mental health in the department of defense: from policy to programs and patients capt robert...
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Mental Health in the Department of Defense: From Policy to Programs and
Patients
CAPT Robert DeMartinoCDR Meena Vythilingam
CDR Robert MariettaCAPT Paul Andreason
Challenges and Opportunities for PHS Officers at the Defense
Centers of Excellence for Psychological Health and
Traumatic Brain Injury (DCoE)
CDR Meena VythilingamDirector, PH CSoC
June 2012
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Who We Are
‒ Mission, Vision and Values
‒ Organization
What We Do
‒ Functions
‒ Programs
‒ Products
Opportunities
Contact Information
Overview
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DCoE - Who Are We?
Mission Improve the lives of our nation’s service members, families and veterans by advancing excellence in psychological health and traumatic brain injury prevention and care.
VisionTo be the Defense Department’s trusted source and advocate for psychological health and traumatic brain injury knowledge and standards, and profoundly improve the system of care.
ValuesExcellenceIntegrityTeamwork
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DCoE* Governance & Authority
Dr. Jo Ann Rooney (acting)Dr. Jo Ann Rooney (acting)
UNDERSECRETARY OF DEFENSEPERSONNEL & READINESS
Mr. Leon PanettaMr. Leon Panetta
SECRETARY OF DEFENSE
Mr. Ashton CarterMr. Ashton Carter
DEP. SECRETARY OF DEFENSE
Dr. Jonathan WoodsonDr. Jonathan Woodson
ASSISTANT SECRETARY OF DEFENSE - HA
Capt. Paul HammerCapt. Paul Hammer
CDR Meena VythilingamCDR Meena Vythilingam
PH-CSOCMs. Kathy Helmick
Ms. Kathy Helmick
TBI-CSOC
Dr. Mark BatesDr. Mark Bates
R&P
Col RobinsonCol Robinson
DD- PH
Ms. HelmickMs. Helmick
DD- TBI
DIRECTOR, DEFENSE CENTERSOF EXCELLENCE PH/TBI
Mr. Carlton Drew
Mr. Carlton Drew
EDUCATION
* Undergoing organizational restructuring and will be transitioning to MRMC
PH Clinical Standards of Care
Dr. Kathy McGrawDr. Kathy McGraw
DEPUTY DIRECTOR
PSYCHIATRIST (SME)310/02 GS-14
CLINICAL GUIDE. COORD.
310/03 GS-13
CLINICAL SUPPORT TOOLS
310/04 GS-13
- DIVISION CHIEF-CLINICAL GUIDELINES
310/01 GS-14
SOCIAL SCIENCE ANALYST
310/05 GS-11
PSYCHOLOGIST (SME)
310/06 GS-14
HEALTH ANALYST
310/07 GS-13
HEALTHCARE ADMIN CONS.320/02 O-4
SR. ENLIST. MH ADVISOR320/03 E-7
NURSE CASE MANAGER320/04 GS-13
- DIVISION CHIEF-PROGRAM EFFECTIVENESS
320/01 GS-14
CLINICAL PSYCHOLOGIST320/05 O-4
PSYCH. CONSULT. LEAD320/06 GS-14
HEALTH ANALYST320/07 GS-13
PSYCHIATRIST CONSULTANT
SENIOR ADVISOR PH
300A/03 GS-14
RES. ASST PROG ANAL.
300A/04 GS-13
Clinical Guidelines Program Effectiveness
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Serve as the principal integrator and authority on psychological health and TBI knowledge and standards for the Defense Department
Uniquely positioned to accelerate improvements in psychological health and TBI outcomes and policy to impact the continuum of care across the services
What We Do
Surveillance Screening Diagnosis TreatmentAcuteRecovery
Rehabilitation Reintegration
Resilience
Continuum of Care
Prevention
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DCoE: PH/TBI Integrator in the System of Care
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Mission: To develop and provide evidence based PH clinical guidelines to the Military Health System.
Functions: Identify, develop, monitor, and revise psychological health Clinical Practice Guidelines (CPGs), Clinical Support Tools (CSTs), and other forms of evidence based guidance designed to assist clinicians in delivering quality care to patients.
CLINICAL GUIDELINES DIVISION
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The VA/DoD CPGs were developed in an effort to standardize the management of PTS and MDD. Some of
the same topics are emphasized for both disorders
Patient centered care Emphasis on screening Emphasis on early identification
and intervention Functional assessment Evidence-based pharmacology
recommendations Providers trained in evidence-
based treatment provide care Patient and family education
VA/DoD CPGs are available at:
www.qmo.amedd.army.mil/pguide.htm
www.healthquality.va.gov/
www.dcoe.health.mil
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A “Toolkit” is comprised of a group of related CSTs. Evidence-based recommendations from the CPGs
provide the foundation for the content of these tools
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A stepped care treatment plan includes a recommended timeline for psychotherapy and
pharmacotherapy interventions
PTSD Care Pathway ModelP
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Care Pathway for PTSD
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Outcome Measures (Porter’s Model)
Structured documentation
Process / alerts
Cost
Patient satisfaction/trust /activation
One Year Mortality RateSuicide Rate
Patient data captured regularly by clinicianElectronic medical records data
Time from Positive Screen to TreatmentFollow-Up With in 4-6 Weeks
Inpatient Hospitalization CostsPrescription Medication Costs
Patient SatisfactionPatient Activation Measure
EXAMPLES OF METRICS/MEASURES:
Expanded Porter’s Model on Next Slide
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Evaluate Individuals Programs DoD Wide Program Effectiveness
National Guard Bureau OSD CAPE
Evaluate Efficacy of CPG and CST
DoD Dashboard
DoD Program Review Evaluation of tools (e.g. CST,
CPG and CR) Outcomes Assessments
related to tools (e.g. CST, CPG and CR)
• RAND: identify, catalogue, assess, evaluate and improe the cost effectiveness of all DoD PH programs
Program Evaluation Division
Caregiver Designation for assistance with severe wounds, illnesses, and injuries
Patient outcomes and quality measures for mental health care services
Translation of Mental Health Research into Innovative Programs
Gender differences in the delivery and effectiveness of mental health services
CAM
Collaboration with the VA- IMHS
Challenges and Opportunities at DCoE
Meena Vythilingam, M.D.CDR, USPHS
DirectorPsychological Health Clinical Standards of Care
Defense Centers of Excellence (DCoE)W: 301-295-2615
DoD and PHS Mental Health PartnershipExperiences at Langley Air Force Base
Bob Marietta, MDCDR, US Public Health Service
COA Annual MeetingJune 22, 2012
Our Mission:• Train, Organize, Equip, & Deploy Expeditionary Medics• Provide World Class Healthcare for our Beneficiaries
-- Anytime; Anywhere!
