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Witness Testimony of Roger Duke, Readjustment Counseling Therapist, Modesto Vet Center, Veterans Health Administration, U.S. Department of Veterans Affairs

Good Afternoon Congressman Denham, Congressman McNerney…: 

Thank you for allowing me to appear before you today to discuss the Modesto Vet Centers’ practices in providing readjustment counseling services to servicemembers, veterans and their families within the larger VA health care system.

Let me begin by providing you a program history. In addition, I hope to also provide you with an appreciation of the Vet Center Culture, our Clinical Services, and to finally address Modesto Vet Center’s collaboration with the VAMC and other partners in our community.

Program History

VA’s Vet Centers are a different kind of environment—a caring, non-clinical setting—in which Veterans can receive care.  Vet Centers are community-based counseling centers, within Readjustment Counseling Service (RCS), that provide a wide range of social and psychological services including professional readjustment counseling to Veterans and families, military sexual trauma (MST) counseling, and bereavement counseling for families who experience an active duty death. Our program in Modesto, like many throughout the country, also facilitates community outreach and the brokering of services with community agencies that link Veterans with other needed VA and non-VA services. A core value of the Vet Center is to promote access to care by helping Veterans and families overcome barriers that may impede them from using those services.

There are currently 300 Vet Centers located in all 50 states, the District of Columbia, Puerto Rico, Guam, and American Samoa.

The Vet Center program was the first program in VA, or anywhere, to systematically address the psychological traumas of war in combat Veterans, and this a full year before the definition of Post-Traumatic Stress Disorder (PTSD) was published in the Third Edition of the American Psychiatric Association Diagnostic and Statistical Manual (DSM III) in 1980.

Modesto Vet Center’s field-based outreach, which will be addressed by Mr. Randall Reyes, and the Vet Center’s ability to rapidly respond to acute PTSD and other post-war readjustment difficulties, makes it a great compliment to existing VHA mental health services. As a young soldier who personally experienced the stressors of combat in Vietnam and then later as a Marine Corps Ground Combat Officer of Fleet Marine Force line units, I can attest to the need to provide the early intervention and outreach that Vet Centers provide.  I have seen the tremendous positive transitions of our military forces in my military career. However, the issue of overcoming stigmatization remains a constant challenge for those of us providing clinical services. In early 2006, while contracted as an embedded psychological counselor for a battle-scared National Guard Infantry Company, I first heard of the Vet Centers. The Modesto Vet Center had not even been formed when outreach workers from Fresno and San Jose Vet Centers reached out to this Battalion of warriors. Since coming on line in Modesto some four years ago the Modesto Vet Center has been a welcomed support for combat veterans and their families. As an outside observer to a very busy “in the trenches” provider, I have been very impressed with the caliber of professionals at the Modesto Vet Center and their willingness to reach out to the community. When my son Jeremy returned from Afghanistan 2004, he had earned his Combat Infantry Badge with 10th Mountain Division. He was one of those who benefitted from early intervention and while in the National Guard, was able to utilize Modesto Vet Center’s Readjustment Counseling. He subsequently returned to active duty as an Army Medic and returned last year from Iraq. He has told me how appreciative he is that he could talk to someone about things he couldn’t even share with his own family. I believe the Vet Centers, to include the Modesto Vet Center, provide a proven ‘best practice’ model in fostering peer-to-peer relationships for those with combat stress disorders.

Modesto Vet Center Culture

Modesto has adapted its program to continually optimize this practice within the context of the community. The unique culture of the Vet Center is evident in Modesto. It is a rapidly responsive team that “leads by example.” I feel very privileged to work at a Vet Center that appreciates and utilizes my strengths and passion for assisting combat Veterans. Headed by our Team Leader, Steve Lawson, the Modesto Vet Center currently employs 3 counselors including one Licensed Clinical Social Worker and one Licensed Marriage and Family Therapist. We have one office manager and one Global War on Terrorism (GWOT) Outreach Specialist. In addition, we partner with VA’s Vocation Rehabilitation, Veterans Service Organizations, California’s Employment Development Department, and the Judicial Outreach of the VA in Menlo Park. Our community partners also include private citizens and community non-profit organizations offering socialization and recreational activities so vital to maintaining mental health. Examples include inland and ocean fishing and crabbing excursions, sailing, horseback riding, and bowling. The area served combines both sprawling urban and rural communities. The Modesto Vet Center relies on the relationship with these communities to support and sustain important aspects of our Vet Center culture.

