a volunteer program, and they come forward and tell their own stories. It helps them, and it certainly helps their peers who may be suffering in silence and isolation and feeling that they are all alone.”
Finally, the office is part of the National Intrepid Center for Excellence. Philanthropist Arnold Fisher raised the money and built a world-class center in San Antonio for amputee care.
“A couple of years ago, Mr. Fisher came forward and said he wanted to pledge the same level of support to the invisible injuries of war,” Sutton said. “That center will become the hub of our networks from around the world.”
The 72,000-square-foot facility will be adjacent to the Navy’s Bethesda, Md., medical campus and, while built with private funds, will be manned by military and civilian employees. The center will treat those with psychological trauma, and families will stay at Fisher Houses to participate in treatments. The center is due to open in the spring.