Our Vision:• Be the Clinical & Expeditionary Center of Healthcare Excellence
633 MDG is a Currency & Operational Platform for our Nation 633 MDG is a Currency & Operational Platform for our Nation
HospitalEnrollment
Sep 11Eligible
PopulationMCSC
Population FY11 Staff
Nellis 44,352 75,716 3,307 1,241
Travis 39,947 80,087 8,463 2,044
Langley 38,274 111,536 12,507 1003
Elmendorf 37,947 53,242 67 1,071
Wright-Patterson 36,540 56,464 3,074 1,815
Eglin 34,137 84,618 8,256 1,380
Keesler 27,128 49,236 2,652 1,589
7 Currency Hospitals in the AFMS 20117 Currency Hospitals in the AFMS 2011
Keesler AFB
Wright-Patterson AFB
Nellis AFB
Travis AFB
Langley AFB
Elmendorf AFB
Eglin AFB
Where the Staff is:
Opportunity to recapture business:Langley: Largest Opportunity—Smallest FootprintLangley: Largest Opportunity—Smallest Footprint
Who Are We? Largest Beneficiary Population in AF
An Even Bigger Multi-Service Market
Largest Growth in Past 3 Years
Busiest in AF for OB
1st C-CMRF mission in DoD & Pilot unit for GRF/HRT
Surgery - 250 OR cases/month
LDRP– 100 births/month
3,100 X-Rays/month
26,000 Outpatient visits/month
83,000 Prescriptions per month
12,000 Dental & Dental Lab Procedures/month
1 of 7 Specialty Hospitals in the AFMS1 of 7 Specialty Hospitals in the AFMS
Multiple Capability Hospital Primary Care Medicine
Family Medicine Pediatrics
Internal Medicine Flight Medicine
Specialty Services
Emergency Services General Surgery
Orthopedics OB/GYN
Ophthalmology Optometry/Audiology
Urology Mental Health
Otolaryngology (ENT) Physical Therapy
Dermatology Chiropractics (AD only)
Oral Maxillofacial Surgery Podiatry
New Services Planned (2011-2012)
Pulmonology Gastroenterology
Neurology Cardiology
Allergy Pathology
Speech Pathology Peds Surgery
Colorectal Surgery MRI/Nuclear Med
Tidewater Overlapping Catchment AreasTidewater Overlapping Catchment Areas
Ft. EustisFt. Eustis
Langley AFBLangley AFB
Naval MedicalNaval MedicalCenter PortsmouthCenter Portsmouth
111,000 Beneficiaries 111,000 Beneficiaries
Total Tidewater :
417,000 Beneficiaries
Huge Population—Huge OpportunitiesHuge Population—Huge Opportunities
Behavioral Health Flight
Deep set of comprehensive services
Occupational medicine Direct patient care Fitness for duty, disability and forensic evaluations Coordination with military officials
24 hour on-call coverage for ER and hospital
Two mental health disaster response teams
Integration with Primary Care Behavioral Health Optimization Program
Joint Army-Air Force Base Family Advocacy Program
Embedded PHS Officers
CDR Bob Marietta, Psychiatrist Mental Health Element Chief
CDR Bryan Davidson, Psychologist Director of Psychological Health, Behavioral Health Optimization
Program
LCDR Jenny McCorkle, Clinical Social Worker Family Advocacy Element Chief
Benefit to Air Force
Much needed, valued services
“Breathing room” Reduces workload for critically manned AF personnel
Flexible support with local control Custom tailor support to provide best fit
Stability Longer tour length Shorter deployments Highly motivated
Experience PHS providers further along in career Diverse background
Benefit to PHS
High profile, visibility Increased attention to mental health services
Provide a much appreciated service
Work in a uniformed service environment Daily uniform wear
Deployment is part of the culture
Participation in disaster response teams Good training for PHS mission
Skills learned carry over to PHS
Discussion Points
Learning curve for Air Force policies and procedures
“Purple suit” Ex-Navy goes Air Force
Leadership roles Integral part of Air Force officer promotion pathway
Acceptance from Air Force officials, colleagues Ex-Air Force provider transfers in to PHS
Uniform
Good to stand out, easily identifiable
BDUs retired by Air Force
PHS headquarters support functions
Results
Integral part of hospital and Air Force Medical System
Trust, appreciation and acceptance
Air Force planning personnel movements around PHS personnel
Questions?