revised respect mil power point presentation 2009 updated 081209
TRANSCRIPT
RESPECT-MilRe-Engineering Systems for the
Primary Care Treatment of Depression and PTSD in the Military
2They Gave so Selflessly
The RESPECT-Mil Team at Fort Campbell
3
Presenting Today:
MAJ Anthony Rhea MSN, FNP, Primary Care Champion, RESPECT Mil
Dr. Jennifer Hanley DNP, Behavioral Health Champion, RESPECT Mil
Robin Slone RN BS, Lead RESPECT Mil Care Facilitator
The RESPECT-Mil Team at Fort Campbell
Continued
4
CARE FACILITATORS:
Ms. Brenda Tanner RN, BSN (Ashau Valley Clinic)
Mrs. Kathy Parish RN, BSN (Bastogne Clinic)
Mrs. Tina Robertson RN (Aviation Health Clinic)
Mrs. Desiree Allen RN (Blue & White Clinic)
AMINISTRATIVE ASSISTANTS: Mrs. Maria Matta AAMrs. Charity King AA
Mrs. LaShanda Harrison AA
Blanchfield Army Community Hospital Fort Campbell, KY
Home of the Screaming Eagles101st Airborne Division
LaPointe Health Clinic(Ashau Valley & Bastogne)
Aviation Health Clinic Carentan Health Clinic
Blanchfield Army Community Hospital, Fort Campbell, KY
Blue andWhite Clinics
Statistics Fort Campbell, KY is home to 30,000
Soldiers including the 101st Airborne Div, 5th SFG, 86th CSH and the 160th Aviation Regiment
In 2008, 140 Soldiers committed suicide military-wide
In 2009, (first 5 months), there were
67 possible Soldier suicides, 17 of those from Fort Campbell, KY
RESPECT- MilProgram from the Office of the Surgeon
GeneralFt. Campbell – One of 22 Army
Installations worldwide with the RESPECT Mil program
Implementation- March 2008 in one clinic (Carentan)
Presently, six clinics successfully operating which makes the program available in all Soldier Health Services Clinics at Fort Campbell, KY
Current Status of ProgramGoal
Clinics= 6(Carentan, Bastogne, Ashau, AHC,
Blue, White)
RCFs (RN) = 5Admin Assist (AA) = 3Training: All PCMsTraining: Support staff
Current Status6 Clinics5 RCF’s (RNs)3 AA 60+ Providers
trained50+Medics trained70+ Nurses trained
Patie
nt Visits
Patie
nt Scr
eened
Positiv
e Sc
reen
s
Pos. s
ent t
o Tre
atm
ent
0500
10001500200025003000
2762 2662
371149
March- July 2008
Mar Apr May Jun Jul0
2
4
6
8
10
6
10
34
33
5
2
0 01 1
01 1
Low IntermediateHigh
Suicide Risk Level
Statistics
Patie
nt Visits
Patie
nt Scr
eened
Positiv
e Sc
reen
s
Pos. s
ent t
o Tre
atm
ent
0
1000
2000
3000
3117 2923
428123
Aug- Dec 2008
Aug Sep Oct Nov Dec0
0.51
1.52
2.53
3.54
4.55
1
5
4
2
0
2 2
1
0
4
2
3
0 0
2
Low IntermediateHigh
Suicide Risk Level
Jan Feb Mar Apr02468
1012141618
01
5
18
02
0
17
13
0
4
Low IntermediateHigh
Suicide Risk Level
Patie
nt Visits
Patie
nt Scr
eened
Positiv
e Sc
reen
s
Pos. s
ent t
o Tre
atm
ent
0
2000
4000
60006068
5346
706 279
Jan- Apr 2009
May June July0
5
10
15
20
25
30
15
24
15
2325
29
47
11
Low IntermediateHigh
Suicide Risk Level
Patie
nt Visits
Patie
nt Scr
eened
Positiv
e Sc
reen
s
Pos. s
ent t
o Tre
atm
ent
0
4000
8000
12000
1600015105 13622
1995580
May-July 2009
RESPECT-MILProgram Standards
Approach contained in “how to” manuals
Primary Care Providers undergo 2 hours of training
Routine primary care PTSD & Depression screening
Positive screens followed by diagnosis & severity assessment
Immediate Care-Facilitator assistance and accountable, continuous follow-up to remission
Weekly specialist input/supervision
BACH Performance
Each Provider has copies
> 95% of PCM have received initial training
> 95% of all routine visits in Carentan clinic receive screening
Average 14% of screens are positive for Depression and/or PTSD
93% of all patients referred to RESPECT- Mil were contacted by RCF Mrs. Robin Slone
97 staffings conducted on 57 patients. Result: 56% had recommended treatment changes
Adult Behavioral Health April 2009 Behavior Health Counselors and Tech’s were
placed in Soldier Health Services Clinics to partner with RESPECT Mil, providing an opportunity to have Soldiers Behavioral Health needs met in a Primary Care setting
All appointments sick call, walk-ins and routine - scheduled appointments are screened for Depression, PTSD and suicide via RESPECT Mil forms
Intermediate to Low Risk Soldiers are counseled and followed until remission, ETS, PCS or transferred to specialty care; WTU, TBI or Adult Behavioral Health
All High Risk Soldiers are referred to Adult Behavioral Health for treatment and follow up
16
Prevalence & Impact Currently 10% of the population is suffering from a
major depressive disorder.
10 % of men and 20% of women will suffer from a major depressive episode in their lifetimes.
