1

Serving Those Who Have Served

Serving Those Who 

Have Served:

Educational Needs of 

Health Care Providers 

Working with Military 

Members, Veterans, 

and their Families 

A Web Survey of Mental Health

and Primary Care Professionals

Dean G. Kilpatrick, Ph.D. 1

Connie L. Best, Ph.D. 1

Daniel W. Smith, Ph.D. 1

Harold Kudler, M.D. 2

Vickey Cornelison-Grant 1

1 Medical University of South Carolina, Department of Psychiatry & 

Behavioral Sciences

2 Rural Health Program, VA Mid-Atlantic Health Care Network (VISN 6)

December 1, 2011
Acknowledgements

This report was sponsored by Contract No. V246-P-0634 between VA Mid-Atlantic 

Health Care Network (VISN 6), Department of Veteran Affairs and the Medical 

University of South Carolina, Department of Psychiatry and Behavioral Sciences, 

National Crime Victims Research and Treatment Center. Opinions and recommendations expressed in this document do not necessarily represent those of VISN 6 

or the Department of Veterans Affairs. The authors would like to acknowledge and 

thank Brittany Baber for her time and efforts on programing the questionnaire and 

managing the data. They would also like to thank all the providers who graciously 

gave of their time to complete the survey.

Citation:

Kilpatrick, D. G., Best, C. L., Smith, D. W., Kudler, H., & Cornelison-Grant, V. 

(2011). Serving those who have served: Educational needs of health care providers 

working with military members, veterans, and their families. Charleston, SC: Medical 

University of South Carolina Department of Psychiatry, National Crime Victims 

Research & Treatment Center.

Acknowledgements

Citation
3

Introduction

The September 11, 2001 terrorist attacks on the World Trade Center in New York City 

and the Pentagon set in motion the longest military conflicts in our nation’s history. In a 

recent editorial in the Journal of the American Medical Association, Charles Hoge (2011) 

documents the toll the conflicts in Afghanistan and Iraq have taken on the mental and 

physical health of those who have served and their families. Many of those who have served 

are still in the active duty Armed Forces, National Guard, or Reserves, whereas others have 

completed their military service and are now veterans.

The men and women who have served in this conflict have family members who are 

concerned about their safety when they deploy. Family members also have concerns about 

the well-being and adjustment of their relatives when they return home. The stressful impact 

of these conflicts upon both those who have served and their families has been magnified by 

several factors, including the long duration of the conflict, the extensive use of the National 

Guard and Reserves, extended tours of duty, and multiple deployments.

Our nation has made a major commitment to address the physical and mental health 

needs of those who have served in Iraq and Afghanistan and their families. Two signature 

injuries of these conflicts are posttraumatic stress disorder (PTSD) and traumatic brain 

injury (TBI). An illustration of the nation’s commitment to improving mental health care 

is that the Department of Veterans Affairs (VA) has added approximately 5000 new mental 

health professionals to its staff and mandated that all veterans treated for PTSD have access 

to treatments with the highest level of empirical support. The VA and the Department 

of Defense (DoD) have also implemented numerous screening, outreach, and treatment 

programs designed to serve those who have served and their families.

____ M ____

Serving 

Those Who 

Have Served:

Educational 

Needs of Health 

Care Providers 

Working 

with Military 

Members, 

Veterans, and 

their Families

A Web Survey 

of Mental 

Health and 

Primary Care 

Professionals

DoD photo by Cherie Cullen

DoD photo by Cpl. Reece Lodder, 

U.S. Marine Corps.
4

However, Hoge (2011) notes that these efforts to 

identify those who need PTSD treatment and get them 

access to effective treatment have been only partially 

successful. Among the key barriers he identifies: ineligibility 

for services, reluctance to seek treatment at VA or DoD 

facilities, treatment dropout, and failure of treatment 

providers to understand key aspects of the military culture 

that influence both the clinical picture of PTSD and service 

members’ willingness to seek treatment. Hoge argues 

that the DoD and VA alone cannot address these unmet 

service needs and that “meeting veterans where they are” 

is essential in both an existential and geographical sense. 

From an eligibility perspective, not all veterans are eligible 

for PTSD treatment services at VA health care facilities, and 

members of the National Guard and Reserves are generally 

not eligible for treatment at DoD facilities unless they are 

in active duty status. In addition, even if they are eligible 

for treatment, many individuals may not live near a DoD 

or VA hospital or outpatient facility. For family members 

of service members and veterans, access to services is more 

complex. Although the VA system is loosening restrictions 

about providing services to family members, priority is still 

given to veterans. Family members of active duty service 

members are eligible for coverage through TRICARE, 

a form of subsidized health care insurance for military 

dependents and retirees, but may not necessarily be seen in 

a military treatment facility. For all of these reasons, it is 

clear that many of those who have served and their families 

receive their health care from providers in the private sectornot from those in DoD or VA facilities.

Meeting veterans where they are is much more than 

providing access to nearby care. According to Hoge, it is 

also essential for treatment providers to understand aspects 

of military and combat culture that help those who have 

served feel understood by providers who are attempting to 

care for them. The military has a unique culture developed 

through rigorous training and maintained by a strong sense 

of membership in an elite group of well-trained professionals. 

Their experiences are difficult to understand by those who 

are not part of the profession. Hoge also describes how 

important it is for treatment providers to understand how 

some behaviors and physical reactions that are considered 

symptoms in civilian life are actually adaptive in combat 

situations (e.g. being extremely vigilant in dangerous 

situations is adaptive, but it becomes the PTSD symptom 

of hypervigilance if it persists in non-dangerous situations). 

Thus, “meeting veterans where they are” requires that we 

understand their culture, their profession, and how their 

“work experiences” and culture have influenced their view 

of their problems, why they might be reluctant to seek 

treatment, and the clinical presentation of their symptoms.

Not all, and perhaps not even most, PTSD assessment 

and treatment is provided by mental health providers, so 

the role of primary care professionals in serving those who 

have served and their families is important. This is true 

in the DoD and VA health care delivery systems, but it is 

particularly true for those who are treated in the private 

sector. Therefore, it is important to include primary care 

as well as mental health providers in any efforts to expand 

access to assessment and treatment services. Primary care 

providers perform an important gate keeping function for 

the health care system and are well-positioned to screen 

for potential problems among those who have served and 

their family members. They also can make referrals to 

mental health providers with special expertise in PTSD 

treatment. Some mental health providers have this 

expertise, but many do not. 

The VA has developed several initiatives designed 

to engage private sector primary care and mental health 

providers in the assessment and treatment of veterans, 

particularly those who reside in rural areas. However, it 

is unclear how many private sector providers are willing 

to collaborate in these initiatives or might be willing 

to participate if they were provided with information 

and training. Nor do we know much about the type 

of information and trainings providers want or need, 

or the ways in which they would prefer to receive the 

information. Such knowledge would be extremely useful 

to those developing educational and training materials 

and to those involved in these VA rural initiatives.
5

Survey Findings

Overview of Project 

Methodology

Overview of Project Methodology

This project was designed to gather information from a large, diverse group of primary 

care and mental health care providers who were predominately from the private sector. A 

web-based survey was designed and conducted by the Medical University of South Carolina 

(MUSC) with funding from the VA’s Office of Rural Health through the VISN-6 Rural 

Health Initiative. The basic strategy was to obtain several lists of primary care and mental 

health professionals and send them an invitation to participate in a brief web survey (see 

Appendix A). The invitation included a description of what the survey was about, stated that 

no compensation was involved and that the survey would take approximately 10 minutes to 

complete, and provided a link at which the survey was located. The survey was constructed 

using the REDCap platform, and it included information about the following topics:

	 •	 Type of specialty and nature of practice

	 •	 Whether practice accepts TRICARE

	 •	 Prior or current service in the Armed Services, National Guard, or Reserves

	 •	 Prior training or employment at VAMC

	 •	 Percent of patient panel who are former or current members of Armed Forces

	 •	 Practices regarding screening of patients for current/former members of the Armed

Forces and their families

	 •	 Opinions about quality of care provided by the DoD and VA

	 •	 Knowledge about eligibility requirements for veterans and Reservists to receive VA care

and willingness to refer patients to the VA

	 •	 Extent to which providers thought they were knowledgeable about, and confident in,

their ability to use best practice treatments for relevant conditions

	 •	 Providers’ interest in training topics and modalities

In addition, providers were given the opportunity to provide open ended responses to 

questions about factors determining their use of educational materials and types of training 

resources that would be most helpful.

Survey Findings

Participation Rate: Of the 327 providers who accessed the survey, 97.6% (n=319) 

agreed to participate. There is no way to determine how many potential providers 

were informed about the study because numerous invitations were sent out by multiple 

organizations, so we cannot determine how many unique individuals received invitations. 

However, it is clear that the vast majority of those who visited the survey site agreed to 

participate.

Description of Provider Sample: As illustrated in TABLE 1, approximately twothirds of providers were mental health professionals, and the remainder identified themselves 

as primary care providers or other professionals. Among mental health professionals, 

psychologists were the most prevalent group, followed by psychiatrists, and social workers/

other mental health professionals. The most prevalent type of primary care specialty among 

providers was family medicine, followed by pediatrics and internal medicine.

“I moved to 

NC because 

my son 

called from 

Afghanistan, 

saying, ‘My 

guys have 

seen too 

much, please 

come down 

here.’ It is 

what I came 

here to do. I 

want to do 

it the best 

way.”

