Congressional Hearing Regarding Connecting Veterans with PTSD with Service Dogs
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"Slower than molasses going uphill on a winter's day and more excuses than a dead horse has flies!"
The Department of Veteran's Affairs (VA) is infamous for its blunders, cover-ups and moving to help veterans at a pace slower than a herd of snails traveling through peanut butter. This is not to mention spending money like a sailor on shore leave for contracts with underperforming outside agencies (outside, like outside the United States!) who are all too often exposed after one Congressional committee after the other gets fed up with the VA's antics and investigates.
The VA's approach to providing service dogs to veterans with PTSD is no exception. Mired in organizational gaffes, cost overruns and continued denial of the overwhelming anecdotal evidence that PTSD service dogs are effective, the VA's PTSD Service Dog research study has only placed 40 dogs with veterans since the study was authorized in 2010 at a cost to taxpayers of $12 million!
Granted, the VA is correct in its statement that there is no empirical evidence to support the effectiveness of PTSD service dogs. However, the VA has access to what is probably the single largest service dog handler population in the United States along with their VA mental health doctors and therapists. The number of veterans with service dogs is growing steadily as affected veterans seek help outside the VA's musty therapy rooms. If polled, scientifically no less, I would venture that the overwhelming majority of veterans with service dogs would attest to a drastic yet positive change in their lives. A change that they will attribute directly to their service dogs. Veterans that are able to get dogs are tossing their psych meds in the garbage and replacing them with the cold nose and loving eyes of their trained canines. I bet a review of those same veteran's mental health medical records would also reflect the positive effects of service dogs providing even more evidence for the VA to ignore.
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| I wouldn't give up that cold nose and loving eyes for anything in this world! |
I swear, the VA administration is stingy with money when it comes to spending that actually helps veterans which is in direct contrast to their unfettered wasteful spending and program mismanagement that, according to whistleblower Jan. R. Frye, the VA’s chief procurement officer, who went public with a stunning admission that the VA likely wastes $6 billion a year on unnecessary contracts, purchases and services. The list of financial fiascos exposed by Mr. Frye include, " the agency's human resources department wasted $6.1 million on two conferences in Orlando, Florida, that treated employees more to vacation than to training" and "that VA employees in the Bronx in New York City had swiped charge cards 2,000 times, saying they were buying prosthetic legs and arms for veterans. Each charge was for $24,999, one dollar below the VA’s charging limit for purchase cards. When lawmakers demanded details about the charges, they were told there was no documentation." For those of you without a calculator, the total amount of theft was $2000 short of $50 million.
I can't make this stuff up. I'm not that creative.
I thought it was interesting that Dr. Michael Fallon, the Chief Veterinary Medical Officer of Research and Development for the VA (your tax dollars at work), in his testimony to the Committee cited the Americans with Disabilities Act (ADA). For most of Americans, the ADA provides equal rights and access to service dogs for people with psychiatric conditions as well as for those with physical ones. Yet the VA affords fewer protections under their far more restrictive regulations. Unlike almost every other Federal agency that has simply agreed to honor the ADA, the VA seized the opportunity to put up regulatory barriers that only serve to restrict the access to facilities and services to those who need them most!. (You can read the entire text of the document that Dr. Fallon submitted to the Committee below the video of the hearing.)
I know that my local VA can't seem to get it right on the ADA vs VA regulations nor do they lift a finger beyond a poorly copied, quite unofficial looking notice discreetly put on a clinic door to inform veterans of the VA's access policies for service dogs as published in the Federal Register. If you look closely you will see that there is no notice of authority or citation of law or regulation to support the asinine restrictions some dog hating neanderthal pulled out of his caboose just to throw his weight around. Most of the restrictions that they cite in this notice are well outside the standard practice of civilian hospitals and definitely not in compliance with the wholly-ignored ADA.
They do, however, have signs posted at the main entrance to the medical center informing visitors "only authorized animals" are allowed inside which cites the ADA as its authority. "Doh!"
