lean: project management · claudia black,mindfulness based meditation based on emotional...

LEAN: PROJECT MANAGEMENT

Create a Veteran Centered

Model of Spiritual Care

Chaplain Fellow Eddie ColfVoiceover Enabled

Initiate

Group Logistics

� Locations: Brooklyn VAMC 15W

� When: Tuesdays (July 21- August 25)

� Time: 2:15PM – 3:15pm

� Scheduled Event on the Ward (Attendance is Voluntary)

� Facilitator = Chaplain

Stumbled Across the Voice of the Veteran

Veteran Responses:

• “Something I can accept.”

• “A better understanding of the chaplain's practice.”

• “A better sense of self.”

My Observations:

• Each Veteran approaches spirituality differently.

• Chaplain might be able to model Spirituality for the Veterans.

• A negative sense of self contributes to relapse and costs V.A. money.

“What do I want out of my spirituality group?”

Interventions for Spirituality

• Reflective Practice, “Formation and Supervision in Ministry” Vol. 33, pages 62-65.

• Moral Injury as Shame. • 3 specific interventions proposed.

• An intervention for Courage. • An intervention for Compassion. • An intervention for Connection.

Reflection on what is needed

Not one of the manualized (evidence based) treatments for PTSD was initially validated on Veterans. (neither was A.A.) What is needed:

Combat Trauma, Moral Injuries, and Suicide: April 13, 2015

What Works in the Trenches? By Shane Eynon, Ph.D.

• Real emotional connection. • Appreciation of cultural & economic factors. • Listen to what Veterans say they need.• And Data.

Old Process for Group

Business Case / Problem Statement Opportunity Statement

• There is much waste in the form of time and energy both on the part of the Veterans and chaplains in addressing topics that are both unnecessary and ineffective in the area of spiritual care.

• Chaplains’ efforts, like the efforts of other clinicians, are tied to their own perceptions of the needs of Veterans.

• There is no formalized method to capture the voice of the Veterans’ for group process model of spiritual care.

• Project may create a Veteran centered model of care. • Veterans’ voice may create a more effective group process.• Providers may use active engagement for delivery of care.• Veterans may receive better care as a result.

• Method may become a model of self supervision.

• Process Model may itself be a spiritual intervention.

Goal Statement Scope

• Create a Veteran centered model of spiritual care. • Success will be measured by:

(1) Receive data that reflects Veterans voice. (2) Use the data to make changes in the group process to better

meet the needs of Veterans.(3) Create method that can be spread to other areas of Hospital.

• In Scope –V.A.M.C. Brooklyn Ward 15W Spirituality Group. • Out of Scope – All Other Areas of the Hospital, all other Chaplain

Services.

Project Plan / Timeline Core Team Members

MilestonesInitiatePlanExecuteMonitor/ControlClose/Spread

Planned Dates AprilMayJuneJulyAugust

Actual Dates AprilMayJulyJuly/AugustAugust/September

NameEddie ColfMartin MontonyeJulie Shahroudi Martin Montonye

DepartmentChaplain CPE Supervisor Quality Mgt.CPE Supervisor

RoleProject LeadChampionCoachSubject Matter Expert

V.A.M.C. Brooklyn

Create a Veteran Centered Model of Spiritual Care

Surveys: Capture Veterans’ Voice

• Purchase Intent: Measures the intent of a consumer’s intent to “purchase” a product or service. Marketing.

• 5 Point Likert Scale

• Modified to ask if the material presented in class is useful.

Surveys: Moral Injury Event Scale

• Wm. Nash Moral Event Scale, 2013. Validated with Active Duty Marines Returning from Iraq. Used at San Francisco VAMC.

• 6 Point Likert Scale

• Measures impact of violating one’s own morals & witnessing moral violations of others.

Strongly Moderately Slightly Slightly Moderately Strongly

Agree Agree Agree Disagree Disagree Disagree

Execute

Facilitation Tool: Group Three

Denial: Stuffing Our Feelings.

Self Judgment: Perfectionist Tendencies.

