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Implementation of evidence-based treatments (EBT) is necessary to address posttraumatic stress disorder (PTSD) in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) military service personnel. Because virtual reality (VR) offers a promising tool for delivery of one type of EBT--exposure therapy--this study explored veterans' perceptions of VR as an assessment tool and treatment adjunct. We conducted semi-structured interviews with 14 OEF/OIF veterans being treated for PTSD after viewing two 3 minute VR scenarios as part of a larger research study. Veterans reported a capacity for immersion in VR in both combat and civilian environments, characterized by self-reported physiological reactivity, thoughts/behaviors similar to those experienced in Iraq, and triggered memories. Although participants were generally positive about VR, they expressed concerns about the possibility of negative reactions after viewing VR. Findings are discussed in the context of further development of VR aided interventions in veteran healthcare systems.

Services can do undue harm to clients when there is a lack of understanding of the effects of trauma from various adverse life events on an individual's functioning. A trauma-informed organization provides care, compassion, and respect toward clients and staff with the understanding that each individual may have experienced trauma in their lifetime. The goal of a trauma-informed organization is to meet clients who have lived through trauma where they are at in their healing journey and prevent re-traumatization. My project focused on elucidating the main themes that are pertinent for an organization to become trauma-informed. I utilized content analysis to examine five trauma-informed organizations' guidebooks from health, child-welfare, education, counselling, and community housing service sectors and created a trauma-informed guidebook. My guidebook outlines eight trauma-informed themes-safety, trust, collaboration, choice, culture, staff, listening, and resiliency-and examples of these themes in practice from the aforementioned service contexts. ii

Purushottam b. thaPa, maureen a. Walton, rebecca cunnIngham, ronalD f. maIo, XIaotong han, PatrIcIa e. savary, brenDa m. booth Substance abuse is a chronic, relapsing condition, yet some individuals over time seem to cease use for factors that are largely unclear. A life threatening episode of cocaine-associated chest pain requiring an emergency department (ED) visit may influence subsequent use. A consecutive cohort (n = 219) of patients who presented to a large, urban ED with cocaine-associated chest pain was interviewed at baseline, three months, six months, and 12 months to evaluate longitudinal rates of subsequent drug use. Overall, there was a significant decrease in cocaine use over time (baseline = 100.0%, three months = 56.5%, six months = 54.2%, and 12 months = 51.7%, p < .05 for baseline versus each follow-up interval). Findings suggest that substance use declines following an ED visit for cocaine-related chest pain. However, about half of the subjects were still using cocaine one year later. Future studies examining the potential impact of brief interventions or case management to intervene with this not-in-treatment ED population are warranted.