Note: In 2011, AOTA identified this and many other topics as emerging niches in occupational therapy. Today, many of these topics have become mainstream. Learn more about the 2011 Emerging Niche series here.
Why emerging? With nearly 1.5 million Americans currently serving in the armed forces and 22.7 million veterans, the issue of veteran care will continue to grow.1,2 Providing care will include treating traumatic brain injury (TBI) among soldiers and helping the growing number of veterans with poly-trauma (e.g., an amputation, TBI, and post-traumatic stress disorder). Recently, an NPR and ProPublicainvestigation found that the military is failing to diagnose, treat, and document brain injuries in veterans, and that Tricare—the insurance-style program for nearly 4 million active-duty military and retirees—will not cover cognitive rehabilitation therapy.3 Even when veterans receive health benefits from the Department of Veteran Affairs (VA), oftentimes aftercare is not covered, and access to those services remains an important challenge for the Department of Defense (DOD) and the VA.4
Get Involved: There are several ways to work with wounded warriors and veterans—as an active duty army OT, a civilian OT, or a researcher, or by working with the VA. Captain Tammy Phipps, CPT, US Army Reserve, MS, OTR/L, CDRS, an army reservist on active duty, and Stephanie Johnson, MS, OTR/L, a civilian occupational therapist, both work at the Walter Reed Army Medical Center in Washington, DC. Phipps met the army surgeon general while deployed to Iraq from 2007 to 2008 and was asked to develop the first driver rehabilitation program run by the DOD. Johnson has worked at Walter Reed for more than 3 years and applied for the position because she developed an interest in working with wounded warriors while in graduate school.
Practitioners interested in working as a civilian OT at a military treatment facility should determine where they are interested in working, try to develop a connection, and pursue opportunities, says Johnson. "My advice would be to definitely pursue it, because it's an amazing opportunity and there are so many different capacities that you can work in as an OT for the army," she says. Phipps recommends that practitioners who are interested in active duty speak with military recruiters to learn about opportunities, such as being able to complete your doctorate when you join the army. "Opportunities for the reserve OT are absolutely incredible," says Phipps. "We have our deployment mission, which is primarily combat stress and mental health, and within the military treatment facilities there are always opportunities to come on as temporary duty to serve the wounded warrior population."
Johnson has noticed an increase in recognition of the importance of occupational therapy at Walter Reed, and she is getting more consults from physicians. Phipps says they are seeing an increase in poly-trauma care with more sophisticated injuries, including multiple limb loss, multiple wounds, and multiple medical complications. "The wounded warriors challenge you to think outside of the box—there's no cookie cutter OT within military medicine," says Phipps. Johnson said that with the poly-trauma injuries, she can never predict what she will see each day and how she will handle it. "We're always learning new things and going out of our way to find out what's best for the warriors to make sure they get optimal care," she says.
Erica Stern, PhD, OTR/L, FAOTA, was asked by COL Mary Erickson, OTR/L, to assist with a research project about driving rehabilitation for service members. Stern's research prior to the project focused on driving among seniors and persons recovering from brain injury, and Erickson believed her research could help service members returning home. Stern suggests that researchers who are interested in working with this population should learn how their research might address military needs by searching literature and connecting with occupational therapy practitioners in the military. One of the best places to make these connections is at AOTA's Annual Conference & Expo, she says. Researchers should also get involved with the consortium of civilian researchers and military occupational therapy practitioners run by Dr. Mary Radomski (contact 612-863-3291). Stern wants all practitioners to remember that even if they don't work with the VA or at a military treatment facility, "we are all health care providers for service members—in schools we are treating the children of deployed and returning service members, and in community hospitals we are treating service members with deployment history."
Both Phipps and Johnson say that it is an honor to work with wounded warriors. "It's an opportunity to serve your country," says Phipps. "It's an absolute honor to be able to be a part of their care and provide them with independence." Johnson believes that wounded warriors are some of the best clients practitioners will ever have. "They are highly motivated, always put forth the maximum effort, and the outcomes you see are just amazing."
Picture by: Brooke Army Medical Center
- AOTA Fact Sheets:
- Official Document:
- OT Practice articles:
- Army Strong: Female Occupational Therapists Reflect on the U.S. Army's Compassionate Services, by Andrew Waite, in February 25, 2013, OT Practice, p. 20.
- Working With Veterans, by William Croninger, MA, OTR/L, in August 20, 2012, OT Practice, p. 13.
- CE Article: Evaluating Sensory Processing in Mental Health Occupational Therapy Practice by Tina Champagne, OTD, OTR/L and Jane Koomar, PHD, OTR/L, FAOTA, in March 26, 2012, OT Practice.
- The New Wounds of War: Polytrauma Care and Occupational Therapy, by Stephanie Yamkovenko, in November 2, 2011, OT Practice
- Shifting Gears: Helping Service Members Return to the Road by Erica Stern, PhD, OTR/L, FAOTA; Theresa Prudencio, MPH, OTR, CDRS; and Elizabeth Sadler, MHA, OTR, in February 7, 2011, OT Practice.
- Molly Asks: Cpt. Erik Johnson, by Molly Strzelecki in May 24, 2010, OT Practice.
- Driving Rehab for Wounded Warriors, by Farrell Sheffield, OTR/L, HTC, CDRS, in October 26, 2009, OT Practice.
- Veterans Affairs by Ashley Opp Hofmann, in September 8, 2008,OT Practice.
- Other Resources:
- Department of Defense Personnel & Procurement Statistics. (2011).Armed forces strength figures for March 31, 2011. Retrieved May 12, 2011 from http://siadapp.dmdc.osd.mil/personnel/MILITARY/ms0.pdf
- United States Department of Veterans Affairs. (2010). Veteran population. Retrieved May 12, 2011, fromhttp://www.va.gov/vetdata/Veteran_Population.asp
- National Public Radio & ProPublica. (2011). Brain wars: How the military is failing its wounded. Retrieved May 12, 2011, fromhttp://www.npr.org/series/127402851/brain-wars-how-the-military-is-failing-its-wounded
- Mojtabai R., Rosenheck R. A, Wyatt R. J., & Susser, E. S. (2003). Use of VA aftercare following military discharge among patients with serious mental disorders. Psychiatric Services, 54(3), 383–388.
Emerging Niche in All Practice Areas