Int. for Courage: Tools For Talking About The Truth.

Int. for Compassion: Listening To Inner Voice.

Int. for Connection: 10 Minute Meditation: Emotional Connection.

Source Material: ACoA Step Workbook , “The One Thing You Need To Overcome Perfectionism.” Erin Dougherty, A Poem by Claudia Black, Mindfulness Based Meditation based on Emotional Awareness.

WEEK THREE H

ANDOUT

Veterans’ Voice: Week Three

N = 7I Definitely

Would Use It

I Probably

Would Use It

I Might

Use It

I Probably Would

Not Use It

I Definitely

Would Not Use It

Q1. Discussion of Denial

#

%

2

28.5%

3

42.8%

2

28.5%

Q2. Discussion of Self-Judgment

#

%

2

33.3%

3

50%

1

16.6%

Q3. Intervention for Courage

#

%

1

14.2%

3

42.8%

3

42.8%

Q4. Intervention for Compassion

#

%

1

16.6%

3

50%

2

33.3%

Q5. Intervention for Connection

#

%

1

16.6%

2

33.3%

2

33.3%

1

16.6%

Veterans’ Voice: Week Five

N = 10I Definitely

Would Use It

I Probably

Would Use It

I Might

Use It

I Probably Would

Not Use It

I Definitely

Would Not Use It

Q1. Affectionate Breathing

Meditation

#

%

7

70%

3

30%

Q2. Discussion of Patience

#

%

5

50%

4

40%

1

10%


#

%

4

40%

6

60%


#

%

6

60%

3

30%

1

10%


#

%

4

40%

4

40%

2 20%

Veterans’ Voice: Week Six

N = 10I Definitely

Would Use It

I Probably

Would Use It

I Might

Use It

I Probably Would

Not Use It

I Definitely

Would Not Use It

Q1. Loving Kindness Meditation

#

%

5

50%

2

20%

2

20%

1

10%

Q2. Discussion Real Hope in

Balance

#

%

5

50%

1

10%

1

10%

3

30%


#

%

5

50%

3

30%

1

10%

1

10%


#

%

6

60%

1

10%

3

30%


#

%

6

60%

1

10%

2

20%

1

10%

Intervene Loop Facilitate Loop

Post Group Process:

Reflection and Change

Monitor & Control

Monitor and Control

� Second Announcement increases Attendance.

� Meditation changed the group dynamics.

� Passing out Surveys has better return. 16.25 (%)

� Guided interventions with newly created tools based on Veteran information leads to a seemingly more dynamic group.

� Veterans receive documents/information on Meditation and topics.

Attendance and Surveys

� Date On Ward Attended Respondents Response Rate

� 7/21 23 19 10 52 %

� 7/28 24 16 7 43 %

� 8/4 24 16 7 43 %

� 8/11 19 13 4 31 %

� 8/18 20 16 10 62 %

� 8/25 24 18 10 55 %

� 6 Sessions

Close & Spread

Close and Spread

� 6 new tools were created based on Group Session and gathering information about Veteran preferences.

� Speak with 15W team on 9/16/2015 about project and preferences from data.

40%

53%

43%

31%

27% 27%

20%

16%18%

7%4%

11%

0%

10%

20%

30%

40%

50%

60%

Intervention for Courage Intervention for Compassion Intervention for Connection

Six Week Average of Veteran Preference for Interventions Utilized ( 7/21 – 8/25)

(N = 48)

Definitely Use

Probably Use

Might Use

Probably NotUse

48.6%45.5%

60.0%

27.1%29.1%

25.0%

14.0%

17.9%

10.0%9.3%7.5%

5.0%

0.9% 0.0% 0.0%0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Discussion Intervention Meditation

Definately Use

Probably Use

Might Use

Probably Not Use

Definately Not Use

Six Week Average of Veteran Preference for Style of Interventions Utilized

( 7/21 – 8/25)

N = 18N = 14 N = 2

45%

15% 16%

8%

3%

14%

44%

13% 13%10%

4%

17%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

1 2 3 4 5 6

Moral Injury: Violations of Others(7/21 – 8/25)