A community mental

health professional
6

Providers’ Experience with the Armed Forces and VA

Type of Provider

Mental Health Professional 67%

Psychologist 32%

Psychiatrist 19%

Social Worker/Other 16%

Primary Care 27%

Family Medicine 17%

Pediatrics 7%

Internal Medicine 3%

Other Professional 6%

Type of Practice Setting

Private Practice 49%

Clinic Based 39%

Hospital 12%

Rural Practice?

Yes 34%

No 60%

Not Sure 6%

Ever Serve in the Armed Forces?

Yes 16%

No 84%

Ever Trained in VA?

Yes 31%

No 69%

Table 1 Overview of Provider sample Among providers, almost half (48.1%) stated that 

the setting in which they worked was a private practice. 

Another 38% worked in a clinic-based practice, and 12% 

worked in a hospital setting. When asked whether they 

would describe their practice as rural, approximately 

one third of providers said yes (34%), 60% said no, and 

the remaining 6% were not sure. Over half (59%) of 

providers stated that their practice accepted TRICARE 

for reimbursement, and 28% said no. Interestingly, 13% 

of providers did not know whether their practice accepted 

TRICARE, suggesting a need for more education about 

this important reimbursement source.

Providers’ Experience with the Armed 

Forces and VA. 

In light of Hoge’s comments about the importance 

of military culture, we thought that is was important to 

determine if providers had served in the Armed Forces and 

about whether they completed any of their professional 

training at the VA.

	 •	 Only one out of six (16%) providers stated that they

had ever served in the Armed Forces including the 

Reserves or National Guard

	 •	 Approximately one third (33%) of the providers had

completed some part of their training in a VA hospital

	 •	 Only one out of eight (12%) have ever been employed

as a health professional in the VA system

Figure 1. Providers’ Estimate of Number of

Service Members in Patient Panel

50-

25-

0- No Ability

to Estimate 15% or Less

Percent

Over 16%

These findings suggest 

that most providers in our 

survey had no direct military 

experience themselves. Also, 

most providers also lacked 

training or working experiences at the VA that could 

have provided them with 

information about veterans 

and military culture.
7

Knowledge of Members

of Armed Forces, 

Veterans, and Family 

Members in Patient 

Panels

Knowledge of Members of Armed Forces, Veterans, and 

Family Members in Patient Panels. 

Providers were asked what percentage of their patient panels was either a current or 

former member of the Armed Forces (see Figure 1). 

	 •	 Approximately two-thirds said between 0-15%

	 •	 Just under 1 in 5 said between 16-50%

	 •	 5% said over 50%

	 •	 11% indicated that they had no ability to estimate

When asked the percentage of their panel who were family members of current or 

former members of the Armed Forces (see Figure 2). 

	 •	 31% said they had no ability to estimate

	 •	 39% said 15% or less

	 •	 27% said between 16-50%

	 •	 3% said over 50%

Respondents were also asked if they regularly screened 

their patients to determine if they were a current or former 

member of the Armed Forces or a family member of such 

a person (see Figure 3). 

	 •	 Almost half of providers (47%) said they did not

screen

	 •	 44% said they did screen

	 •	 9% said it was not necessary to screen because they

knew their patients quite well

From these responses, it is clear that systematic 

screening for military or veterans status was not the norm 

among these providers. Many 

did not know the proportion 

of their case loads who were 

either current or former 

members of the armed forces 

or family members of the 

same. This suggests that 

implementing some type of 

brief screening would improve 

recognition.

“I probably have 

a significant 

number of 

former service 

members 

that I’m 

unaware of.”

A community mental

health professional

Figure 2. Providers’ Estimate of Number of

Family Members in Patient Panel

50-

25-

0- No Ability

to Estimate 15% or Less

Percent

Over 16%

Figure 3. Providers’ Screening for Military 

Experience

50-

25-

0- Do Not

Screen

Do

Screen

Percent

Screening Not

Necessary
8

Attitudes about VA 

and DoD Health Care 

Services:

Distance of Practice from 

Nearest VA and DoD 

Health Care Facility Distance of Practice from Nearest VA and DoD Health 

Care Facility 

One question of interest was whether providers’ practices were located near VA or DoD 

health care facilities. Although providers who are in close proximity to VA or DoD facilities 

still have a valuable role to play, those whose practices are more distant from VA or DoD 

facilities are better situated to serve those who lack ready access to a VA or DoD facility.

When asked how far away their practice was from the nearest VA medical facility:

	 •	 3% said not sure

	 •	 3% said over 2 hours

	 •	 50% said between 30 minutes and 2 hours

	 •	 44% said less than 30 minutes

When asked how far their practice was from the nearest DoD medical facility:

	 •	 17% said not sure

	 •	 27% said over 2 hours

	 •	 49% said between 30 minutes and 2 hours

	 •	 7% said less than 30 minutes

Two interesting findings emerge from these responses. First, VA facilities tend to be 

located closer to the practices of these providers than DoD facilities. Second, most of these 

providers indicate that their practices are more than thirty minutes away from VA or DoD 

health care facilities. This indicates that most of these providers were practicing in a location 

that was not adjacent to VA or DoD health care facilities.

Attitudes about VA and DoD Health Care Services: 

It is reasonable to assume that providers have attitudes and opinions about VA and DoD 

health care systems and the quality of care delivered within these systems that influence their 

willingness to collaborate with health care professionals 

within these systems. Likewise, such attitudes and 

opinions may also influence willingness to provide care. 

Therefore, the survey included several questions designed 

to measure relevant attitudes and opinions. The format of 

these questions involved presenting a series of statements 

and asking respondents to the extent to which they agreed 

with the statement. 

The first statement was “The VA healthcare system does 

an adequate job meeting the medical and mental health 

needs of veterans and returning Reservists.” As illustrated 

in Figure 4, more than 4 out of 10 respondents did not 

agree that VA healthcare system meets these needs, and almost one-third of respondents 

were neutral in their assessment. Slightly more than one quarter of respondents agreed that 

VA is doing an adequate job meeting medical and mental health needs.

“I do what I 

do without any 

idea of what the 

DoD/VA team 

is up to. My 

role is second 

guessing and 

advising the 

patient what 

to ask for and 

what to watch 

out for.”

A community mental

health professional

Figure 4. VA healthcare system does an adequate

job of meeting the medical and mental health needs

of Veterans and returning Reservists (N=317)

50-

25-

0- Agree Neutral

Percent

Disagree

-

-
9

The second statement was “Active duty members of the Armed Forces receive adequate 

medical and mental health services from providers within the DoD health system.” As 

Figure 5 indicates, respondents had mixed opinions about the adequacy of care provided 

within the DoD system. 

	 •	 Most were neutral and said that they neither agreed

nor disagreed with the statement.

	 •	 Slightly more than one in four providers agreed that

members of the Armed Forces received adequate care 

from the DoD. 

	 •	 Over a third of the practitioners disagreed that

adequate care was provided at DoD facilities.

The third statement assessed opinions about whether 

“VA health care system provides high quality medical and 

mental health care.” Figure 6 illustrates the responses to 

this statement.

	 •	 Approximately a third of providers were neutral in

their assessment.

	 •	 Only one provider in five disagreed with thestatement.

Another statement addressed whether “My concerns 

about the quality of service provided in VA facilities make 

me hesitant to refer eligible patients to VA for medical and 

mental health care services.” As Figure 7 indicates:

	 •	 Almost half of providers disagreed with this statement,

indicating that they are not hesitant about making 

such referrals.

	 •	 About a third of providers had neutral opinions about

this statement.

	 •	 Almost onein five providers agreed with thestatement,

indicating that their concerns about the quality of 

services at VA resulted in their reluctance to refer 

patients to the VA.

These findings have implications for potential outreach 

efforts by VA and DoD. First, many providers already 

have reasonably favorable attitudes about VA and DoD 

health care systems and the quality of medical and mental 

health care that these systems provide. Second, attitudes 

about VA care appear to be somewhat more favorable than 

those about DoD care. Third, the fairly large percentage 

of providers who had neutral responses indicates that there 

is a major “target of opportunity” for educational outreach about VA and DoD health care 

systems. Providers with neutral opinions are providers who can be converted to advocates if 

they are provided with more information.

Figure 5. Active duty members of the Armed 

Forces receive adequate medical and mental 

health care services from providers within the 

DoD health system (N=316)

50-

25-

0- Agree Neutral

Percent

Disagree

Figure 6. VA health care system provides high

quality medical and mental health services (N=316)

50-

25-

0- Agree Neutral

Percent

Disagree

Figure 7. My concerns about the quality of service

provided in VA facilities make me hesitant to refer

eligible patients to the VA for medical or mental

health care services (N=316)

50-

25-

0- Agree Neutral

Percent

Disagree
10

Knowledge of Eligibility

Requirements for VA 

Services, How to Make 

Referrals, Desire for 

More Information, and 

Referral Practices

Knowledge of Eligibility Requirements for VA Services, 

How to Make Referrals, Desire for More Information, and 

Referral Practices: 

 It is difficult for providers to make referrals to the VA health care system if they do 

not understand eligibility requirements to receive VA services. As inspection of Figure 8 

indicates, practitioners were interested in increasing their knowledge about these eligibility 

requirements: 

Agree Neutral Disagree

Figure 9. I am knowledgeable about how to refer

a Veteran for medical or mental health care

services at the VA (N=317)

50-

25-

0-

Percent

Figure 8. I would like to be more knowledgeable

about the eligibility requirements for Veterans and

Reservaists to receive VA services (N=318)

75-

50-

25-

0- Agree Neutral

Percent

Disagree

	 •	 Over half of providers said they would liketo be more

knowledgeable about VA eligibility requirements.

	 •	 Just under one-third were neutral.

