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Research Highlights
Peer-visitor project fosters mutual help
among veterans with polytrauma
November 10, 2007
Rehabilitation psychologist Rhonda Williams, PhD, of the
Puget Sound VA says that among the veterans she's worked
with, "There’s very much a help-your-buddy mentality." She
and her colleagues are capitalizing on that mindset as they look
to develop training materials for a polytrauma “peer visitation”
program.
The effort, funded by VA’s Health Services Research and Development
Service, is modeled after a program developed by the
Amputee Coalition of America (ACA) and
successfully put into action at Walter Reed
Army Medical Center. At that site, more than
100 "peer visitors"—themselves military
amputees—have completed a one-day training,
undergone evaluation and certification,
and visited with more than 500 veterans of
OIF and OEF who have lost limbs. By all accounts,
veterans on both sides of the encounter
have benefited.
Williams' VA study is focusing on polytrauma—
severe injuries and wounds that
affect many organs and systems in the body.
Usually the result of blasts, polytrauma can
often involve limb loss as well as a complex
web of other injuries: brain injury, spinal
cord injury, nerve and organ damage, burns,
wounds, fractures, vision loss, hearing loss.
Addressing brain injury is one of the key
challenges for Williams' group. Can a veteran
who is himself coping with brain injury
be an effective peer visitor?
"We’re trying to learn what modifications
need to be made to the training to
enable someone with a brain injury to fill
this role," says Williams. Smaller training
groups and shorter sessions might be part of
the answer. Another solution might be "reminders
or templates during the visit to help
them stay on track if they’ve got memory or
attention problems." For instance, visitors
might use cue cards that outline what to
say or not say, and perhaps alarm clocks to
remind them to check their cards.
The research team, which also includes
Pat Isenberg, MS, and Paddy Rossbach, RN,
from the ACA and Dawn Ehde, PhD, from
the University of Washington, is creating
manuals for trainers and prospective peer
visitors. They’re also working on materials
for caregiver peer visitors—that is, parents
or spouses of polytrauma-injured veterans
who would visit other family caregivers
coping with similar circumstances.
The VA study team is guided by an
advisory panel of 10 polytrauma experts, six
veterans who have been through polytrauma,
and six caregivers. One of the questions
the researchers are exploring is who
qualifies as a "peer." How closely do visitor
and patient have to resemble each other—in
terms of injury or military and personal
background—for there to be a meaningful,
therapeutic interaction?
"Everyone’s going to have a different
constellation of injuries," notes Williams.
"We’re asking, do you have to have an amputation
in order to be an effective peer visitor
for an amputee? What if one had a burn
and one didn’t? What if one had a brain
injury and the other didn’t? What if one is
an officer and the other is an enlisted person?
What if one was injured in combat and
the other in training?" Based on discussions
so far, she says, many of these differences
don’t appear to be crucial.
The researchers also have to sort out
which types of health issues, besides brain
injury, could be problematic in peer visitation.
If a visitor has struggled with PTSD,
could his own symptoms flare when he
hears combat stories from a patient? Can
a visitor still struggling with functional
problems inspire someone in the early
stages of recovery? What level of hearing
impairment is enough to frustrate communication?
What’s clear is that peer visitation is
therapeutic for both patient and visitor.
"The people who have trained as peer
visitors love fulfilling this role," says Williams.
"They feel they’re giving back, and
it solidifies a sense of mastery for them. It
highlights the progress they’ve made, and
makes them feel the things they’ve learned
the hard way can help the next guy."
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