The Hearing wasn't for naught. Rory Diamond, the Executive Director of K9s for Warriors, Cole Lyle, a veteran with PTSD, and Steve Feldman, Executive Director of the Human Animal Bond Research Initiative (HABRI) all offered very positive and supportive statements confirming what every veteran with a PTSD service dog already knows: trained psychiatric service dogs are indeed effective. Of particular note is the list of results of the internal study done by K9s for Warriors that, among many other things, showed that "The average K9s warrior is on 10-15 medications when beginning our program. 92% see those medications reduced or eliminated after graduation, " and, "Before receiving their service dog, 93% of the participants reported that symptoms associated with PTSD played a major role in their inability to enjoy activities. After receiving their service dog only 18% of participants continued to report that their symptoms played a major role." Links to their testimony are provided below. They are a must read for anyone in the service dog industry and, of course, affected veterans.
Not too long ago I was asked, "how does a grown man find relief from his PTSD symptoms in a dog?" This person was in the position to make such an inquiry. He was not ridiculing me but was looking for a sincere answer to see if I understood the process that has taken place to change my life for the better since Rambo came along.
I answered the question to the best of my ability without going into an hour long speech but ultimately it was Rambo who answered the question best. When I started to show fatigue and frustration, Rambo got up from his down position on the floor and very inconspicuously put his head in my lap. I looked down at his big brown eyes and ran my fingers through the soft fur around his ears and my frustrations melted away.
The VA may not know if or how a PTSD dog is therapeutic but my dog knows!
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| This is a view of how my day starts each morning! |
Click the links below to read the testimony presented at the hearing:
Committee on Oversight & Government Reform, Subcommittee on National Security
April 14, 2016
STATEMENT OF DR. MICHAEL FALLON, CHIEF VETERINARY MEDICAL OFFICER OFFICE OF RESEARCH AND DEVELOPMENT, VETERANS HEALTH ADMINISTRATION (VHA), DEPARTMENT OF VETERANS AFFAIRS (VA) BEFORE THE SUBCOMMITTEE ON NATIONAL SECURITY HOUSE COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM APRIL 14, 2016
Good morning, Chairman DeSantis, Ranking Member Lynch, and Members of the Subcommittee. Thank you for the opportunity to speak about Veterans with posttraumatic stress disorder (PTSD) and service dogs.
VA is in the midst of an ongoing study that pairs Veterans with PTSD with service dogs. I am accompanied today by Dr. Patricia Dorn, Director, Rehabilitation Research and Development Service,and Dr. Chris Crowe, Senior Mental Health Consultant and Liaison to the DoD Defense Centers of Excellence for Psychological Health and TBI. Section 1077 of the 2010 National Defense Authorization Act directed VA to undertake a 3-year study to assess the benefits, feasibility, and advisability of using service dogs for the treatment or rehabilitation of Veterans with physical or mental injuries or disabilities, including PTSD. VA designed the study to focus completely on Veterans with PTSD because: the benefits of utilizing service dogs and guide dogs for physical disabilities were well established;PTSD is a high priority health issue in Veterans, and the benefits of service dogs in assisting people with mental health diagnoses have not been established in scientific literature. As mandated by Section 1077, the study assesses the impact of service dogs on Veterans’ quality of life, their usage of prescription drugs and healthcare resources, and their employment status.
The study has been conducted in two phases. The first phase started in July 2011 and was a pilot study based primarily at the Tampa VA Medical Center (VAMC). Service dogs for the study were purchased from three organizations through contracts. Veteran enrollment in the pilot study had to be suspended in January 2012 after two different service dogs bit the children of Veterans in the study. In response to these bite incidents, VA study team members maintained responsibility for interactions with Veterans after pairing, reduced involvement of the service dog vendor post-pairing, and increased the frequency of interactions between Veterans and the study team to identify and solve potential dog behavior problems as soon as possible. Veteran enrollment resumed in July 2012, but less than a month later ,Veteran enrollment was again suspended due to the discovery of serious problems with the health and training of dogs provided by the remaining dog organization under contract. 26 Veterans already participating had the opportunity to finish the study, but no new Veterans could be enrolled because no additional dogs were available. Of the 26 Veterans enrolled in this phase, twelve completed the study, and four are expected to finish by February 2017. VA recognized that major changes to the dog procurement contracts, study design,and study management were needed. Visits were conducted with a variety of dog training groups to seek advice and get suggestions on how to prevent the serious problems encountered in the pilot study. These groups included well-established and respected service dog organizations, military working dog training organizations, and Department of Defense and civilian Federal dog training units.