	 •	 Only 12% said they did not wish to become more

knowledgeable.

However as illustrated in Figure 9, most providers do 

not think they are knowledgeable about how to refer a 

Veteran for medical or mental health care at the VA: 

	 •	 Fewer than one-third of providers said they were

knowledgeable. 

	 •	 Almost 6 out of 10 providers disagreed that they are

knowledgeable.

	 •	 14% were unsure.

Of the 93 providers who said they were knowledgeable about how to refer Veterans to 

the VA, over half (58%) said they sometimes made referrals to the VA. Only 13% said they 

never made referrals. Twenty-six percent said they made referrals often (13%) or very often 

(13%), and 3% said they were not sure about how frequently they made referrals.

Providers were asked the extent to which they agreed with the statement, “I am 

knowledgeable about support service in my community for family members of current and 

former members of the Armed Forces.”

	 •	 Only 28% of providers agreed with this statement.

	 •	 Almost 6 out of 10 providers disagreed, indicating

that they were not familiar with such community 

services.

	 •	 The remaining 15% neither agreed nor disagreed

with the statement.

These findings indicate that many providers need 

increased education about VA eligibility requirements. 

Also, perhaps relatedly, many providers state that they 

do not refer all eligible patients to the VA. Finally, the 

majority of providers say that they are unfamiliar with 

support services for families, suggesting another potential educational need. 
11

Knowledge About and

Confidence In Best 

Practice Treatments 

for Conditions Among 

Current and Former 

Members of the Armed 

Forces

Appropriateness of 

Screening for Stress of 

Being Part of a Military 

Family and of Applying 

Knowledge Gained in

Civilian Treatment of 

PTSD and Depression 

when Treating Military 

Populations

Appropriateness of Screening for Stress of Being Part 

of a Military Family and of Applying Knowledge Gained 

in Civilian Treatment of PTSD and Depression when 

Treating Military Populations: 

The vast majority (90%) of providers agreed that it is helpful to ask family members of 

current and former members of the Armed Forces about stressors related to being part of a 

military family. Only 1% disagreed, and 9% were neutral. This suggests that most 

providers think it is important to ask family members about these stressors.

Those who thought it was helpful to ask about military family stressors were 

asked how often they asked family members about such stressors.

	 •	 23% said very often

	 •	 27% said often

	 •	 38% said sometimes

	 •	 5% said never

	 •	 7% were not sure

This indicates that only half of providers who think it is helpful to screen 

actually do so often or very often. An obvious question is why these providers do 

not screen, but the survey did not ask this follow-up question.

Another relevant question is whether providers think that knowledge and skills 

obtained by treating civilians can be applied to treating military populations. When asked 

whether they agreed that it was appropriate to apply knowledge about treating PTSD or 

depression in civilians to these treatment of these conditions in military populations:

	 •	 62% said it was appropriate

	 •	 13% said it was not appropriate

	 •	 25% were neutral

These findings suggest that most providers believe that treatment expertise acquired 

in the civilian sector is applicable to treatment of conditions such as PTSD and depression 

among individuals from the military.

Knowledge About and Confidence In Best Practice 

Treatments for Conditions Among Current and Former 

Members of the Armed Forces.

Providing treatment services to current and former members of the Armed Forces is 

facilitated if providers are knowledgeable about best practice treatments and are confident in 

their ability to deliver them to current and former members of the Armed Forces. Therefore, 

the survey asked two questions about treatment of several conditions that are particularly 

relevant. The first set of questions asked providers how knowledgeable they were about the 

treatment of each condition. The second set of questions asked how confident they were 
12

about treating each condition among current and former 

members of the Armed Forces.

Table 2 contains responses concerning knowledge 

about best practice treatments for these conditions. Major 

findings were:

	 •	 There were differences in knowledge of best practice

treatment for different conditions.

	 •	 The conditions with the highest knowledge ratings

were treatments for depression (61%), suicide (52%), 

and family stress and relationship problems (50%).

	 •	 Fewer than half of providers said they were

knowledgeable about best practice treatments for 

PTSD (45%), substance abuse/dependence (42%), and

TBI (24%).

Table 2 Knowledgeable About Best Practice 

Treatments for Relevant Conditions Among 

Current and Former Members of the Armed Forces

	 •	 Providers were most confident in their ability to treat

depression, suicide, and family stress and relationship 

problems. 

	 •	 Providers had less confidence in their ability to use

best practice treatments for PTSD, substance abuse/

dependence, and TBI.

Table 3 Confidence in Ability to Provide Best 

Practice Treatment for Relevant Conditions Among 

Current and Former Members of the Armed Forces

PTSD and TBI have been described as the signature 

injuries of the current military conflicts, so it is noteworthy 

that providers were less knowledgeable about, and less 

confident in the use of, treatments for PTSD and TBI than 

for other conditions. This also suggests that an opportunity 

exists for increased education and training about treatments 

for these conditions. It may be that providers with greater 

knowledge about and confidence in their ability to provide 

treatment for major conditions affecting members of the 

Armed Services would be more likely to screen for past or 

current military status.

Knowledgeable About 

Best Practices Agree Neutral Disagree

In Treatment of: 

PTSD 45% 17% 38%

TBI 24% 18% 58%

Depression 61% 20% 19%

Substance Abuse/

 Dependence 42% 21% 37%

Family Stress and 

 Relationship Problems 50% 24% 26%

Suicide 52% 20% 28%

Table 3 provides information about the extent to which 

providers said they were confident in their ability to provide 

best practice treatments for these relevant conditions to 

current or former members of the Armed Services. As 

was the case for knowledge, providers were more likely 

to express confidence in their ability to use best practice 

treatments for some conditions than for others.

Confident in Ability

to Deliver Best Practice Agree Neutral Disagree

Treatment for: 

PTSD 41% 23% 46%

TBI 19% 22% 59%

Depression 64% 17% 19%

Substance Abuse/

 Dependence 39% 21% 40%

Family Stress and 

 Relationship Problems 51% 24% 25%

Suicide 51% 20% 29%
13

Topics Providers Would 

Like to Learn More 

About

Topics Providers Would Like to Learn More About. 

The next set of questions identified several topic areas and asked providers whether they 

would like to obtain more information. For each statement, respondents were asked if they 

agreed that they would like more information about the topic, if they disagreed, or if they 

were neutral. Providers’ responses are summarized in Table 4. Major findings were:

	 •	 Over half of providers wanted more information about providing care to current or

former members of the Armed Forces with legal troubles and to Veterans and Reservists 

with significant housing problems.

	 •	 Also, 8 out of 10 providers wanted more information about the medical and mental

health problems of current and former members of the Armed Forces and their families.

	 •	 Almost three-fourths of providers wanted more information about the roles of women

in the military and how that might impact their health.

Table 4 Providers’ Interest in Obtaining Information About Relevant Topics

These findings indicate that most providers are interested in learning more about all of 

these topics. It is also noteworthy that very few providers state that they are not interested 

in learning about them. This suggests that providing information about each is likely to be 

received positively by providers.

When asked to respond to the statement, “Because of the demands on my time, 

learning about the health needs of veterans, service members, and their families is not a 

priority for me”:

	 •	 Only 20% agreed with this statement.

	 •	 29% were neutral

	 •	 51% disagreed, indicating that they were open to learning more.

These findings indicate that even busy providers will make the time to learn more about 

the pressing problems of service members.

Interested in More Information About: Agree Neutral Disagree

Roles women fulfill in the military and possible 

impact of these roles on women’s health

Providing care to current or former members of 

the Armed Forces who have gotten in trouble 56% 20% 24%

with the law

Providing care to Veterans and returning 

Reservists who are homeless or who have 55% 21% 24%

significant housing problems

Medical and mental health problems of current 

and former members of the Armed Forces 79% 15% 6%

and their families

72% 16% 12%
14

Training Methods and 

Resources Identified by 

Providers as Being Most 

Useful for Increasing 

Knowledge “Literally, I 

cannot afford 

financially to be 

away from my 

office for sick 

days, vacations, 

or extended 

holidays, 

let alone for 

training or 

other purposes.”

A community mental

health professional

Training Methods and Resources Identified by Providers 

as Being Most Useful for Increasing Knowledge.

Any training must consider not only the content of training that should be provided 

but also the way to provide information that would be most useful to providers. Therefore, 

the survey identified a number of potential training resources and asked providers which 

resources would be most useful in increasing their own knowledge about medical and 

mental health problems experienced by current and former members of the Armed Forces. 

Responses are compiled in Table 5. The most popular resources were:

	 •	 Web-based training courses

	 •	 Conferences or workshops

	 •	 One page informational handouts

The following resources were viewed as helpful by fewer providers:

	 •	 Telephone consultation with experts

	 •	 Pocket cards with symptoms

	 •	 Tri-fold brochures

	 •	 Teleconference (e.g., Skype) consultation with expert

Table 5 Which of the following types of resources 

would be most useful for increasing your own 

knowledge about medical and mental health 

problems experienced by current and former 

members of the armed forces? Identify all that apply

Educational Resource Percent

Web-based training courses 63%

Conferences or workshops 62%

One page informational handouts 51%

Telephone consultation with expert 37%

Pocket cards listing symptoms or 

phone numbers 37%

Trifold brochures 34%

Teleconference (e.g., Skype consultation 

with expert 21%

Other 5%
15

Most Important 

Factors in Determining 

Whether Providers Will 

Use Informational or 

Training Resource

Most Important Factors in Determining Whether 

Providers Will Use Informational or Training Resource

Understanding factors related to training resource use is also important because it 

provides insights into the reasons providers do and do not avail themselves of training 

offerings. As detailed in Table 6, providers said the most important factors were:

	 •	 Convenience (e.g., distance from home, ease of access, flexibility of scheduling)

	 •	 Cost

	 •	 Ability to obtain CME or CE credits

Other factors were identified as important by fewer providers:

	 •	 Time away from practice

	 •	 Ability to get more referrals

	 •	 Receiving credentials for completing training

Based on these responses, it is clear that Web-based training courses have much to offer, 

particularly if they can be offered at low cost and provide CME or CE credits. They are 

convenient, do not require time away from one’s practice, can be provided at low or no cost, 

and can give CME and CE credits.