Clinical Services

Readjustment counseling in Modesto is pretty typical of the clinical services offered by the 300 Vet Centers nationally. I and my colleagues provide a wide range of psychotherapeutic and social services to eligible Veterans and their families in the effort to make a successful transition from military to civilian life. They include:

  • Individual and group counseling for Veterans and their families
  • Family counseling for military related issues
  • Bereavement counseling for families who experience an active duty death
  • Military sexual trauma counseling (MST) and referral if required (gender specific)
  • Educational classes on PTSD, Couples Communication, Anger and Stress Management, Sleep Improvement, and Transition Skills for Civilian Life
  • Substance abuse assessment and referral
  • Employment assessment and referral
  • Screening & referral for medical issues, including mTBI, depression, etc.
  • VBA benefits screening and referral

Safety and Confidentiality

It is my belief that it’s not so much the uniqueness of clinical services that sets Vet Centers apart from other Community-based Outpatient clinics, as it is the combat veteran’s sense of safety and belonging experienced when they first come through the doors of the center. I have heard repeatedly by Veterans, both young and old, that they have a “connection” to one another. You can see this played out, whether in a PTSD process group or in a game of dice. The ritual is the same. You are a fellow warrior and whatever you’re going through, you belong. The role that staff plays in providing this safety goes beyond confidentiality, which is of paramount importance. There is an elevated sense that staff respects the uniqueness of all combat Veterans and hold in strictest confidence all information disclosed in the counseling process.  From orientation to closure the message is the same: No information will be communicated to any person or agency outside of RCS unless specifically requested by the Veteran, or as excepted in current clinical practices.

Collaboration with VAMC and Community Partners

  • Bi-directional referral process
  •  Participation in VA Medical Centers Mental Health Councils
  •  Joint Participation in VA and Community Events
  •  Medical Centers provide to Vet Centers:
  • External clinical supervision at a majority of Vet Centers
  • Clinical Liaisons who coordinate the care for complex cases (judicial outreach) and shared Veterans and provide quality reviews of Veteran suicide and other critical events.
  • Administrative Liaisons to support fiscal, human resource, procurement, and engineering service functions.
  • Both Modesto Vet Center and VAMC have jail access to incarcerated Veterans

Community Partnerships are integral to successful support for veterans while they are in the readjustment process. Our counselors have been involved in Restorative Justice along with other stake holders in the community. From time to time, Vet Center Counselors have provided expert advice to the courts on PTSD assessment and treatment in support of California Penal Code 1170.9. I have been invited to be a regular instructor to the Law Enforcement Academy’s Crisis Intervention Training to provide a perspective to crisis negotiators on the issues facing combat veterans as they return and readjust to their communities. This relationship has played out in a positive manner on the streets of Modesto where, in one example, a combat Veteran was given a referral to our office in lieu of possible involvement with law enforcement. The Stanislaus County Mental Health Forensics Program Manager has praised this collaborative community partnership and the role the Modesto Vet Center has played in elevating cultural competence towards Veteran issues, especially those returning from combat.

In my own experience, I have appreciated the challenges that come with serving combat Veterans. Whether advocating in court, arranging reintegration for a wayward active duty soldier, providing bereavement services for family members, or listening and comforting a World War II Veteran crying over loses felt over 60 years ago, the Modesto Vet Center is there, “Keeping the Promise.”

Thank you again for the opportunity to appear before you. I am now prepared to answer your questions.