Clinical Military Psychologists

Jan 18 Ch 5,6

Disclaimer

Information and opinions expressed by Maj Dhillon and other military/government employees providing lectures are not intended/should not be taken as representing the policies and views of the Department of Defense, its component services, or the US Government.

Overview

• Clinical Psychologists• Pediatric Psychologists• Forensic Psychologists• Prescribing Psychologists• Behavioral Health Consultants• Clinical Health Psychologists• Neuropsychologists• Military Mental Health Technicians

Clinical Psychologists

• Doctoral Level• American Psychological Association (APA) accredited

program• Pathway:

– APA internship– Direct accession

• Retention bonus• Board Certification Bonus• Licensed in any state• Must be able to do any job, anywhere, with anyone

Pediatric Psychologists

• Same as clinical but completed post doctoral fellowship in child psychology

• Specifier on job code designating specialty • Highly sought for overseas assignments and

stateside big military medical facilities

Forensic Psychologists

• Same as clinical but completed post doctoral fellowship in forensic psychology

• Fellowship can include working with criminal investigation arm of their service

• Testify as expert witness in UCMJ cases– Mental status during criminal act, capacity to

understand and participate in proceedings, opinion on insanity defense, etc.

• Conduct evaluations for UCMJ cases• Job code specifier after training

Prescribing Psychologists

• Same as clinical but obtained M.S. in psychopharmacology and supervised prescribing hours before certification

• Specifier on job code• Born from operational necessity due to critical

shortage of psychiatrists and psychiatric nurse practitioners

Behavioral Health Consultants

• Any Mental Health provider except psychiatry• 4 weeks of training • Located within primary care clinic• Consult with primary care managers (PCMs) on patient

cases involving behavioral component such as:– Weight management, Smoking cessation, Prescription adherence,

Chronic Pain Management, sleep problems…• 50% of formal mental health care conducted in primary care• 15-30 min appointments, behavior and functioning focused,

patient belongs to PCM, BHC gives feedback on consultation to PCM

Clinical Health Psychologists

• “applies scientific knowledge of the interrelationships among behavioral, emotional, cognitive, social and biological components in health and disease to the promotion and maintenance of health; the prevention, treatment, and rehabilitation of illness and disability, and the improvement of the health care system.

Clinical Health Psychologists

• Specifically focus on physical health conditions where behavioral factors play a primary or secondary role

• Population Health Management – Survey health of population, provide preventative

care and interventions, disease management and outcome measurement

– Primary prevention: prevent onset of a condition– Secondary prevention: identify those at risk– Tertiary prevention: treat symptomatic patients

Clinical Health PsychologistsPost doctoral fellowship training 1-2 years

– assessment/management of chronic disease and illness

– Health maintenance via prevention

– Evaluate intervention effectiveness

– Interdisciplinary collaboration– Disease management team

development– Develop a population health

approach– Conduct applied clinical

research

• Job code identifier• Primarily assigned to big

military medical facilities• AF is a major post doc

fellowship training site• Biofeedback certification• Provide:

– Tobacco cessation, weight management, chronic pain management, insomnia management,

Neuropsychologists

• 2 year post doc fellowship • Focused on brain-behavior relationships• Evaluate members of their service based on the

regulations for that service– Army and AF have different regulations when it

comes to aviators and medication• Job code specifier• Most frequently placed in larger military

medical facilities

Neuropsychologists

• Differs from civilian neuropsychology– Readily available baseline assessment data for

most mil members• ASVAB• AFOQT• Service member records

– Neuropsych measures developed for specific military populations (i.e., Armstrong Laboratory Aviator Personality Survey)

Neuropsychologists

• Fitness for Duty Evaluations– Assess type, level, an prognosis of neurological

impairment– Traumatic Brain Injury

• Mil mbrs at high risk due to training, environment, and combat

• Cognitive, emotional, behavioral, physical deficits• Significantly impact knowledge, skills, and abilities required of

technical jobs in military• In combat concussive blasts more common than penetrating

ones and cause cerebral damage but are more difficult to identify

Neuropsychologists

– Medevac process from theater to Continental US (CONUS):• Injury on battlefield• Self Aid and Buddy Care on battlefield• Rapid medical response by medical technicians• Battlefield hospital care stabilizes member• Aerovac to Landstuhl Regional Medical Center in