Factor Percent

Convenience (e.g., distance from home, 

ease of access, flexible scheduling) 84%

Cost 68%

Ability to obtain CME or CE credits 65%

Time away from practice 46%

Ability to get more referrals of service 

members, veterans, Reservists, and 

their families 22%

Receive credential (e.g., certificate or 

accreditation) for completing training 20%

Other 3%

Table 6 What are the most important factors in 

determining whether you will use an informational 

or training resource? Identify all that apply
16

Comparisons of 

Rural and Non-Rural 

Providers

Comparisons of Rural and Non-Rural Providers.

One of the major objectives of the project was to identify characteristics, opinions, 

training needs, and training preferences of providers practicing in rural areas. We assumed 

that there would be many similarities between providers whether they practiced in rural 

areas or not, but we also know that there are particular challenges associated with practicing 

in rural areas. Therefore, we divided the sample into two groups based on rural vs non-rural 

practice location. For the purpose of the following analyses, 18 providers who were not sure 

whether their practice was rural were excluded, resulting in two groups: a) rural (n=107), 

and b) non-rural (n=188) providers. Next, we conducted a series of Chi Square analyses to 

determine if there were significant differences between the Rural (R) and Non-Rural (NR) 

groups with respect to their survey responses. Based on these analyses, we will focus on the 

survey responses that were significantly different between the two groups, but we will also 

describe the responses that were not significantly different.

	 •	 Providers in the R group weresignificantly morelikely than thosein the NR group to be

primary care professionals (53% vs 14%) but less likely to be mental health professionals 

(44% vs 83%) Other professionals did not differ across the two groups (3% vs 3%).

	 •	 Type of practice differed significantly. Providers in the R group were more likely than

those in the NR group to practice in clinics (51% vs 32%) and less likely to practice in 

hospitals (7% vs 15%) and private practice settings (42% vs 53%).

	 •	 Providers in the R group were more likely than those in the NR group to accept Tricare

(73% vs 50%).

	 •	 There were no significant differences between the R and NR groups with respect to

having served in the Armed Forces (20% vs 15%) or having done training in the VA 

(26% vs 35%). However, providers in the R group were significantly less likely than 

those in the NR group to have been a VA employee (6% vs 15%) and to have served on 

the clinical staff at the VA (4% vs 11%).

	 •	 There were no significant differences between the R and NR groups with respect to

their estimates of the percentage of current or former members of the Armed Forces in 

their practice.

	 •	 When asked to estimatethe percentage of family members of current orformer members

of the Armed Forces in their practice, there were significant differences between the R 

and NR groups. A larger percentage of the R group than the NR group estimated that 

under 50% of their patient load were family members (74% vs 62%), but a smaller 

percentage said they had no ability to estimate (24% vs 35%).

	 •	 A significantly smaller proportion of the R group than the NR group said they routinely

screened their patients for military, veterans, and family member status (37% vs 47%).

	 •	 Not surprisingly, the nearest VA health care facility was significantly farther away from

providers in the R group than in the NR group. For example, 57% of providers in 

the NR group said the nearest facility was less than 30 minutes away vs only 20% of 

providers in the R group.

	 •	 DoD health care facilities were also significantly more likely to be farther away from R

group members than from NR groups. For example, 37% of the R group said the nearest 

such facility was more than 2 hours away in contrast to only 23% of the NR group.
17

	 •	 There were no significant differences between the two

groups in attitudes about whether the VA and DoD 

meets mental health and medical needs, whether 

the VA provides high quality medical and mental 

health services, whether the provider wanted more 

information about eligibility for VA services, concerns 

making them hesitant to make a referral to the VA, 

knowing how to refer patients to the VA for services, 

and how frequently they made such referrals to the VA.

	 •	 There was no significant difference between R and NR

group members with respect to how helpful they thought 

it was to ask family members about stressors related to 

being part of a military family, and how frequently they 

asked family members about military stress.

With respect to how knowledgeable they were about best 

practice treatments, there were few significant differences 

between rural and non-rural providers (see Table 7).

	 •	 Rural providers were more likely than non-rural

providers to disagree that they were knowledgeable 

about best practice treatments for depression (26% vs 

16%), substance abuse/dependence (26% vs 15%), and

suicide (37% vs 24%).

	 •	 There were no significant differences among rural and

non-rural providers in professed knowledge about best 

practice treatment of PTSD, TBI, and family stress 

and relationship problems.

Knowledge About 

Best Practices in Agree Neutral Disagree

Treatment of:

PTSDNS 

Rural 55% 33% 12%

Non-Rural 63% 23% 14%

TBINS 

Rural 19% 17% 64%

Non-Rural 27% 17% 56%

Depression* 

Rural 60% 14% 26%

Non-Rural 63% 21% 16%

Substance Abuse/

Dependence* 

Rural 62% 12% 26%

Non-Rural 63% 21% 16%

Family Stress & 

Relationship ProblemsNS 

Rural 47% 26% 28%

Non-Rural 54% 21% 25%

Suicide* 

Rural 43% 20% 37%

Non-Rural 59% 17% 24%

* Significant Difference, NS Not Significant

Confidence in Ability to 

Provide Best Practices Agree Neutral Disagree

in Treatment of:

PTSD* 

Rural 34% 20% 46%

Non-Rural 51% 14% 35%

TBINS 

Rural 15% 21% 64%

Non-Rural 22% 22% 56%

Depression* 

Rural 62% 12% 26%

Non-Rural 67% 18% 15%

Substance Abuse/

DependenceNS 

Rural 40% 23% 37%

Non-Rural 39% 18% 43%

Family Stress & 

Relationship ProblemsNS 

Rural 49% 23% 29%

Non-Rural 53% 23% 24%

Suicide* 

Rural 43% 20% 37%

Non-Rural 58% 18% 24%

Table 7 Knowledge About Best Practice 

Treatments for Conditions Among Current and 

Former Members of the Armed Forces: Rural vs. 

Non-Rural Providers

Table 8 Confidence in Ability to Provide Best 

Practice Treatment for Relevant Conditions 

Among Current and Former Members of the 

Armed Forces: Rural vs. Non-Rural Providers

* Significant Difference, NS Not Significant
18

With respect to confidence in ability to provide best practice treatments, rural and 

non-rural providers were significantly different on some treatments but not on others 

(see Table 8).

	 •	 Rural providers were more likely than non-rural providers to disagree that they were

confident in their ability to treat PTSD (46% vs 35%), and they were less likely to agree 

that they were confident in their ability to use best practice treatments for PTSD (34% 

vs 15%).

	 •	 Rural providers were more likely than non-rural providers to disagree that they were

confident in their ability to treat depression (26% vs 15%).

	 •	 Rural providers were less likely than non-rural providers to agree that they were

confident in their ability to use best practice treatments for suicide (43% vs 58%).

	 •	 There were no significant differences between rural and non-rural providers in their

confidence with respect to treatment of TBI, substance abuse/dependence, or family

stress or relationship problems.

With respect to providers’ interest in obtaining information about relevant topics, 

rural and non-rural providers did not differ significantly on interest in women’s roles in the 

military, providing care to veterans and Reservists with legal problems, or learning more 

about the medical and mental health problems of Armed Forces members, veterans and 

family members. However, rural providers were more interested than non-rural providers 

in learning more about providing care to homeless veterans and Reservists (65% vs 49%).

There were no significant differences between rural and non-rural providers’ views as to 

which types of educational resources they thought would be most useful.

In summary, rural and non-rural providers were similar in most respects, but some 

significant differences were noted. One relevant difference was that the provider mix 

included a higher percentage of primary care as opposed to mental health in rural areas, 

with the converse being true in non-rural areas. More providers accepted TRICARE in 

rural areas. Fewer rural providers screened patients for active duty military, veteran, and 

family member status. Rural providers’ practices were more distant from the nearest VA and 

DoD health care facilities. Rural providers were less familiar with some forms of treatment 

and expressed less confidence in the use of best practice treatments for PTSD, depression, 

and suicide. Interestingly, there were no significant differences in the topics rural and 

non-rural providers were interested in learning about or in the types of learning resources 

they preferred. Therefore, it appears that rural providers have many of the same opinions 

and educational needs as their counterparts in non-rural areas, although there is clearly a 

rationale for tailoring some training materials to accommodate special needs and concerns 

of those in rural areas. 
19

MUSC-VISN-6 Rural Health 

Professionals Survey

As a part of the survey, providers were asked to 

respond to five open-ended questions. Although there was 

no requirement to complete the open-ended questions, 

providers had the opportunity to comment on each of 

the questions. Several modal themes emerged and those 

themes are reported in this section. A more detailed report 

of the modal themes for each of the open-ended questions 

containing a selection of providers’ comments can be found 

in Appendix B of this report. 

Open-Ended Questions: 

____ M ____

#1 What would motivate you to spend your time and 

energy learning about the medical or mental health 

needs of current and former members of the Armed 

Forces and their families?

This open-ended question had the greatest number of 

responses. Four major themes emerged. 

