Posted October 17, 2018

Alan Peterson, PhD (Lt Col USAF, Ret.), University of Texas Health Science Center at San Antonio

In light of the impact and prevalence of posttraumatic stress disorder (PTSD) among post-9/11 active duty Service members and Veterans, the Psychological Health and Traumatic Brain Injury Research Program (PH/TBIRP) seeks to fund research on prevention, detection, diagnosis, and treatment of military-relevant PTSD and traumatic brain injury (TBI). Established in 2006 at The University of Texas Health Science Center at San Antonio (also known as UT Health San Antonio), the South Texas Research Organizational Network Guiding Studies on Trauma and Resilience (STRONG STAR) received PH/TBIRP funding in 2008 to establish a Multidisciplinary PTSD Research Consortium for the development of therapies for PTSD and its comorbidities. In order to address an important gap in PTSD research and ensure military relevance for its findings, STRONG STAR aimed from its inception to conduct most of its research with active-duty Service members at military installations.

STRONG STAR is specifically designed to ensure that experts in military PTSD research from across the nation work together to help target complex problems that cannot be adequately addressed by any single investigator or institution. It also is strategically located in such a way as to bring the consortium's expertise together and deliver clinical research efforts where they are most needed. STRONG STAR is headquartered in San Antonio, Texas, a city dubbed �Military City, USA� due to the presence of the largest military and Veteran population in the United States. The San Antonio Military Healthcare System is also the Department of Defense's largest military medical complex. In addition, South-Central Texas is home to one of the largest populations of active-duty and recently discharged post-9/11 combat Veterans. STRONG STAR's studies have been conducted in this region at key military facilities, including Brooke Army Medical Center, Wilford Hall Ambulatory Surgical Center, and Carl R. Darnall Army Medical Center (CRDAMC).

A key to STRONG STAR's success has been its collaborative relationship with CRDAMC at Fort Hood. As one of the most populous U.S. military installations in the world and with the highest number of post-9/11 deployments, Fort Hood has been a primary research site for STRONG STAR. Since STRONG STAR's initial funding in 2008, the Fort Hood site has grown to become the largest university-based combat-PTSD research site in the nation. The collaboration is mutually beneficial, as STRONG STAR provides assistance to overburdened military health care providers by conducting state-of-the-science randomized controlled trials (RCTs) using leading treatments for PTSD. In return, STRONG STAR benefits by enrolling active duty Service members in RCTs designed to test, develop, and optimize treatments.

STRONG STAR has become fully integrated with the CRDAMC Department of Behavioral Health and has about 40 full-time research faculty and staff housed within clinic space at the medical center. Providers are credentialed through the hospital and document patient encounters in the electronic medical record system, AHLTA. This has allowed the STRONG STAR team to receive referrals from on-post providers for its clinical trials, advancing the provision of care to the overflow of Soldiers with behavioral health struggles related to PTSD and commonly co-occurring disorders such as insomnia. The STRONG STAR team at Fort Hood has conducted over 6,000 assessment encounters and treated more than 1,500 active duty Service members with first-line recommended evidence-based treatments.

With the opening of the new Carl R. Darnall Army Medical Center building in the spring of 2016, the original hospital was renovated, and in 2017, the STRONG STAR group moved into what is now known as the 418th Contracting Support Brigade Headquarters Building in the original CRDAMC hospital. With 28 offices and over 13,000 square feet of space, STRONG STAR's new location comfortably accommodates STRONG STAR's large staff and patient load, creating enhanced opportunities for new and complementary initiatives, including continuing education and provider training programs.

On February 1st, 2018, STRONG STAR hosted an Open House and Continuing Education Event in its Fort Hood offices, welcoming providers from across the Fort Hood military installation, the community, and members of UT Health San Antonio. Twenty posters were displayed throughout the facility, developed by STRONG STAR and its partnering network, the Consortium to Alleviate PTSD (CAP), informing attendees of the ongoing progress into military-relevant PTSD research. Consortia Coordinator COL Stacey Young-McCaughan, PhD, RN (U.S. Army, Retired) and STRONG STAR's Director of Research at Fort Hood, Katy Dondanville, PsyD, delivered a presentation regarding the past, present, and future of STRONG STAR. The event also afforded attendees the opportunity to learn more about STRONG STAR and CAP regarding ethical considerations and standard practices in place for consortia-related clinical research studies in a presentation conducted by Kristi Pruiksma, PhD alongside trainees* in psychology and social work. Numerous dignitaries** were in attendance.

STRONG STAR's Director Alan Peterson, PhD (Lt Col USAF, Ret.), is a clinical psychologist, who leads the STRONG STAR and CAP consortia. When asked �What is the biggest benefit of conducting research in an integrated environment in a medical treatment facility, Dr. Peterson said �Fort Hood is the largest integrated psychological health clinical trial research operations center in the DoD. This allows DoD research funds to support state-of-the-art assessment and treatment of active duty as part of large, military-relevant clinical trials.� Dr. Peterson indicated that the Open House successfully raised visibility and awareness for STRONG STAR and CAP's ongoing efforts to treat PTSD and its comorbidities. His team intends to host an Open House on an annual basis to raise awareness of their cutting-edge research on detection and treatment of PTSD, to keep the greater Fort Hood community engaged with the two consortia, and to provide a learning environment for all.

*Hannah Tyler, PhD, Wyatt Evans, PhD, Tara Casady, PhD, Mariya Zaturenskaya, MA, and Heidi Rathbun-McVeigh, LCSW.

**Dignitaries and special guests attending the STRONG STAR Open House at Fort Hood included COL Charles Haislip, CRDAMC Deputy Commander at the time of the Open House; LCDR Allah-Fard Sharrieff, CRDAMC Deputy Chief of the Department of Behavioral Health; LTC Lataya Hawkins, CRDAMC Chief of the Department of Behavioral Health; MAJ Kelly Rivera, CRDAMC Chief of Child and Family Behavioral Health Services; representatives from the CRDAMC Sleep Disorders Clinic; representatives of all Embedded Behavioral Health Units on post at Fort Hood; Maj Gen (USAF, Ret.) Byron Hepburn, MD, and other delegates from UT Health San Antonio.

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