As many as 70% of those individuals were undiagnosed and untreated prior to RESPECT Mil
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Prevalence & ImpactDEPPRESSIVE DISORDER ranks as the
5th most common diagnosed disorder
in the primary care setting.
(Only after hypertension, well-child checks, diabetes mellitus, and routine general medical examinations.)
(Dartmouth-Northern New England Coop - Summer 2003 report)
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Post-Deployment Health Consequences
Hoge et al, AJP 2007
2,863 Iraq War Veterans one-year post-deployment
0%
10%
20%
30%
40%
50%
60%
Limb Pain Back Pain ≥2 Sickcalls/ mo
≥2 Missedwork days
PTSDNO PTSDTwice as many
sick call visits!!
0%
10%
20%
30%
40%
50%
60%
Limb Pain Back Pain ≥2 Sickcalls/ mo
≥2 Missedwork days
PTSD
NO PTSD
19
Common Treatment Options Primary Care Providers
Behavioral Health Specialist
Service Members
RESPECT Mil Care Facilitators, RN
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Usual Treatment OptionsAntidepressant medications
Self management plans
Referral for psychological counseling and/or RESPECT Mil Care Facilitation
Combinations of any or all of the above
21
RESPECT Mil
& Adult Behavioral
Health Within the Clinics at Fort Campbell, KY
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The Prepared Practice
PCM
Recognition & diagnosis (screening tools)
Patient treatment selection & education
Initiation of treatment & referral to Care Facilitation/Management
Continuing treatment & treatment modifications
Continuation/maintenance phase & relapse prevention
Pri
mary
Care
Pro
vid
ers
23
Care Facilitator = Registered Nurse
Serve as a guide not therapist
Facilitate adherence to treatment
Assess & monitor treatment response
Educates Soldiers about medication, Sleep Hygiene
Reassesses for PTSD, Depression and Suicide each contact
Schedules Counseling Appt. if warranted or referred
Communicates with PCM & Behavior Health Specialist
Coord
inate
s
Com
mu
nic
ati
on
Care Facilitation
24
The Behavioral Health Interface
Consulting Psychiatrist and Counselor
Care Facilitator Case Staffing
Informal consultation with clinicians
Formal patient consultation & treatment
Psychological assessment & counseling recommendations
Beh
avi
ora
l H
ealt
h
Sp
eci
ali
st
25
Support StaffRESPECT Mil Medical Support Staff
Assist with screening & use of screening tools
Use of depression/PTSD management forms & recordkeeping
Communication protocols
Calculate statistics for each clinic
Scheduling and linkages with Care Facilitators
Su
pp
ort
Sta
ff
PATIENT VISITS
26459
PATIENTS SCREENED
23977
90.6%
POSITIVE SCREENS 4056
16.9%
General Statistics ( March 08- July 09)
Patient Visits Patients Screened
Positive Screens
0
5000
10000
15000
20000
25000
30000
Patients Seen at Clinic
% of total
positive screens
POSITIVE SCREENS 3973
POSITIVE FOR DEPRESSION 1337 33%
POSITIVE FOR PTSD 448 11%
POSITIVE FOR PTSD&DEPRESSION 1168 29%
FALSE POSITIVE 1020 26%
Positi
ve S
cree
ns
Positi
ve- D
epre
ssio
n
Positi
ve-P
tsd
Pisitiv
e Dep
ress
ion-
Ptsd
False
Pos
itive
0500
1000150020002500300035004000
3973
1337
448
1168 1020
Positive Diagnosis
POSITIVE SCREENS MINUS FALSE POSITIVES 2953
POSITIVE SCREENS ALREADY IN RESPECT MIL 122
POSITIVE SCREENS ALREADY IN ABH 1128
POSITIVE SCREENS ALREADY IN TREATMENT (RM, ABH, OTHER)
1321
Positi
ve m
inus
Fal
se P
ositi
ve
Positi
ve a
lread
y in
Res
pect
-Mil
Positi
ve a
lread
y in
ABH
Positi
ve a
lread
y in
trea
tmen
t0
500
1000
1500
2000
2500
3000
2953
122
1128 1321
Positive Already in TX
REFERRED TO R.M. 462
REFERRED TO ABH. 325
REFERRED TO OTHER SOURCE 119
VISITS REFERRED (RM, ABH, BOTH, OTHER)
1113
Referred to Re-
spect-Mil
Referred to ABH
Referred to other source
Visits referred
0
200
400
600
800
1000
1200
462325
119
1113Referrals
Advantages of RESPECT Mil ProgramAdditional Resources (education, “tools”
and additional Staff)Improved screening/identification Diagnostic tools add objectivity to treatment
planImproved Suicidal Risk AssessmentImproved Communication between Primary
Care and Specialty Care through RCFFacilitates a Primary Care “team approach”
Advantages of Behavioral Health in Clinics
Additional ResourcesImmediate evaluation for positive risk
for suicideDecreased escorts via command Direct admit to inpatient statusImproved counseling appointments keptDecreased stigma of Adult Behavioral
Health
Challenges at Fort CampbellProviders and staff see RESPECT-Mil as extra workSupervision of RCFs and AAs (HN or Champion)Contacting Soldiers by telephone during duty hoursProviders understanding that RCFs do not counselFollow-up Soldiers that are Inpatient, PCS, ETSDuplication of work (paper & electronic charting)Whether to screen every visitPCP diagnosis PTSDDividing caseload for RCFs
QUESTIONS