The first theme suggested that a significant number of 

providers were not aware that many of their patients are 

current or former members of the Armed Services or their 

family members. Therefore, providers do not perceive a need 

for specialized training in this area. However, there was 

very little in the responses suggesting that providers make 

an attempt to screen their patients to determine whether 

or not their patients are/were in the Armed Services or are

family members. 

The second theme indicated that the providers’ negative 

perceptions of TRICARE were directly related to their lack 

of motivation to learn about the health or mental health 

needs of military members and their families. Negative 

perceptions centered on perceived low reimbursement 

rates, past and current difficulties working with TRICARE 

and/or the DoD, and a perceived lack of collegiality when

working with TRICARE and/or the DoD. A few of the

providers surveyed suggested the lack of acceptance of 

Licensed Professional Counselor (LPC) credentials by 

TRICARE as a deterrent to their motivation to learn more. 

The third theme centered on availability, content, and 

delivery of training. Comments from many providers 

highlighted the need to minimize hours that require them 

to be out of their offices. It was interesting however, that 

many of the providers surveyed who offered comments 

on potential training appeared to assume an in-person 

type model of training as the only format for a learning 

experience.

A fourth theme indicated a motivation to learn more 

about the health and mental health needs of current/former

members of the Armed Forces and their families was based 

purely on a desire to better serve this population. A sense 

of patriotism and service to country on the part of the 

providers was revealed in the responses.

____ M ____

#2 What concerns, if any, do you have about the quality 

of medical and mental health care services provided 

within the DoD healthcare system?

This question drew many responses from the providers 

surveyed saying they did not have direct knowledge about 

the DoD healthcare system and that their opinions came 

from news reports or second-hand reports from their 

patients. Providers indicated that many of their opinions 

that were influenced by news reports or anecdotal reports 

were fairly negative. 

Of those providers surveyed who expressed a more 

direct knowledge of the DoD healthcare system, the major 

theme that emerged was a belief that the DoD system is 

currently unable to meet the needs of military members 

or their families, including Reservists. In addition, many 

expressed concerns that future needs will also go unmet. 

In addition to the general concern about a system that is 

unable to meet demands, other concerns expressed provided 

more specific information. These concerns focused on the 

lack of continuity of care, lack of easy access to care without 

encountering “red tape,” and issues of confidentiality.

MUSC-VISN-6 Rural Health Professionals Survey
20

____ M ____

# 3 What concerns, if any, do you have about the quality 

of medical and mental health care services provided 

within the VA healthcare system?

Many providers surveyed indicated that their views of 

the VA healthcare system were quite similar to their views of 

the DoD healthcare system. The most frequently expressed 

concern was that the system was overloaded and, therefore, 

unable to meet the clinical need. Several of the comments 

from the providers were lengthy but focused on problems 

with access, bureaucracy, distance, poor services for women, 

uninterested physicians, and the lack of communication 

and/or collegiality with community providers. Providers

that we surveyed reported a broad range of responses 

regarding the quality of VA services reflecting what may 

be significant variability in their experience with local VA 

facilities and providers.  This suggests that different VA’s are 

successful in engaging community providers to significantly 

different degrees. There were some comments expressed by 

providers regarding concerns about adequate health and 

mental health care availability in the future.

____ M ____

#4 What barriers, if any, do you see in your community 

with respect to accessing heath care services for current 

and former members of the Armed Forces and their 

families?

Providers reported several barriers to current and 

former members of the Armed Forces and their families 

in terms of accessing health care services. Distance to VA 

or DoD hospitals/clinics; lack of transportation; and travel

time necessary to receive services were frequently cited. 

They express concern that VA’s bureaucracy and lack of 

willingness to engage community providers as partners are 

barriers to effective care. Providers surveyed also highlighted 

specific negative effects these barriers had on members of 

Armed Services and their families. 

Many of the providers cited issues with TRICARE in 

response to this question. Finding providers who accept 

TRICARE, difficulties being paneled with TRICARE, and 

perceived low reimbursement rates, were all frequently cited 

by providers. These barriers were mentioned as especially 

significant for those needing mental health services. The 

bureaucracy of TRICARE in general was also listed as a 

barrier.

Providers did offer some advice on how to reduce 

barriers. Some examples and suggestions were pragmatic 

such as having more flexible hours/evening hours at VAs.

Other suggestions called for the VA to develop better 

outreach and to provide information to communities/

providers about available services.

____ M ____

# 5 If a new, on-line information resource were created 

addressing medical and behavioral concerns among 

current and former members of the Armed Forces and 

their families, what topics would be most helpful to 

you?

Not surprisingly, the most frequently cited topics by 

were PTSD, TBI, depression, substance abuse, suicide, 

anger management, and domestic violence. As one provider 

said, “any of them that relate to mental health treatment.” 

It should be noted that when the providers were 

referring to information about available treatments, they 

were consistent in requesting information on those topics 

be “evidence-based,” coming from “the latest research,” and 

those involving “best practices.”

Respondents also indicated that information on issues 

experienced by military families would be helpful. Many 

providers also indicated, either directly or indirectly, 

the need for information on understanding the military 

culture. Providers expressed a need for information about 

the military (DoD) and VA treatment options for their 

patients, as well as information on community resources 

that might augment other forms of healthcare Armed 

Forces members or their families are currently using.
21

Conclusions and Recommendations

1. The survey should be replicated with a national 

sample of providers to determine if findings generalize.

2. Providers lack, but need, information about VA 

and DoD healthcare systems, eligibility requirements, and 

referral procedures. The data indicate that information on 

how to become a TRICARE provider and how to work with 

TRICARE to maximize service and expedite processes is 

greatly needed. 

3. Many providers stated that they had no basis for 

knowing how many of their current or potential patients 

are members of the Armed Forces, Veterans, or family 

members. Therefore, the data indicate the need for the DoD 

and VA to share information with community providers 

regarding the numbers of Service Members/Veterans and

family members (including Active and Reserve Component 

Members) who fall in within the providers’ local areas. 

Sites such as http://www.unc.edu/cssp/datacenter/

already exist and are free and in the public domain. This 

site includes access to geospatial maps of these populations 

which could easily inform providers of the potential 

numbers of military/veterans who may be in their current

patient groups or potential patient groups.

4. Fewer than half of the providers said that they 

regularly screened for military involvement. This was 

especially true of rural providers. Based on the survey 

data, providers should be encouraged to include at least 

one screening question to be asked of every patient: “Have 

you or someone close to you served in the Armed Forces?” 

Training in efficient and sensitive ways to screen patients 

about their military service experience is needed for 

providers.

5. Given the relatively low percentage of providers 

with military experiences, provider training should focus 

on improving their understanding of military culture. 

Available training on deployment stress and related mental 

health issues should be widely disseminated to rural 

providers, professional associations and organizations, 

community groups, and other public domains. The website, 

www.aheconnect.com/citizensoldier, is a good example 

of an educational site that includes and focuses on military 

culture topics. 

6. Providers indicated that information on community 

programs that provide additional, non-medical support for 

members of the Armed Forces and their families was needed. 

Military OneSource http://www.militaryonesource.mil

and http://afterdeployment.org/ are examples of where 

needed information can be found. Including informational 

sites in any outreach efforts to rural providers would appear 

to be in order, given their lack of proximity to VA and DoD 

health care facilities. 

7. Providers are more knowledgeable about, and are 

more confident in their ability to provide, Best Practice 

treatments for depression, suicide, and family stress than 

they are about and for TBI, PTSD, and substance abuse/

dependence. This indicates a need for more training 

materials about how to identify, assess, and treat TBI, 

PTSD, and substance abuse/dependence. Rural providers

may particularly benefit from such materials. In rural areas, 

mental health expertise may be more scarce, so greater 

awareness of military issues is even more important for 

primary practitioners.

8. Web-based courses as a training resource for 

providers have much to offer because they are convenient, 

reduce provider’s time away from their practices, can 

be provided at low cost, and can be easily and centrally 

modified when updates and/or changes become available.

9. While VA has already made significant progress in 

developing telemental health bridges to rural communities, 

in order to address remaining training/access disparities

between rural and non-rural providers indicated by 

this survey, further augmentation of tele-mental health 

training partnerships between DoD, VA, and community 

rural providers should be considered. Such a partnership 

could allow rural providers to receive training and case 

consultation from experts within DoD or VA settings and 

would not require significant technological upgrades for 

providers. Direct care for patients in community settings 

might also be possible, if confidentiality issues can be 

satisfactorily overcome.

10. Finally, data from this survey indicate that 

perceptions of some providers are consistent with the 

perceptions of many of their patients, the media, and even 

DoD and VA that much still needs to be done to improve 

the access, availability, timeliness, and frequency of care 

Conclusions and Recommendations
22

Resources

within DoD and VA healthcare systems. DoD and VA have 

clearly made great strides in transforming the quality of 

care provided to those who have served yet survey responses 

indicate that perceptions among community providers, 

rural and non-rural, may lag behind these significant 

enhancements.  These perceptions remain problematic 

whether they are true, false, or only partially true. If the 

perceptions are false or only partially true, there is clearly 

a need for DoD and VA to continue efforts to spread the 

word about the progress made among community providers 

and clearly map for them steps by which Service Members, 

Veterans and their family members can successfully enter 

the DoD/VA continuum of care.  To the extent that at least

some of these perceptions are true (or true for only some 

regions), this means that there are still gaps in meeting the 

current and future needs of members of the Armed Forces, 

Veterans, or their families. In any case, the information 

gathered in this survey about community providers’ 

perceptions is extremely valuable because it instructs us 

about where there is still work to be done in correcting 

misperceptions, improving quality of care, or both.

