Several murders at Fort Bragg in 2002 led Eric Elbogen to wonder if violence was a growing problem for some veterans.
Elbogen, a forensic psychologist in UNC’s Department of Psychiatry, was working with civilians then, but the troubling news of soldiers’ violence began a change in his career path.
His work since then has led to a groundbreaking way to assess a veteran’s risk for violence and to help prevent it. Elbogen and his research team were the first to develop risk assessment tools designed for military veterans that can be used by clinicians treating veterans in both VA and non-VA facilities.
The tools came after Elbogen completed a National Institutes of Health-funded national survey to identify which U.S. veterans of wars in Iraq and Afghanistan with Post Traumatic Stress Disorder (PTSD) may be at most risk for aggression after deployment and what strategies could potentially help reduce the likelihood of violence when veterans return home.
The study examined eight protective factors associated with significantly lower levels of violence in veterans:
- Meeting basic needs;
- Living stability;
- Social support;
- Spiritual faith;
- Ability to care for oneself;
- Perceived self-determination; and
- Resilience (ability to adapt to stress).
Veterans with these factors were 92 percent less likely to report severe violence than veterans whose lives did not include them. More than three-quarters of veterans were low-threat because they indicated that their lives included most of the protective factors.
“The majority of veterans are not violent,” Elbogen said.
The evolving work goes beyond the often one-dimensional, knee-jerk use of PTSD in media reports about veterans committing violent acts.
From a Chapel Hill-based clinic not too far from two military bases – Fort Bragg and Camp Lejeune – Elbogen’s team is well situated to help veterans. “It’s a plus being near North Carolina’s high proportion of military families to civilians, ranking second in the United States,” he said.
Elbogen spends time with veterans, listening and getting to know them. He gives them tools to help cope with stress.
“I run a group called CALM, which stands for Client-centered Anger and Life Management,” he said. “My 11-year-old daughter said it should be called ‘Cool And Laidback Mood.’ The veterans like her acronym much better, not surprisingly.”
Elbogen also leads a financial counseling group at the VA called $teps for Achieving Financial Empowerment ($AFE).
At other times, he’s collecting and analyzing data that lead to ideas on how to help veterans further.
Because of the state’s number of military personnel, UNC Hospitals is a TRIcare- (military insurance) designated site. Three years ago, UNC Hospitals saw 12,000 TRIcare patients a year, and it was on track to increase by 1,000 a year.
The more than 30,000 visits included spouses, kids and reservists, and the numbers reflect the hospital’s history of helping veterans. In fact, the first hospital building, N.C. Memorial Hospital, was built in the early 1950s as a memorial to North Carolinians in the armed forces, past and present.
Elbogen’s efforts grew from his time as a crisis clinician working with mentally ill civilians. At that time, few guidelines existed to predict who would be violent or aggressive, and Elbogen wanted to understand how to better predict such behavior. So, he studied violence risk assessment at the University of Nebraska’s Law and Psychology Program.
An internship at Harvard Medical School followed, after which he worked at Duke University Medical Center before joining the UNC Forensic Psychiatry Program and Clinic in the Department of Psychiatry in 2007. He also holds a joint appointment as a clinical psychologist at the Durham VA Medical Center.
Elbogen had begun changing his research focus in 2002 after a number of murders on military bases.
“With the wars in Iraq and Afghanistan, I began to wonder if aggression would be an issue for our newly returned veterans,” he said. “And if it was, I wanted to figure out how to help our veterans, when they returned home from combat, identify who was at risk and determine what to do about it.”
By that time, clinicians had assessment tools for civilians, but there were no tools to assess veterans. Elbogen’s desire to apply what was known about civilians to veterans accelerated at the Durham VA.
“I shifted to applying the science of violence risk assessment to veterans,” he said.
He won a grant from the NIH to develop tools to assess and reduce violence in military veterans. Elbogen’s team reviewed previous research and conducted new studies to identify risk factors for aggression, suicide and alcohol misuse in veterans. They have identified risk and protective factors related to violence, which clinicians can use to assess a veteran’s risk of violence.
The team in UNC’s forensic psychiatry program and clinic includes Sally Johnson and several master’s- and Ph.D.-level clinicians and postdoctoral fellows. Psychiatry professor Aysenil Belger oversees MRIs and ERGs conducted as part of the team’s research. (See go.unc.edu/p6K3J.)
“We want to make sure our research gets used in real-life clinical practice,” Elbogen said. “The VA is a great vehicle for this because they’ve had an excellent electronic medical record system for a long time.”
With the screening on track, the team is helping veterans bring protective factors to their lives, something Elbogen describes as an “inoculation” against violence. These include money management intervention with an emphasis on employment and the use of mobile apps to promote mindfulness and goal achievement.
Elbogen’s work, which he said is incredibly rewarding, is part of the UNC system’s programs for active-duty military veterans and their families known as the UNC Partnership for National Security.
“Today’s veterans show a strength and integrity of character that is rare,” he said. “These are a statistically small group of individuals who selected an occupation in which they risk life and limb every day. They are truly heroes.
“To help veterans who’ve allowed me to have the kind of life I have, I can ask for no higher honor.”