The original study design was reviewed again by mental health professionals, all of whom have a research interest in diagnosing or treating PTSD in Veterans and have academic appointments at affiliate universities. Collectively,they have published over 100 articles on PTSD, trauma recovery,or stress in scientific journals. Dr. Thad Abrams leads the Iowa City study team. He is a psychiatrist with the Iowa City VAMC Mental Health Service Line and has extensive experience treating Veterans with PTSD. Dr. Bekh Bradley-Davino was the initial lead for the Atlanta study team until he assumed greater responsibilities as the Director of the Mental Health Service Line at the Atlanta VAMC. Previously, he wasthe Director of the Atlanta VAMC Trauma Recovery program. Dr. Kelly Skelton now leads the Atlanta study team. She is the Acting Deputy Director of the Mental Health Service Line in Atlanta and the Medical Director of the Atlanta VAMC Trauma Recovery program.Until her recent retirement from VA, Dr. Kathy Magruder was a Research Health Specialist in the Research Service Line at the Charleston, South Carolina VAMC. She has extensive experience as a clinical researcher, has published extensively on PTSD and other mental health conditions in Veterans, and is an Associate Editor of the Journal of Traumatic Stress. Dr. Dan Storzbach leads the Portland,Oregon study team. He is a Research Psychologist and the Lead Neuropsychologist for the VA Portland Health Care System Neuropsychology Clinic.
As a result of consultation with dog training experts and the mental health research team, as well as thorough analysis of other lessons learned, key changes were made in the study design: VA hired its own dog trainers to provide support to Veterans after they received a study dog, thus eliminating bias in the study. This required developing an entirely new position within VA. VA developed its own contract health, behavior, and training standards for dogs,instead of relying on the varying standards in use by individual organizations.These standards are based upon portions of DoD working dog contract health standards, and utilize the Assistance Dog International Public Access Test and the American Kennel Club Basic and Advanced Canine Good Citizen tests. VA dog trainers tested candidate dogs against the VA contract standards before accepting dogs into the study and paying for them. VA study staff are responsible for interacting with Veterans after they receive a dog to ensure that any problems with the dog or Veteran-dog pairing are quickly identified and corrected. Veterans with children less than 10 years of age in the household would not be eligible for the study until the safety record of at least 20 dogs from each organization could be evaluated. Note: no vendor has reached the 20 dog delivery mark yet; the evaluations are still in progress. Instead of purchasing dogs only from organizations located close to a VA study site, a full and open contract competition was held to seek out the best possible dog producers. The new dog “vendors” chosen were Canine Companions for Independence (Santa Rosa, California and other sites), the Armed Forces Foundation and partner K2 Solutions (Pinehurst, North Carolina), and the Auburn Technology and Research Foundation with partner iK9, incorporated (Auburn, Alabama). Instead of only one VA study site, three sites are opened to increase the enrollment rate and enroll Veterans from different parts of the country.Atlanta, Georgia; Iowa City, Iowa;and Portland, Oregon were chosen as the study sites for the revised (“Phase 2”) study.
We also standardized the service dog required tasks so that dogs from different vendors would have similar training, reducing experimental variability. The service dog tasks chosen, based upon Veteran feedback in the Tampa pilot study and input from VA PTSD clinicians, were “block,” “behind,” “lights,” “sweep,” and “bring” (retrieve).