Useful Web Resources

We have compiled a list of useful web resources in Table 

9. These sites provide a broad range of information and 

training of the type that providers state they would like to 

receive. Many of these sites have already been mentioned or 

described, but we would like to highlight a few that may be 

particularly useful. The first set of sites provides nationallevel information.

	 •	 The VA National Center for PTSD site provides an

enormous amount of material about a variety of topics 

that is relevant for providers, for veterans, and for 

families. This information includes training materials 

for providers.

	 •	 The VA Website contains valuable information about

the VA, eligibility requirements for health care and 

other services, and location of VA facilities.

	 •	 TheVAOffice ofRuralHealth site providesinformation

particularly relevant for providers in rural settings, 

including information about particular concerns of 

veterans and families in rural settings.

Resources

CPTWeb: 

http://cpt.musc.edu 

Military One Source:

https://www.militaryonesource.mil 

Defense Centers of Excellence: 

http://afterdeployment.org/. 

TRICARE: 

http://www.tricare.mil/ 

VA Website: 

http://www.va.gov 

Vet Center Finder: 

http://www.va.gov/directory/guide/vetcenter_flsh.asp 

VA National Center for PTSD: 

http://www.ptsd.va.gov/ 

VA Office of Rural Health: 

http://www.ruralhealth.va.gov/ 

VISN 6 Mental Illness, Research, Education and Clinical 

Center: 

http://www.mirecc.va.gov/visn6/ 

VA/DoD Clinical Practice Guidelines for the Management 

of Traumatic Stress: 

http://www.healthquality.va.gov/Post_Traumatic_Stress_

Disorder_PTSD.asp

Painting A Moving Train (free, accredited training on Deployment Mental Health for Community Providers developed by a joint DoD/VA/State and Community Team): 

http://www.aheconnect.com/citizensoldier 

International Society for Traumatic Stress Studies: 

http://www.istss.org 

Substance Abuse and Mental Health Services 

Administration:

http://www.samhsa.gov/MilitaryFamilies/

VA Crisis Line (1-800-273-8255): 

http://www.veteranscrisisline.net/

Table 9 Useful Web Resources

	 •	 The VA/DOD Clinical Practice Guidelines for

Management of PTSD site provides a comprehensive 

review of the strength of evidence supporting major 

treatments for PTSD.

	 •	 The Defense Centers of Excellence site has a wide

variety of useful material for service members, families, 

and health professionals with emphasis on evidencebased practices.

Useful Web Resources
23

____ M ____

Reference

Hoge, C. (2011). Interventions for War-related 

Posttraumatic Stress Disorder: Meeting Veterans Where 

They Are. JAMA; 306(5), pp. 549-551.

APPENDIX A

Participating Programs and Agencies

Professional Associations:

Connecticut Psychiatric Society

www.ctpsych.org

North Carolina Psychiatric Association

http://www.ncpsychiatry.org

Pennsylvania Psychiatric Society

www.papsych.org

Psychiatric Society of Virginia, Inc.

www.psva.org

North Carolina Psychological Association

www.ncpsychology.org

National Association of Social Workers, Maryland 

Chapter

http://www.nasw-md.org/

State Agencies:

North Carolina Division of Mental Health, 

Developmental Disabilities, and Substance Abuse 

Services

http://www.ncdhhs.gov/mhddsas/

North Carolina Department of Health and Human 

Services

http://www.ncdhhs.gov

North Carolina Office of Rural Health and 

Community Care

www.ncdhhs.gov/orhcc/

National Association of Community Health Centers

http://www.nachc.org

Community Care of North Carolina (CCNC)

http://www.communitycarenc.org

	 •	 The Painting a Moving Train site, developed by a joint

DOD/VA/State and Community team, provides free

training on deployment mental health.

	 •	 The International Society for Traumatic Stress Studies

(ISTSS) site includes background information on 

PTSD and related disorders as well as information 

about training opportunities.

The National Crime Victims Research and Treatment 

Center has developed a number of free web-based courses 

designed to provide training to mental health professionals. 

These include:

CPTWeb (http://cpt.musc.edu) is a multi-media webbased training for mental health providers seeking to learn 

Cognitive Processing Therapy (CPT) for PTSD. This 

course is designed to teach clinicians about using CPT with 

military populations and teaches all of the components of 

CPT using concise explanations, video demonstrations, 

and clinical scripts. Learners completing CPTWeb receive 

9 hours of continuing education credit free of charge. The 

development of this program was funded by the US Navy 

Bureau of Medicine and Surgery. 

TF-CBTWeb (www.musc.edu/tfcbt) is a web-based

training course designed for therapists on delivering 

Trauma-Focused Cognitive-Behavioral Therapy. This 

program has been very successfully disseminated (over 

100,000 registered learners from 111 countries). The course 

has ten modules that follow the components of TF-CBT 

and learners who complete this course receive 10 hours of 

continuing education credit free of charge. 

CTGWeb (www.musc.edu/ctg) is a follow-up training

course to TF-CBTWeb and teaches therapists how to apply 

TF-CBT to cases of child traumatic grief after the loss of a 

loved one. Each module is structured similarly to those of 

TF-CBTWeb and is modular and multimedia. 

TF-CBTConsult provides online, automated clinical 

consultation to therapists using TF-CBT. Users can 

enter a question or set of keywords to view a long list of 

commonly asked consultation questions concerning TFCBT. Answer pages contain concise text answers, video 

explanations by the TF-CBT developers, video dialogues 

between TF-CBT experts concerning clinical issues, and 

video clinical demonstrations. TF-CBTConsult is available 

only to learners who have completed TF-CBTWeb.

Reference

APPENDIX A: Participating Programs and Agencies
24

APPENDIX B

MUSC-VISN-6 Rural Health 

Professionals Survey 

Open-Ended Questions: 

____ M ____

#1 What would motivate you to spend your time and 

energy learning about the medical or mental health 

needs of current and former members of the Armed 

Forces and their families?

The first grouping of responses suggested that a 

significant number of providers were not aware that many 

of their patients may be current or former members of the 

Armed Services or their families. Therefore, providers do 

not perceive the need for specialized training. Illustrative 

comments include:

	 •	 If we had a greater presence in our patient panel of

current and former members of the Armed Forces and 

their families.

	 •	 Having a larger percentage of veterans of recent

conflicts referred to my practice.

	 •	 If my practice had a greater number of patients in this

population.

	 •	 If I were to receive more referrals for this population.

However, little in the responses suggests that providers 

make an attempt to screen their patients to determine 

whether they are/were in the Armed Services or are family

members. Several providers acknowledged they have not 

been screening their patients regarding military status: “I 

think the first step would be determining how many of 

my patients are current or former members of the Armed 

Forces. I probably have a significant number of former 

members that I’m unaware of,” and, “They are a population 

of patients that is more common than I probably realize.”

The second theme among responses indicated that the 

providers’ negative experiences with and perceptions of 

TRICARE were directly related to their lack of motivation 

to learn about the health needs of military members 

and their families. Responses centered on perceived low 

reimbursement rates, past and current difficulties working 

with TRICARE and/or DoD, and a perceived lack of

collegiality when working with TRICARE and/or DoD.

A few survey providers noted that the lack of acceptance of 

LPC credentials by TRICARE decreased their motivation 

to learn more: 

	 •	 If TRICARE would reimburse better that would

motivate me to be a provider and therefore motivate 

me to seek up-to-date information on children/family

issues of military families.

	 •	 I have made numerous attempts (via phone) to have

someone contact our organization to learn about 

TRICARE and what can be done to become a provider 

under the umbrella. We have been unsuccessful in 

securing a call back.

	 •	 We need adequate resources for TRICARE military

families especially psychological services, and we need 

adequate reimbursement from TRICARE for the 

services we provide to children of military families.

	 •	 My 18 physician group would consider doing more

work with TRICARE if the reimbursement were 

enhanced. We are the only TRICARE providers in a 

30 mile radius, but I do not know if we will continue to 

participate at the currently inadequate reimbursement 

rates.

	 •	 If you accepted the LPC credential, I would be very

interested in working with vets.

	 •	 Less bureaucracy in reimbursement, authorization,

etc. Having easy and accessible professionals to reach 

out to us. 

	 •	 If I felt I were part of a “team” managing a patient,

I would want to know what the team knows. As it 

is, DoD/VA team apparently is doing something. I

do what I do without any idea of what they are up to. 

My role is frequently second guessing and advising the 

patient what to ask for and what to watch out for.

	 •	 Just becoming invited to utilize the resources (not

being locked out because we are not DoD).

The third type of response focused on aspects of 

potential training activities. Respondents commented 

on training content, availability, and assessibility. Many 

providers highlighted the need to minimize time out of the 

office:

APPENDIX B: MUSC-VISN-6 Rural Health Professionals 

Survey
25

	 •	 Convenient affordable training.

	 •	 High quality, information dense (i.e., effective use of

time in learning), and not requiring a lot of time away 

from my practice. 

	 •	 Literarily I cannot afford financially to be away from

my office for sick days, vacations, or extended holiday, 

let alone for training or other purposes.

	 •	 I would be interested in this if I could be part of a

group that met face-to-face for continuing ed/peer

supervision and if it did not involve a lot of paperwork/

certification in addition to my current credentials for 

payment or collection of fees. 

	 •	 E-mail containing web links to further information,

conferences, etc.

	 •	 CEU’s, time, location.

	 •	 Location of training, cost of training, referrals,

resources available.

	 •	 Ease of availability at a reasonable cost or fee.

