The Responsibility Project^®. Exploring what it means to do the right thing

Lieutenant Rocco’s recently returned from deployment in Iraq and he’s having trouble acclimating. He sits near the edge of a sofa in his social worker’s office, still dressed in fatigues, and sporting a buzz cut. Even though he says he’s okay, he admits to getting flack from his boss about his lack of productivity and that he’s arguing with his wife. "There are things I don’t want to talk about with her. Things I can’t get out of my head," he says.

The more you listen in on Lieutenant Rocco’s session, the easier it becomes to forget the slightly odd cadences of his speech and the blocky outlines of his clothing which point out that the Lieutenant isn’t a real person. He’s a digital avatar designed to be a training tool as part of University of Southern California School of Social Work’s curriculum for the Master of Social Work degree with a Sub-concentration in Military Social Work. A virtual patient like Lieutenant Rocco teaches prospective counselors how to deal with soldiers returning from duty where they may have witnessed life-altering atrocities.

One in three of the nearly two million American soldiers returning from tours in Iraq or Afghanistan will have Post Traumatic Stress Disorder (PTSD). You can’t look at them and see battle scars or missing limbs. They're not wounded in the traditional sense, but they're wounded nonetheless.

PTSD manifests in a variety of ways, from substance abuse to domestic violence, even suicide, which is reaching epidemic proportions. U.S. Department of Veterans Affairs found suicides among veterans increased 26% between 2005 and 2007. Today, one in five suicides involves a veteran, and they can’t rely only on a 1-800 hotline to stem the growing tide. "If [a soldier] comes in and says ‘I’m suicidal,’ you can’t mess it up," says Dr. Anthony Hassan, director of USC’s Center for Innovation and Research on Veterans and Military Families (CIR).

Though the staggering statistics are reaching unprecedented levels, the good news is that with early screening and access to adequate treatment and counseling, the psychological effects of combat are treatable. The challenge, Hassan says, is to train a new generation of clinical social workers to deal with veterans’ mental trauma.

"Currently, the biggest obstacles veterans with mental health injuries face to get care are stigma and shortages of mental health professionals," says Paul Rieckhoff, executive director and founder of Iraq and Afghanistan Veterans of America (IAVA), a nonprofit organization whose mission is to improve the lives of Iraq and Afghanistan Veterans and their families.

As a retired Major in the U.S. Air Force, Hassan knows that having a military concentration is critical to the success of the social workers’ therapeutic training. "If a veteran doesn’t make a therapeutic alliance [with the social worker] and come back after the first visit, they won’t come back," he says, leaving them open to a number of problems. That's where Lieutenant Rocco comes in.

Reickhoff says veterans are concerned that if they reveal mental health problems, they will be seen as weak or be judged because of it. "In my experience (and supported by research), many vets experiencing PTSD struggle with some level of sleeplessness, anxiety, irritability, intrusive memories, or feelings of isolation. You also see the strain in friendships, relationships and marriages," says Reickhoff.

Civilian social workers are often intimidated by military clients while the vets are not comfortable with therapists who have no experience in combat, Hassan adds. On both sides of the equation, "They just don’t get it," he says.

The virtual patients help to bridge that gap, says Hassan, by making students aware of the language and acronyms specific to the military, as well as providing them with the kind of immediate assessments that were just not available in traditional role-play.

Created by the USC Institute for Creative Technologies (ICT), a university-affiliated Army research center (UARC) through a team led by Dr. Albert "Skip" Rizzo, the virtual patients are becoming more sophisticated in terms of their overall look, voice recognition, and artificial intelligence capabilities.

ICT is developing other "Virtual Patients" to complement Lieutenant Rocco. Rizzo’s team is working to create a female soldier as a “training tool for clinicians to practice sensitive interviewing skills for addressing the growing problem of sexual assault within military ranks.” Rizzo says the system is also being designed for use by command staff to foster better skills for recognizing the signs of sexual assault in subordinates under their command and for improving the provision of support and care.

All this technology and the start-up costs for the CIR is being supported by the assistance of two grants to the tune of over $6 million, with $3.2 million coming from the Department of Defense.

“I think vets welcome counseling from someone who has 'been there' and can identify with their unique experience,” Rieckhoff says, but cautions, "We also need to continue to push the DoD and the VA to continue to focus on the mental health challenges of returning troops, these issues will only intensify in the coming years."