Interdisciplinary Pain Interdisciplinary Pain Team Training Team Training ProgramProgramMichael E. Clark, Michael E. Clark, PhDPhDCandon Norton, Candon Norton, PsyDPsyD

Chronic Pain Rehabilitation ProgramTampa Veterans’ Hospitalwww.vachronicpain.org

History & DevelopmentHistory & Development

2008 VA National Pain Initiative2008 VA National Pain Initiative– Proposal for enhanced pain services Proposal for enhanced pain services

nationwidenationwide Increase the number of pain specialistsIncrease the number of pain specialists Enhance primary care providers’ pain management Enhance primary care providers’ pain management

knowledge and skillsknowledge and skills Stimulate the development of interdisciplinary pain Stimulate the development of interdisciplinary pain

services nationwide services nationwide

– Specific training objectives and Specific training objectives and timeframes were contained in the National timeframes were contained in the National Pain Initiative proposalPain Initiative proposal

Each facility is expected to send at least one primary Each facility is expected to send at least one primary care provider for training in the “stepped care” model care provider for training in the “stepped care” model of pain treatment within two years of initiative of pain treatment within two years of initiative approvalapproval

Each VISN is to implement at least one CARF-Each VISN is to implement at least one CARF-accredited interdisciplinary pain management accredited interdisciplinary pain management program within 5 years of initiative approval. program within 5 years of initiative approval.

History & DevelopmentHistory & Development

The VA National Pain Initiative proposed that the Tampa VA Chronic Pain Rehabilitation Program (CPRP), serve as the model center/training site.

The Interdisciplinary Pain Team Training Program provides program development and consultation services to treatment teams nationwide.

MissionMission

Provide VA clinical care staff with Provide VA clinical care staff with the information and tools the information and tools necessary to effectively treat necessary to effectively treat veterans and active duty service veterans and active duty service members with chronic pain members with chronic pain conditions utilizing the conditions utilizing the biopsychosocial model within an biopsychosocial model within an interdisciplinary frameworkinterdisciplinary framework

Current Training StaffCurrent Training Staff

1 FTE Pain Psychologist1 FTE Pain Psychologist– Serves as coordinator of training Serves as coordinator of training

programprogram 1 FTE Pain RN1 FTE Pain RN

– Serves as Nurse Educator and Support Serves as Nurse Educator and Support Pain specialists in each discipline of Pain specialists in each discipline of

the CPRP volunteer time to help the CPRP volunteer time to help educate training participants.educate training participants.

Team-OrientedTeam-Oriented

Our goal is for each facility to send as Our goal is for each facility to send as many core members of the treatment many core members of the treatment team as is feasible. team as is feasible.

Taking part in our program as a unit Taking part in our program as a unit helps educate the treatment team to helps educate the treatment team to each other’s specialty areas while each other’s specialty areas while fostering the communication and fostering the communication and teamwork necessary for teamwork necessary for interdisciplinary pain management to interdisciplinary pain management to function at its best.function at its best.

Chronic Pain

Psychology

Medicine

Occupational Therapy

Physical Therapy

PsychiatryPharmacy

Recreation Therapy

Nursing

Social Work

Dietetics

Pool Therapy

Vocational Rehabilitatio

n

Training FormatTraining Format

An individualized itinerary An individualized itinerary corresponding to each visiting team’s corresponding to each visiting team’s unique training needs and goals is unique training needs and goals is developeddeveloped

Training experiences incorporate Training experiences incorporate didactic sessions, interaction with and didactic sessions, interaction with and observation of interdisciplinary observation of interdisciplinary treatment modalities. treatment modalities.

Training takes place at the James A. Training takes place at the James A. Haley Veterans’ Hospital in Tampa, FL Haley Veterans’ Hospital in Tampa, FL and typically lasts 2-4 days. and typically lasts 2-4 days.

