Tri-service Integrator of Outpatient g p Programming Systems (TrIOPS)
Transcription
Tri-service Integrator of Outpatient g p Programming Systems (TrIOPS)
Tri-service Integrator g of Outpatient p Programming Systems (TrIOPS) Improving Psychological Health Outcomes for Service Members through Synchronization and Service Delivery Integration CDR Jerry O’Toole Division Chief 22 May 2013 Deployment Health Clinical Center (DHCC) Brief History Gulf War Health Center ̶ 1994 • Clinical care for 1991 Gulf War veterans with chronic pain and medically unexplained physical symptoms (MUPS) • Track I of Specialized Care Program (SCP) developed in 1995 --- Three-week multi-disciplinary care for MUPS Deployment Health Clinical Center ̶ 1999 • HA Policy 99-028, Policy - Establishment of DoD Centers for Deployment Health Health, 30 Sep 99 • DHCC is involved in direct clinical care, health services delivery research, and clinical education/outreach • SCP b becomes ttertiary ti llevell off care iin th the D DoD/VA D/VA P Post-Deployment tD l t Health Clinical Practice Guideline • Track II developed in 2005 to address deployment-related stress, Post Traumatic Stress Disorder (PTSD) and/or difficulties adjusting to rere deployment 2 Deployment Health Clinical Center (DHCC) Brief History continued DHCC Becomes Component Center – 2008 • Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) Replication of the DHCC Program proposed – 2009 • Replicate the DHCC SCP Track II and disseminate throughout DoD • DHCC leadership recommends change to replication mission • Change recommended based on multiple existing programs • Recommendation accepted • R Replication li ti initiative i iti ti ttransitioned iti d tto a S Synchronization h i ti & O Optimization ti i ti of all existing SCPs across the Department of Defense • TrIOPS launched in 2011 3 A Thousand Flowers Blooming Army Vice Chief of Staff GEN Peter W. Chiarelli Army Medical Symposium in San Antonio Antonio, 2009 “The problem is there’s a thousand flowers blooming, and unless you are a trained behavioral health person you have no idea which one to pick.” 2010 RAND Report: Programs Addressing PH and TBI Among g U.S. Military y Servicemembers and Their Families • Despite p the p proliferation of p programs g and related efforts, an ongoing g g challenge for DoD is to identify and characterize the scope, nature, and effectiveness of these various and ever-evolving activities. Prior to this report, there has been no full accounting of what programs exist and programs g complement p “traditional” service p provision and how these p routine care. 4 TrIOPS Precursor Force Health Protection Conference – 2010 • DHCC sponsored special meeting at the Arizona conference • 11 Army SCP directors, staff, and other stakeholders • Identification Id tifi ti off obstacles, b t l challenges, h ll and d recommendations d ti Obstacles & Challenges • Joint Federal Behavioral Health • Staffing – Quality & Quantity • Support S t – Command C d • Space – Not Conducive to Treatment Needs • Productivity – Coding & RVUs 5 Their Recommendations Create a coalition or network of intensive outpatient programs Facilitate communication and collaboration amongst and between programs Promulgate evidence and recommendations for best practices across the DoD Develop a centralized evidence base regarding program practice guidelines, standards of care, and program effectiveness Provide technical assistance and program consultation based on the k knowledge l d and d experience i gained i d iin th the course off synchronizing h i i care Evaluate and track new and existing programs 6 Our Recommendations ✓ Create a coalition or network of intensive outpatient programs ✓ Facilitate communication and collaboration amongst and between