Germany for further care• Transfer to CONUS military/VA medical center• Defense Veterans Brain Injury Center (DVBIC) for

specific treatment and rehabilitation for TBI

Neuropsychologists

– Attention Deficit Hyperactivity Disorder & Learning Disorders• No entry to military service w/history of ADHD,

unsatisfactory academic performance and /or current NEED for medication

• If diagnosis made after member is in military, retention in service possible only if symptoms do not interfere with ability to do job

• Accommodations are not possible in military environment• Inability to perform results in an administrative discharge

as opposed to a medical discharge

Neuropsychology

• Military Aerospace Neuropsychology– Branch of clinical neuropsych managing

assessment, selection, and disposition of military and NASA members on flying status

– Integrates clinical-, aviation-, and neuro-psych– 90% of air mishaps are due to human factors– Must assess and integrate interplay of cognitive,

information processing, sleep/fatigue, stress, ergonomics, toxicity, personality factors on flying

Neuropsychology

– AF School of Aerospace Medicine inaugurated by President Kennedy the day before his assassination at Brooks AFB in San Antonio now moved to Wright Patterson AFB, OH

– Also address issues like airsickness, gravity loss of consciousness, hypoxia, mishap investigation, human factors research, stress reactions to flying, motivation to fly, air traffic control, reverse malingerers

Neuropsychology

• Multidimensional Aptitude Battery (MAB-II) – Different norms for pilots, (look at drop in

performance as opposed to impairment defined by regular norms on measures like IQ)

– FS IQ=120.8, SD=8.2, – Impaired performance is 2 SDs below mean• Avg IQ is actually an impairment for pilots

Neuropsychologists

• MicroCog-Generalizes well to common neuropsych conditions– Reaction Time and Information Processing Speeds

are especially important in assessing high performance aircraft pilots

• Armstrong Laboratory Aviator Personality Survey– Produced and standardized by AF gives profile of

flyers in Personality, Psychopathology, and Crew Interaction domains

Neuropsychologists

• NEO PI-R Personality measure on 5 factors– Neuroticism (low), Extraversion (high), Openness (middle),

Agreeableness (low), and Conscientiousness (high)

• Critical components of aviator neuropsych assessment: speed/accuracy; attention/ concentration; vigilance; memory; working memory; auditory, spatial, and kinesthetic processing; new learning; multi-tasking; cognitive flexibility, problem solving

Neuropsychologists

• Aviator profiles– The Right Stuff—fighter pilot: aggressive, dominant,

exhibitionistic, impulsive, playful– The Company Man—transport pilot: high achievement,

endurance, affiliation, and orderliness– The Wrong Stuff—low exhibition, understanding,

affiliation, and orderliness– High somatization due to high defensiveness and denial

of psychological problems– Most pilots are RTD due to high resiliency and

achievement orientation

AF Mental Health Techs

• Per AFMAN 36-2108, 4Cs are supposed to be able to: Support MH svcs in psychiatry, psychology, social work, FAP, ADAPT, & MHC.

• Assist pro-staff w DEVELOPING & IMPLEMENTING tx plans.

• PERFORMS specified MH tx.• REPORTS & DOCUMENTS pt care.

Military Mental Health Techs

• Conduct/assist in individual & group tx.• Perform initial, basic, & standard psych

assessment, clinical interviewing, MSEs• Assist in: dx, tx, pt education, & disposition

planning.• Observe, monitor, record, & report pt progress.• Assist in or arrange pt referral to public, private

or mil community agencies.

Military Mental Health Techs• Training

– Tech School--MH Apprentice:– 3 mos training DSM-IV-TR diagnostic criteria– How to do an intake interview– Operations of MH elements

• EXPERIENCE to obtain--MH Journeyman:– Administering, scoring & reporting psych testing;– Interviewing pts for biopsychosocial hx& personal info; – ASSISTING pro staff to carry out prescribed tx plan

• EXPERIENCE to obtain--MH Craftsman:– Conducting briefings.– Performing or supervising Psych assessment.– Interviewing pts and assisting in tx or substance abuse prevention & counseling