The study was also strengthened by adding a second experimental group of Veterans who received emotional support dogs instead of service dogs. The basic obedience and health standards are the same for both types of dogs in the study, and both dog types provide love,affection, and an emotional bond with people, and have legal rights to housing and the cabins of commercial aircraft. However, service dogs are given much wider public access rights than emotional support dogs through the Americans with Disabilities Act, and only service dogs are trained in specific tasks that assist with a disability. By comparing and contrasting the results of the two groups, we expect to be able to better determine what features of each dog type are responsible for any benefits observed in the Veterans.Each Veteran enrolled in the study has a 50/50 chance of receiving a service dog or an emotional support dog. A description of all the test instruments used in the study and instructions for Veterans interested in volunteering for the study are found on the ttp://www.clinicaltrials.gov website (study number NCT02039843). The instruments are administered about quarterly over 21 months to assess measures of self-care, interpersonal interactions and participation in society, the severity of PTSD symptoms, sleep-related problems, suicidal ideation, severity of mood disorders and substance abuse, anger directed at others, inpatient and outpatient visits, medication usage, and measures of employment and work productivity.
Veteran enrollment in the revised Phase 2 study began in December of 2014. Early planning suggested that the three study sites would collectively be able to enroll about 12 Veterans a month; however, the study experienced severe delays due to human resources problems in hiring VA dog trainers, and the complexity of the study required additional staffing at each of the three study sites. These problems led to a much lower monthly enrollment rate.
As of the first week in April 2016, 107 of 220 Veterans have been enrolled in the study, and all three study teams will finally be fully staffed to achieve an enrollment rate of 12-15 Veterans per month, which would allow all 220 Veterans to be enrolled by the end of this year or early 2017. Veterans remain in the study for about 21 months so data collection will end about 21 months after the last Veteran is enrolled, which would be late 2018. The data will then be analyzed,and the results will be published in a peer-reviewed scientific journal.
While VA does not purchase service dogs for Veterans, VA does provide benefits to eligible Veterans with a recognized service dog, which include free high quality veterinary wellness and medical/surgical insurance, certain hardware costs, and certain Veteran travel costs associated with training with the service dog. This benefit extends to service dogs prescribed for a disabled Veteran to manage a diagnosed visual, hearing, or substantial mobility impairment, in order to enable the Veteran to live independently.38 C.F.R. §17.148 (77 Fed. Reg. 54,381, Sept.5, 2012). Currently, VA does not provide benefits for PTSD or mental health dogs because they are not known to be effective in overcoming specific functional limitations; this study is incredibly important in building the evidence base. VA continues to monitor other scientific literature for quality evidence to inform future policies and remains strongly committed to completing the current PTSD and service dog study at an estimated cost of at least $12million.
Existing Effective Treatment of PTSD
VA is strongly committed to the delivery of the best care for Veterans with PTSD. Advances in research have led to a range of effective treatments for PTSD that reduce symptoms and increase functioning and well-being. The VA/Department of Defense Clinical Practice Guideline recommends trauma-focused cognitive behavioral therapy [such as Prolonged Exposure(PE), and Cognitive Processing Therapy(CPT)], Eye Movement Desensitization and Reprocessing, stress inoculation, selective serotonin reuptake inhibitors, and venlafaxine, a serotonin norepinephrine reuptake inhibitor, as primary treatments for PTSD. PE and CPT are among the most widely studied types of trauma-focused cognitive behavioral therapy. Evidence demonstrating their effectiveness is particularly strong. VHA Handbook 1160.01, Uniform Mental Health Services in VA Medical Centers and Clinics, requires that all VA medical centers provide access to either PE or CPT. VAhas supported this requirement by training upwards of 7,000 therapists in these treatments as part of a broader initiative to disseminate evidence-based psychotherapy for mental disorders.Uptake of PE and CPT across the VA health care system was rapid; by 2009, 96 percent of VA facilities were providing PE or CPT and 72 percent were providing both.VA also offers a range of treatment options to treat PTSD and associated symptoms and is using telehealth technologies to increase the availability of treatment for PTSD. VA remains open to new and innovative treatments for PTSD and supports research on these treatments as part of its portfolio on PTSD and related conditions.
Mr. Chairman, I appreciate the opportunity to appear before you today. We are prepared to answer any questions you or other Members of the Committee may have.
