Soldier as Teacher: the Impact of the Army’s Innovations in Behavioral Healthcare Delivery on the Training of All Psychiatrists (original) (raw)
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Military medicine, 2006
The integration of mental health treatment with primary care is a U.S. Air Force priority. Unfortunately, manning shortages limit the utility of psychiatry in existing Air Force health care models. In this study, we present efficient and data-driven models for psychiatric involvement with primary care. These models include the use of psychiatrists as clinical consultants and primary care educators. Certain factors are required to implement these models including command support for locating psychiatrists within primary care, data-driven educational approaches, collaborative clinical care, and administrative support.
The Best of Both Worlds: Psychiatry Training at Combined Civilian-Military Programs
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Air Force psychiatry faces the task of training competent military psychiatrists in an era of continuing reductions. Beginning in the 1980s, the Air Force started collaborating with University partners to create hybrid training programs, civilian-military psychiatry residencies. These mergers provide stability for Air Force psychiatry training in the face of increased operational missions and uncertain military recruiting. As a result of these combined programs, Air Force psychiatry residents gain access to a broader range of civilian clinical experience and expertise while maintaining a focus on distinctive military requirements. The combining of programs opens up options for academic activities which may not have otherwise existed. Both military and civilian residents benefit from the occupational psychiatry experiences available within military clinical sites. These programs give civilian residents a chance to assist active duty members and their families and provide insight into...
Child, Family, and School Behavioral Health Care in the Military Health System
Military Behavioral Health, 2020
Army family member health and resilience directly impact soldier readiness and are critical to maintaining a deployable force. Military families face unique stressors, including combat deployments, that can negatively impact child and family functioning. In 2014, the Army implemented the Child and Family Behavioral Health System (CAFBHS), one of 11 standardized behavioral health (BH) programs supporting soldiers and their families. CAFBHS is a comprehensive model of care consisting of five interrelated components that function in a synchronous manner: 1) BH providers located in CAFBHS clinics within Military Treatment Facilities supporting and collaborating with Patient-Centered Medical Homes; 2) School BH that embeds BH providers in on-post schools; 3) Community Outreach which organizes military and civilian resources to support soldiers and families; 4) Standardized evidence-based/ informed training curricula for BH providers and primary care managers (PCMs) in treating common pediatric BH disorders; and 5) Regional-level Tele-behavioral Health Consultation in support of PCMs. Patient report of therapeutic alliance is high and outcomes for depression, anxiety and posttraumatic stress disorder for adult family members exceed Army standards. This paper describes the implementation of CAFBHS and provides lessons learned to successfully sustain and expand this integrated BH model of care across the military health care system.
Impact of a mental health trainee interdisciplinary program on a veteran population
JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY, 2020
BackgroundLess than half of adults with mental illness receive mental health services. Several barriers exist to accessing care including stigma and shortage of mental health clinicians. Due to the increasing demand for mental health services, the American health care system has begun moving toward an interprofessional approach.ObjectiveThe primary objective was to evaluate the impact of a trainee‐led interprofessional mental health team on treatment outcomes.MethodsThis single‐center, retrospective, observational analysis was conducted at a Veterans Affairs medical center from August 2013 through April 2019. Eligible patients were identified using the clinic roster and manual review was utilized to exclude patients based on defined criteria. Patient demographics, referral source, initial appointment date, enrollment status, psychiatric diagnoses, and mental health assessment measures were collected. The primary outcome was change in Patient Health Questionnaire (PHQ‐9), General Anx...
Enhancing Assessments of Mental Health Programs and Program Planning
This study focuses on psychological health (PH) care for active duty service members (including activated members of the Reserve Components). Particular attention is paid to post-traumatic stress disorder (PTSD) for three reasons: first, it is frequently related to combat stress, and, thus, brings into focus interrelationships between line and medical responsibilities for the effectiveness and treatment of service members; second, because of its historical antecedents (shell shock, battle fatigue, and combat exhaustion) and the long history of attempts to deal with them; and third, because of the very high costs it imposes in disability payments to those whom treatment has failed to cure. This study brief was prepared for the Office of the Director, Cost Assessment and Program Evaluation (CAPE).
Primary care-mental health integration in healthcare in the Department of Veterans Affairs
Families, Systems, & Health, 2010
Affairs (VA) has been undergoing tremendous transformation in the past 15 years with regard to the delivery of health care. This special issue describes one aspect of this transformation of the largest health system in the U.S.; the system-wide efforts to integrate mental health treatment into the primary care setting in VA. This primary care-mental health integration (PC-MHI) is being accomplished through the central VA system support and implementation of three primary models developed in the field: the White River Colocated models, the Behavioral Health Laboratory, and TIDES (Translating Initiatives in Depression into Effective Solutions). The papers in this special issue describe the development of these models, local and regional efforts to prepare medical centers to adapt and implement PC-MHI, and the impact of the integration on mental health care in these settings. These efforts could represent a national model of PC-MHI implementation for health care systems throughout the U.S.
Military Medicine, 2011
Objective: To evaluate critically whether treatment models existed in the literature to treat a soldier with multiple psychiatric and other comorbidities and propose a mental health model consisting of an integrated multidisciplinary treatment team for use in military outpatient settings. Method: A case example was described to demonstrate the complexity of presentation including depression, anxiety, insomnia, post-traumatic stress disorder, chronic pain, substance abuse, relationship problems, and suicide attempts. Literature search was conducted for the period 2004-2009. Articles that referred to collaborative/integrated care were examined in detail. Results: Seven articles described collaborative care. Of these, fi ve described collaboration with only primary care and 2 with other specialties including pain, substance abuse, and vocational rehabilitation services. Most articles gave a broader description of the collaborative model. Some postulated a theoretical framework. One described collaborative care in detail but was coordinated by only one professional. None described integration of providers involved in the patient's care. The process of implementation was not suffi ciently described. Conclusion: Because of limitations in the published literature, a mental health model consisting of a multidisciplinary integrated treatment team is proposed to treat the soldiers in the military outpatient setting.