Stigma often clouds the association between military service and post-traumatic stress disorder (PTSD), characterizing this population with an overly broad brush. One program at Rush University Health System for Health seeks to deconstruct these stereotypes, offering an accelerated program to veterans whose PTSD may not have responded to traditional therapy.
“The Road Home Program at Rush University Medical Center is part of the Wounded Warrior Project’s Warrior Care Network,” said Kevin Hiner, PsyD, clinical psychologist and manager of Rush's Accelerated Treatment Program, which is part of the Road Home Program. The network provides a variety of mental health services for veterans and their family members.
Rush University System for Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
As a psychologist and a veteran, Hiner said his continued mission is to support those who served and are still serving with compassionate and effective treatment.
“I recognize the complexities of life during and after military service, including the demands and impacts,” he said. “I am grateful to work with a team at the Road Home Program that is uniquely familiar with these challenges and strives to provide veterans, service members, and their families with well-rounded, respectful, and evidence-based care.”
The Road Home Program emphasizes engagement even before patients arrive.
“We try to be very intentional,” Hiner said, noting patient care navigators and clinicians connect with patients ahead of time so they know what to expect and can begin building that relationship.
The program’s structure also plays a key role. Daily sessions help reduce avoidance and reinforce learning, he said. Patients practice and build up their skills in real time so they’re better equipped to continue them when they go home.
There are no out-of-pocket costs to participate in the program, Hiner added. Patients can go online to enroll in the program themselves or have a physician refer them to it.
Condensed treatment delivers on results
The accelerated treatment model offers a markedly different approach to PTSD care—one designed to deliver results in weeks rather than months. Among those services is the accelerated treatment program, an intensive outpatient model focused on evidence-based PTSD care, primarily cognitive processing therapy (CPT).
“The in-person Accelerated Treatment Program is delivered over two weeks instead of several months,” Hiner explained. In a traditional format, CPT is typically one session per week, averaging about 12 sessions.
In contrast, the Accelerated Treatment Program condenses that timeline significantly. Patients travel to Chicago and participate in therapy twice daily with the same clinician, alongside group therapy, wellness services such as mindfulness and acupuncture, and consultations with physicians on issues like traumatic brain injury, pelvic floor health, chronic pain and medication management.
“Frequency and structure of this approach have really helped reduce dropout rates,” Hiner said. “It helps minimize avoidance, which is often a significant feature of PTSD, and allows our patients to build momentum and see progress very quickly.”
The program removes financial barriers as well, he said, noting that “we cover the costs of travel, lodging and food while they’re here,” he noted.
A virtual version of the program is also available in most states, offering similar individual therapy sessions for people unable to commit to two weeks away from home.
Rethinking treatment-resistant PTSD
The program often serves veterans whose PTSD has not improved with prior care—something Hiner says should prompt physicians to reconsider how treatment is delivered.
“When we’re talking about treatment-resistant PTSD, it’s really important to consider how this might reflect limitations in treatment delivery, not necessarily a lack of a patient’s capacity to recover,” he said.
In some cases, patients may not have received evidence-based care, or treatment may have been disrupted by life circumstances or avoidance, which are both common in PTSD.
“The key message for physicians is that non-response or minimal response to treatment is not the same as untreatable,” Hiner emphasized. “It’s a signal to reassess how treatment was delivered.”
Avoiding assumptions about veterans and PTSD
Hiner also stressed the importance of avoiding broad assumptions about veterans’ mental health.
“It is important to avoid equating military service with trauma and with pathology,” he said, adding that “most veterans do not develop PTSD.”
Such assumptions can reinforce stigma and lead to misinterpretation of symptoms or overlooked diagnoses.
Instead, physicians should ask open-ended, neutral questions such as, “Can you tell me about your military experience?” and avoid presuming combat exposure or psychological impact. It’s also important to recognize that trauma is not limited to combat. Other experiences, including military sexual trauma, can lead to PTSD, noted Hiner.
At the same time, physicians should acknowledge strengths associated with military service. Looking at discipline, resilience and leadership skills can help provide a more balanced perspective, he said.
Another effective approach is to use the patient’s own language, saying the word “commander” instead of “boss,” Hiner added.
Recognizing signs in clinical settings
PTSD and related conditions may present indirectly in primary care and other settings. Physicians should watch for sleep disturbances, concentration problems, chronic pain, hypervigilance and emotional changes such as persistent anger, guilt or difficulty experiencing positive emotions.
“They might engage in coping mechanisms that may not be very effective for them, like substance use or disordered eating,” Hiner said.
Avoidance can also manifest as missed appointments or disengagement from care.
“That may be reflective of symptomatic avoidance rather than noncompliance,” Hiner said. Additionally, it’s important to ask about suicidal ideations.
Common pitfalls—and better approaches
Among the most common mistakes made are avoiding conversations about trauma, relying solely on medication and underestimating the importance of trust.
A more effective approach is trauma-informed and patient-centered.
That means taking a collaborative approach, providing choice and empowering patients, he said. Simple steps—such as explaining procedures before touch, asking for consent and framing symptoms as understandable responses rather than pathology—can make a significant difference.
Physicians should also normalize help-seeking.
“Coming to treatment can feel like a weakness,” Hiner noted. “Talking about the courage it takes to seek support can be really important.”
Equally important is awareness of evidence-based therapies such as cognitive processing therapy, prolonged exposure for PTSD or cognitive behavioral therapy.
“Expressing confidence in these treatments can help generate hope,” he said.
Helping patients access the right care
Physicians play a critical role in connecting veterans to appropriate treatment.
“The first part is just knowing different referral resources,” Hiner said, including both VA and non-VA options like the Road Home Program and other Warrior Care Network sites.
Some patients may prefer community-based care for reasons such as access, privacy or prior experiences. Others may need a higher level of care, such as intensive outpatient or residential treatment.
Ongoing physician involvement remains essential. Following up, reinforcing engagement and helping coordinate care all help build rapport and trust, he said.
A program built on results and relationships
Feedback from referring physicians has been positive, particularly when patients return with meaningful improvements.
“That gives further data to that physician,” Dr. Hiner said. They can say, “I’ve recommended this program before, and here’s what people experienced and how they benefited.”
That kind of reassurance can reduce barriers for future patients and increase confidence in seeking care.
While the accelerated treatment program focuses primarily on PTSD, the Road Home Program also offers outpatient services for a broader range of mental health conditions in Illinois and Indiana, along with virtual accelerated treatment across most of the U.S.
“We’re predominantly PTSD-focused in the accelerated program,” Hiner said, “but our broader services address a wide range of mental health concerns.”