(N = 48)

Negative

Positive



44%

13% 13%10%

4%

17%

53%

21%

17%

2% 2%4%

0%

10%

20%

30%

40%

50%

60%

1 2 3 4 5 6

Moral Injury: Violations of Self(7/21 – 8/25)

(N = 48)

NEGATIVE

POSITIVE



Importance/Satisfaction Tool

0102030405060708090

100

0 20 40 60 80 100

USEFULNESS

M

O

R

A

L

I

N

J

U

R

Y

SIX WEEK USEFULNESS/MORAL INJURY PAIRED SCORES

( 7/21 – 8/25)

(N = 44)

Usefulness: Median: 85%

Mode: 100%

Moral Injury: Median: 65%

Mode: 82%

0102030405060708090

100

0 20 40 60 80 100

USEFULNESS

M

O

R

A

L

I

N

J

U

R

Y

SIX WEEK USEFULNESS/MORAL INJURY OTHERS’ BEHAVIOR PAIRED SCORES

( 7/21 – 8/25)

(N = 44)

Moral Injury, Others’ Behavior:

Median: 70%

Mode: 83%

0102030405060708090

100

0 20 40 60 80 100

USEFULNESS

M

O

R

A

L

I

N

J

U

R

Y

SIX WEEK USEFULNESS/MORAL INJURY OWN BEHAVIOR PAIRED SCORES

( 7/21 – 8/25)

(N = 44)

Moral Injury Own Behavior:

Median: 60%

Mode: 80%

No Discernable Cluster.

Difficult to read. 0

102030405060708090

100

0 20 40 60 80 100

USEFULNESS

M

O

R

A

L

I

N

J

U

R

Y

Motivational Interviewing Tool

0102030405060708090

100

0 20 40 60 80 100

L.U./H.I. H.U./H.I.

L.U./L.I. H.U./L.I.

Usefulness/Importance

H.U./H.I. “I don’t have this problem & the intervention was not helpful?”

H.U./L.I. “I have this problem & the intervention was not helpful?”

L.U./H.I. “I don’t have this problem & the intervention was helpful?”

H.U./H.I. “I have this problem & the intervention was helpful?”

Style: Empathic Normalization. We’re all messy.

47.9%

28.0%

15.7%

8.0%

0.4%0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

1 2 3 4 5

Cumulative Responses for Usefulness

3 Common Types of Likert Scale Bias:

Institutional:

Positive Bias

People Pleasing:

Middle Bias

Wary or On Guard:

Negative Bias

Definitely Probably Maybe Probably DefinitelyUse Use Not Not

� Including a Veteran in preparation for group could become a standardized process.

� The “institutional bias” on slide 34 helps make sense of what may be an error in reporting or awareness on the part of the Veteran on slide 28.

� Dissociation is characteristic of early recovery, our veterans may have limited awareness.

� Meditation seems to influence Veteran perception in other ways.

� I don’t know what caused the linear diagonal grouping on slide 31.

� There is no single model for spread at the end of this project although it seems some intuitive changes were made in the group process leading to an overall more useful group for the veterans.

� Just because interventions for Courage and Connection ranked lower than those of Compassion on the whole, it doesn’t mean that courage and connection are unimportant topics, it may mean that we need a different M. I. communication style.

� Data may not represent the Voice of the Veterans. It may represent the way that one group of Veterans encounters that particular chaplain. For example, the highest rated item is a form of meditation that I practice regularly.

� Breaking down the data into any smaller components based on source is possible with a longer project.

Final Comments

Special Thanks

� Martin Montonye for his helping me to see the Veterans.

� Andrew Sioleti for encouraging me to make positive changes in the group process.

� Julie Shahroudi for working with me in the detailed and at times messy process of trying to listen to Veterans.

� Staff Chaplains, Fellows and Residents at the NYHHS.

[email protected]

Vox vetores, vox Dei

lean: project management · claudia black,mindfulness based meditation based on emotional...

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