	 •	 In order to take time away from my practice to get

training for providing services to a relatively specialized 

population, I will have to know that when I return to 

my office, this training is going to pay.

A fourth theme among responses revealed a motivation 

to learn more about the health and mental health needs 

of current/former members of the Armed Forces and their

families that was based purely on a desire to serve this 

population better. A sense of patriotism and service to 

country was evident in the responses.

	 •	 Willingness to help that population.

	 •	 Their need. I am very interested in helping those

who have put themselves in harm’s way to defend our 

freedom. 

	 •	 Serving more of these patients.

	 •	 Concern for the well being of men and women who

have sacrificed for their country and concern for the 

well being of their families.

	 •	 Whatever I can do to assist them and their families, I

am honored to do so.

	 •	 Sense of responsibility, as a fellow citizen. That’s it.

	 •	 My desire to see this population re-integrate into

society with the least amount of trauma to themselves 

and/or family members. I would be willing to attend

trainings in order to learn how to conduct effective 

intake assessments in order to link members to the best 

(and most adequate) community resources. 

	 •	 I am a trauma specialist who moved to NC because

my son called from Afghanistan, saying, ‘My guys have 

seen too much, please come down here.’ It is what I 

came here to do. I want to do it the best way.

____ M ____

#2 What concerns, if any, do you have about the quality 

of medical and mental health care services provided 

within DoD healthcare system?

Many providers said they did not have direct knowledge 

about the DoD healthcare system and that their opinions 

came from news reports or second-hand reports from 

their patients. Many of their opinions were influenced by 

negative news reports or anecdotal reports. For example:

	 •	 Reports from patients and families as well as media

indicate many limitations and problems.

	 •	 Nothing that hasn’t been reported by the New York

Times or agreed to by the VA and DoD.

	 •	 I will willingly admit that the press is my main source

of information regarding health care for the military. 

It is certainly my impression that our current resources 

are not sufficient.

	 •	 I only know what I hear through the media (60

Minutes, etc.), which seems to lean towards insufficient 

(lack of access rather than lack of quality) mental health 

services.

	 •	 They are based mostly on what I hear from others, and

from some family members, but include: long waiting 

lists, feeling like the system is way too cumbersome 

and that services can’t be accessed, concerns about 

confidentiality; lack of accessto appointment timesthat

coordinate with work and school demands; inability

to access specialists (e.g., can see a therapist but they 

may not specialize in working with kids, working with 

domestic violence, etc.).
26

Of those respondents who expressed a more direct 

knowledge of the DoD healthcare system, the major theme 

that emerged was a belief that the DoD system is currently 

unable to meet the needs of military members or their 

families, including Reservists. In addition, many expressed 

worry that future needs will also go unmet. While 

frequently praising the DoD providers, providers expressed 

concern that the system, as a whole, is inadequate to meet 

the needs.

	 •	 I think the quality of care is in many ways excellent

but there aren’t enough resources to meet the current 

mental health need of the military and their families. 

	 •	 Lack of treatment providers and long waiting lists.

	 •	 Access to services. Particularly for Reservists.

	 •	 There is a huge demand. The demand is not going to

abate any time soon. Rather, I believe it will certainly 

increase. 

	 •	 Routine complaints by patients and internal reports

from the military hospital that they are overwhelmed 

and cannot keep up with the incoming.

	 •	 My concerns haveless to do with the quality of the care

than with the quantity available and with the need to 

have non-DoD connected services for those unwilling 

to access DoD affiliated services.

	 •	 I believethe DoD healthcaresystem provides good care

but cannot handle the volume. Our military active 

duty psychologists set up a local PTSD group, but then 

the psychologists were sent to Afghanistan. Continuity 

of care falls apart. The psychologists I have met are 

good at their jobs but often are limited to twenty 

minute sessions due to volume of patients. The most 

recent military psychologist just was rotated and rereferred her caseload to our clinic. We gladly support 

and admire their efforts but suspicion, paranoia, and 

resistance to trust are an integral part of the PTSD 

process and keeps being triggered by the switching of 

professionals who are helping these troops.

In addition to the general concern about an overburdened system, other comments expressed more specific 

concerns. These focused on the lack of continuity of care, 

“red tape,” and issues of confidentiality.

	 •	 Clients have expressed that it’s difficult to navigate the

red tape involved.

	 •	 Too many deployments, notenough continuity of care.

	 •	 Docs discourage active duty people from discussing

mental health concerns.

	 •	 I am concerned about the amount of medications that

are prescribed vs. behavioral interventions.

	 •	 Too many hoops for significantly mentally ill people to

jump through.

	 •	 Lack of confidentiality of mental health records,

stigma, or penalty for mental health/substance abuse

issues.

	 •	 Rapid turnover of personnelso thereis often insufficient

consistency; unavailability of providers in certain

specialty areas; patient concerns with confidentiality

and the possible impact of disclosure on military status.

	 •	 The DoD healthcaresystem is very difficult to usefrom

the perspective of practicing outside of the system—we 

do not receive any communication from the providers 

within the DoD if we are concurrently caring for an 

individual within the system; makes continuity of care

very difficult, dangerous for the patient.

	 •	 DoD is doing an admirable job. Recent influx

of Iraq war population, new policies that require 

proactive screenings for mental health problems, and 

their general processing role (admit and discharge 

exams) has resulted in systemic overload for DoD/

VA systems. Given this, I am encouraged to see the 

State Psychological Association take a pro-active role 

in promoting community involvement (add capacity/

competency in non-military service system).

____ M ____

# 3 What concerns, if any, do you have about the 

quality of medical and mental health care services 

provided within the VA healthcare system?

Many providers indicated that their views of the VA 

healthcare system were quite similar to their views of the 

DoD healthcare system. The most frequently expressed 

concern was that the system was overloaded and, therefore, 

unable to meet the clinical need. This theme is captured 
27

in the following comments that also describe how the 

perceived lack of adequate services by the VA affects 

community providers.

	 •	 The available services are not sufficient. Vets have

to wait unacceptably long periods of time to receive 

services, and those of us in the community who lack 

adequate training with this population are left to 

struggle through as best we can. The counties are 

often called upon to provide services to vets who are 

otherwise insured and should be able to get treatment 

through the VA, but there are too many barriers and 

not enough providers.

	 •	 It is grossly inadequate. I constantly have to use my

time and resources to help patients that are not getting 

their needs met through the VA system. 

Just as respondents pointed out what they perceived

to be problems with the DoD healthcare system, they also 

highlighted specific problems they perceive within the VA 

system. Several comments were lengthy but focused on 

problems with access, bureaucracy, distance, poor services 

for women, disinterested or unmotivated physicians, and the 

lack of communication and/or collegiality with community

providers. Each of these problem areas was reported by a 

significant number of providers. 

	 •	 The wait times to schedule regular appointments

are distant sometimes, and many of their rules 

—e.g., for missed appointments, late appointments, 

reimbursements—are very rigid and bureaucracydriven, rather than patient-oriented. 

	 •	 Our “local” VA hospital is 3 1⁄2 hours away one way.

Most vets cannot afford the gas. The clinics that 

are available locally do not provide PTSD or TBI 

retraining. One clinic 90 minutes away has a Vietnam 

group but does not allow OIF or OEF or Gulf War vets 

and does not take women. 

	 •	 Poor services for women especially.

	 •	 I know some excellent providers who work in the

VA system. The problems I hear about are related to 

extremely heavy caseloads, waits for appointment, 

lack of support services, untreated substance abuse 

problems.

	 •	 Patients have reported their dissatisfaction to me,

especially about lack of personal concern for them, 

especially by psychiatrists who spend little time with 

them and are uninterested in details of their experiences, 

and who make little personal contact. Patients are 

especially put off by mental health professionals who 

take notes on a computer screen while speaking with 

them, often making no eye contact.

	 •	 The VA “system” is a black hole. Impossible to get

any information out about medical care issues. I 

see vets who travel to the VA several times a year for 

prescriptions. They presumably have a doc at the VA. 

I write prescriptions. They change the prescriptions. 

Never a letter, copy of their notes, labs....nothing. 

I give patients information to carry---never an 

acknowledgement. I cannot imagine that connecting 

with Behavioral Health professionals will be any easier. 

Variability between VA facilities and providers was also 

noted. 

	 •	 There is a high degree of variability among individual

practitioners within the VA and quality of service 

depends on which provider the person gets. Some 

people I would highly recommend, and others I would 

just as soon avoid altogether.

	 •	 I have a bit more familiarity with the VA system, and

I feel rather certain that the accessibility and quality 

are very uneven from one location and/or facility

to another. My impression is that, nationwide, the 

services available through the VA system range from 

the very best available anywhere to the very worst 

available anywhere.

There were also comments expressing concerns about 

the availability of health and mental health care in the 

future.

	 •	 I am concerned about thefuture quality and availability

of services for veterans because of current federal budget 

issues and being involved in various conflicts over the 

last decade. This, in combination with rising health 

costs makes me concerned that there will be even more 

pressure to reduce costs and limit services. Since many 

effective treatments for ‘mental’ health issues are long 
28

term, I am concerned that like what has happened 

with most private insurance companies there will be 

a push to limit the duration that those services will be 

provided.

Some survey providers also included specific suggestions 

to improve services or other aspects of the VA system. 

	 •	 I also believe that our outreach to current and

former members of the Armed Forces would be more 

successful if mental health providers were required to 

learn basic information about military training and 

structure (ranks, branches, MOS, etc.), U.S. military 

history, combat (including major operations or battles 

of specific wars), and typical impact of combat on the 

family. This would convey the respect that these men 

and women deserve.