Training FormatTraining Format

Typically, training includes an assortment Typically, training includes an assortment of the following topicsof the following topics– Interdisciplinary pain treatment program Interdisciplinary pain treatment program

development development – Information on CARF accreditation standardsInformation on CARF accreditation standards– Integration of pain outcomes measuresIntegration of pain outcomes measures– Cognitive-behavioral pain treatmentCognitive-behavioral pain treatment– Polytrauma pain treatmentPolytrauma pain treatment– OEF/OIF pain screening and treatmentOEF/OIF pain screening and treatment– Blast-related headache treatmentBlast-related headache treatment– Medical managementMedical management– Interventional treatmentInterventional treatment

OutcomesOutcomes

7 Training Sessions7 Training Sessions 18 Participants from VAMCs, CBOCs, & 18 Participants from VAMCs, CBOCs, &

military medical facilitiesmilitary medical facilities– Training groups ranged in number from 1-9Training groups ranged in number from 1-9– Various disciplines represented in training Various disciplines represented in training

groupsgroups 6 Psychologists6 Psychologists 4 PM&R Physicians4 PM&R Physicians 2 Nurses2 Nurses 2 Anesthesiologists2 Anesthesiologists 1 Pharmacist 1 Pharmacist 1 Chief of staff1 Chief of staff 1 Primary care physician1 Primary care physician 1 PM&R Program Administrator1 PM&R Program Administrator

OutcomesOutcomes

Implemented pre-, post-, and follow-up Implemented pre-, post-, and follow-up assessment measures beginning with the assessment measures beginning with the most recent 10 participantsmost recent 10 participants– Pre-training data collected upon arrival to training Pre-training data collected upon arrival to training

program prior to any content presentationprogram prior to any content presentation– Post-training data collected on last day of training Post-training data collected on last day of training

after completion of content presentationafter completion of content presentation– Follow-up questionnaires will be sent to graduates Follow-up questionnaires will be sent to graduates

6 months after completion of the training program6 months after completion of the training program Feedback is attained using a 5-point Likert Feedback is attained using a 5-point Likert

ScaleScale– 1 = Not At All or Never1 = Not At All or Never– 5 = To A Very Great Extent5 = To A Very Great Extent

Pre-Training Means

Post-Training Means

Skills needed for interdisciplinary

pain care?3.67 5

Knowledge needed to participate

in interdisciplinary pain care?3.33 4.75

Resources needed to implement

interdisciplinary pain program?

2.44 2.75

Satisfaction with training staff?

- 5

Satisfaction with training facilities?

- 4.63

Satisfaction with training content?

- 4.88

Overall satisfaction with training

Program?- 5

Recommend to other providers?

- 5

OutcomesOutcomes

Future DirectionsFuture Directions

Marketing & Recruitment for team Marketing & Recruitment for team participation in the Interdisciplinary participation in the Interdisciplinary Pain Team Training ProgramPain Team Training Program

Formalization, Standardization, & Formalization, Standardization, & Dissemination of Provider Dissemination of Provider Education ResourcesEducation Resources

Formalization, Standardization, & Formalization, Standardization, & Dissemination of Patient Education Dissemination of Patient Education ResourcesResources

How to Get StartedHow to Get Started

Contact the coordinatorContact the coordinator– Provide information about the current status Provide information about the current status

of pain management programs at your VA of pain management programs at your VA facility.facility.

– Indicate which members of your treatment Indicate which members of your treatment team will be visiting.team will be visiting.

– Specify group goals for training, as well as Specify group goals for training, as well as individual goals for treatment team members.individual goals for treatment team members.

Secure travel support from your local Secure travel support from your local facility or VISN.facility or VISN.

Contact InformationContact Information

Coordinator: Candon Norton, PsyDCoordinator: Candon Norton, PsyD

Website: Website: www.vachronicpain.org

Phone Number: 813-972-2000, ext. Phone Number: 813-972-2000, ext. 55695569