____ M ____

#4 What barriers, if any, do you see in your community 

with respect to accessing heath care services for current 

and former members of the Armed Forces and their 

families?

Several barriers to accessing health care services were 

noted. Distance to VA or DoD hospitals/clinics, lack of

transportation, and travel time necessary to receive services 

were frequently cited. Survey providers also highlighted 

specific negative effects these barriers had on Armed 

Services members and their families: 

	 •	 Nearest VA is one hour away.

	 •	 Distance is a problem, as some don’t have reliable

transportation.

	 •	 Our community is rural with few resources. The

nearest VA is two hours away.

	 •	 Distance from the nearest VA facility as well as

community resources such as transportation to/from

the VA.

	 •	 We service individuals across 34 counties and many

are 2 to 3 hours away from the nearest facility. With 

limited transportation, they often don’t get the care 

they need. 

	 •	 Our area is very rural, so distance is a barrier. While

our VA has expanded, the closest location is still 30-

40 minutes away, and many people lack transportation 

or they cannot get all the services they need at that 

location.

	 •	 Transportation from outlying rural areas where many

of the military persons/families actually live and the

difficulty in getting services consistently.

Many of the survey providers cited issues with 

TRICARE. Locating providers who accept TRICARE, 

difficulties being paneled, perceived low reimbursement 

rates and burdensome bureaucracy were all frequently 

cited by survey providers. These barriers were mentioned 

as especially significant for those needing mental health 

services:

	 •	 Not all practices accept TRICARE. 

	 •	 For TRICARE Prime members, restricted access due

to PPO insurance panel.

	 •	 Lack of TRICARE approval for care.

	 •	 TRICARE reimbursement is too low, thus it’s not

widely accepted.

	 •	 TRICARE’s abysmal rate of reimbursement for

psychologists. At best I break even, and sometimes I 

lose hundreds of dollars/day seeing TRICARE family

members.

	 •	 As far as the availability of psychologists in the

community, specifically, I don’t think there are very 

many TRICARE-authorized providers around. As 

for me personally, I will accept TRICARE Standard 

reimbursement, but I literally can’t afford to accept the 

low rates offered by the HMO-like TRICARE plans.

	 •	 I have had a very difficult time finding mental health

counselors for children who accept TRICARE. This 

is the greatest barrier. Almost none in our area accepts 

TIRCARE.

	 •	 TRICARE reimbursements are notoriously poor for

mental health services, which severely limits their 

access to good mental health care and discourages 

practitioners from treating military personnel 

(including retired), informing themselves about 
29

the needs of this population, and accepting them as 

patients. Insurance is a tremendous obstacle!

	 •	 Too much bureaucracy in reimbursement,

authorization, referral, etc.

	 •	 TRICARE is very unsupportive of using insurance to

see out-of-network providers.

	 •	 The bureaucracy of TRICARE. I asked for

information about becoming paneled with them and 

never heard anything. This was a red flag for me as to 

the responsiveness of TRICARE, so I did not pursue 

the matter.

Providers also identified additional systemic barriers to 

care for members of the Armed Services and their families:

	 •	 No coordination between state systems of care and the

local VA facilities. 

	 •	 The Veterans Affairs Officer is uninformed about needs

and treatment available.

	 •	 Losing jobs during active duty status for Reservists and

then not having TRICARE insurance long enough. 

The insurance lasts 6 months and the problems surface 

shortly after in many circumstances, and they are 

unable to access services and aren’t well informed about 

VA benefits.

Several respondents offered advice on how to reduce 

barriers. Some suggestions were pragmatic, such as having 

more flexible hours/evening hours at VAs. Others called for

the VA to develop better outreach and to publicize available 

services:

	 •	 After hours services (clinic) to accommodate working

patients, and more therapists and prescribers in mental 

health–especially with substance abuse.

	 •	 If joining a military panel was madeeasy and had some

kind of incentive, i.e., “fair compensation,” trainings, 

information, referrals, I believe it would benefit 

everyone!

	 •	 I would personally refer moreif I had moreinformation

about how to refer.

	 •	 Moremarketing and public announcementsidentifying

potential resources would inform veterans and their 

families about treatment/service options.

____ M ____

# 5 If a new, on-line information resource were created 

addressing medical and behavioral concerns among 

current and former members of the Armed Forces and 

their families, what topics would be most helpful to 

you?

Of the open-ended questions, this one had the most 

uniformity in terms of responses. Specifically, and perhaps 

not surprisingly, the most frequently cited topics included 

PTSD, TBI, depression, substance abuse, suicide, anger 

management, and domestic violence. As one provider said, 

“any of them that relate to mental health treatment.” Some 

providers added that they would also like information on 

“how their symptoms might differ from the symptomatology 

of the general population,” and “differences that have 

been found in the Armed Forces population versus other 

populations in terms of assessment/intervention in areas

such as depression, PTSD/trauma, family conflict, etc.” It

should be noted that when the providers were referring to 

information about available treatments, they were consistent 

in requesting that information be “evidence-based,” drawn 

from “the latest research,” and “best practices.”

In addition to information/training about common

behavioral health issues (e.g., PTSD, TBI, depression, etc.), 

some providers also indicated that information on issues 

experienced by military families would be helpful: 

	 •	 Stress on military families. Deployments, before,

during, and after. Frequent disruption of life given reassignments of duty stations.

	 •	 Transitioning home. Issues for families postdeployment. Issues for families upon homecoming. 

Providers also indicated, either directly or indirectly, 

the need for information on understanding the military 

culture:

	 •	 Best practices, military cultural competency.

	 •	 I run a psychiatry residency and I would be interested

in materials I could use to teach residents about care of 

service members and veterans.

	 •	 Understanding of stressors unique to military families

and service personnel.
30

	 •	 The majority of my staff has never served. Thus they

need everything from understanding the culture, 

major stressors, and how to individualize treatments.

One addition topic that many respondents suggested 

would be helpful to them was how to obtain information 

about the military (DoD) and VA treatment options 

for their patients efficiently. Similarly, the providers also 

requested more information on community resources that 

might augment other forms of healthcare Armed Forces 

members or their families are currently using: 

	 •	 Mental health resource list specific to my geographic

area.

	 •	 How to negotiate chain of command when advocating

for individual service members and their families. 

What additional resources might be available for 

soldiers trying to get through the Warrior Transition 

Unit. What to do when you learn about unfair 

practices.

	 •	 Also need a one-stop simpleto usesiteto advise civilian

providers of the available federal programs to address 

various problems that service members, their families, 

and Veterans face in their everyday lives (for examples, 

there is not Legal Aid service for Veterans needing 

assistance). A similar one-stop site (preferable ‘live, 

knowledgeable human being’) available to those in 

federal governmental service who don’t keep up with 

programs in the civilian world.

	 •	 More on community based government/city council’s

support in providing service outside of the medical/

mental health basic services, e.g., support groups, 

centers, rehab services, employment training, etc.
National Crime Victims Research and Treatment Center

National Crime Victims Research 

and Treatment Center

The National Crime Victims Research and Treatment Center (NCVC), established in 1977, is a division of the 

Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina. The faculty and 

staff of the NCVC have been devoted to achieving a better understanding of the impact of criminal victimization 

on adults, children, and their families. As the NCVC has grown, so has its mission. Its research focus, professional 

education efforts, and clinical services have expanded to address psychological responses to virtually all types of 

traumatic events, including disasters, combat, and accidental injuries. In addition to traditional methods of scientific 

dissemination, NCVC faculty also share their expertise through public policy consultation to the DVA, the DoD, 

and other national and international organizations. The NCVC has earned considerable recognition for the scope of 

its mission, research excellence, and high quality clinical services. Information about the NCVC and its clinical and 

research programs has appeared in major national print and news outlets, including all broadcast network morning 

and evening news programs, C-Span, CNBC, and CNN. NCVC faculty members have provided invited testimony 

to U.S. Senate and House of Representative Committees and served as Committee Members for the Institute of 

Medicine. Learn more about the NCVC here: www.musc.edu/ncvc.

The NCVC is also a leader in the use of technology for the dissemination of training in evidence-based mental 

health therapies for those affected by traumatic stress. The NCVC currently offers several self-directed, multi-media, 

Web-based training courses for mental health providers. Other Web-based resources, including training courses for 

victim advocates and self-help resources for disaster victims, are being developed. Current training courses include:

	•	CPTWeb (http://www.musc.edu/cpt) is a multi-media web-based training for mental health providers seeking 

to learn Cognitive Processing Therapy (CPT) for PTSD. This course is designed to teach clinicians to implement 

CPT with military populations and teaches all of the components of CPT using concise explanations, video 

demonstrations, and sample clinical scripts. Course completers receive 9 hours of continuing education credit free 

of charge. 

	•	TFCBTWeb (www.musc.edu/tfcbt) is a web-based training course designed to teach therapists the components 

and methods of Trauma-Focused Cognitive-Behavioral Therapy for child and adolescent trauma victims and their 

families. The course has 10 modules that follow the components of TF-CBT, and learners who complete this 

course receive 10 hours of continuing education credit free of charge.

	•	CTGWeb (www.musc.edu/ctg) is a follow-up training course to TF-CBTWeb and teaches therapists how to 

supplement TF-CBT in cases of child traumatic grief after the loss of a loved one. Six hours of free continuing 

education credit are available. 

	•	TFCBTConsult (www.musc.edu/tfcbtconsult) provides online clinical consultation to therapists using TF-CBT. 

Like CTGWeb, TFCBTConsult is available only to learners who have completed TFCBTWeb.