programs ✓ Promulgate evidence and recommendations for best practices across the DoD ✓ Develop a centralized evidence base regarding program practice guidelines, standards of care, and program effectiveness ✓ Provide technical assistance and program consultation based on the k knowledge l d and d experience i gained i d iin th the course off synchronizing h i i care ✓ Evaluate and track new and existing programs 7 TrIOPS Mission & Vision Mission Impact behavioral health specialty care programming systems by integrating and optimizing care across the Military Health System Provide resources, products, and services to ensure that programs g and the overarching g system y are continuously y improving Vision Be recognized as the central and trusted agent for the promotion of specialty care programming effectiveness and excellence 8 Promoting a Culture of Effectiveness 4 MATUR RITY 3 1 2 AWARENESS/ KNOWLEDGE TIME EXPERIENCE CENTRALIZED & TRUSTED EXPERTISE SOURCE TrIOPS: O S Building a network for f meaningful f system change 9 Treatment Spectrum Outpatient Intensive Outpatient Partial Hospitalization Day Treatment Residential Treatment Inpatient Specialty Care Programs 10 Treatment Spectrum Outpatient Intensive Outpatient IOP •Fort Bragg /Pope Field •Fort Campbell •Fort Carson •Fort Knox •WRNMMC WRNMMC II (TRP) •NBHC Groton •Fort Stewart •Camp Lejeune •Cherry Ch P Point i t •Camp Pendleton Partial Hospitalization Day Treatment PHP/Day Treatment •Fort Belvoir •Fort Benning •Fort Bliss •Fort Gordon •Fort Hood I (Reset) •Fort Fort Hood II (IOP/DTP) •NM Jacksonville •Landstuhl •NMCSD I (C5) •Camp Pendleton * •Fort F t Sam S Houston H t •Fort Stewart Residential Treatment Inpatient RTF •Fort Jackson •NMCSD II (OASIS) •Tripler AMC 11 JB Lewis-McChord 2003-2010 [4] DHCC Track I & II 1995-2012 [3] Lovell FHC WRNMMC TRP 2006 [4] Fort Carson 2010 [5/6] Camp Pendleton 2008 [6] NBHC Groton 2012 [4] JB McGuireDix-Lakehurst NBHC Portsmouth I Fort Belvoir 2011 [4] Fort Knox Fort Campbell 2008 [6] NBHC Portsmouth II Fort Bragg NMC San Diego I 2010 [8] NHC Cherry Point Fort Gordon 2009 [3] Fort Bliss 2007/2012 [24]→[4] NMC San Diego II 2010 [10] Fort Sam Houston 2012 [3] Fort Jackson Fort Hood I 2008 [3] Fort Hood II 2011 [4] Fort Benning 2012 [2] Fort Stewart 2011/2012 [2]→[6] NMC Jacksonville 2010 [10] Landstuhl L d t hl 2009 [8] Legend: Tripler AMC 2006 [8] Camp Lejeune Army Navy Program Staffing Each program operates under an interdisciplinary p y staff model Disciplines represented include: •Psychology •Social S i lW Work k •Psychiatry •CAM •Nursing •Other disciplines include: •Occupational Therapy •Neurology •Physical Therapy Professional Disciplines Social Worker(s) 14 Psychologist(s) 14 Psych Tech(s) 10 CAM Practioner(s) 10 Psychiatrist(s) 10 8 RN/NP(s) 5 Chaplain(s) 4 Rec Therapist(s) 9 Other(s) 0 5 10 Number of Programs 15 13 Treatment Modalities Treatment Format 17 Group 13 Individual 10 Marital/Couples 8 Family 0 5 10 Number of Programs 15 14 Treatments Offered Psychotherapeutic Approaches 15 CBT 12 CPT Most programs g are utilizing g Cognitive Behavioral Therapy (88%) and/or Cognitive Processing Therapy (71%) Approximately half (53%) of programs are also providing p g Eye y Movement Desensitization and Reprocessing to their participants 9 EMDR 6 Art 5 PDT 5 PE 4 DBT 2 Equine or Animal-Assisted 9 Other 0 5 10 15 Number of Programs 15 Additional Treatment Approaches Treatments Off d (Cont’d) Offered (C t’d) 14 CAM 14 Psycho-education Psycho-educational sessions cover topics such as Grief Grief, Sleep Hygiene, and Anger Management 11 Pharmacotherapy Psycho-education and some form of Complementary and Alternative Medicine (CAM) are both offered by 14 programs (82%) 8 Recreational Ther CAM practices include – but are not limited to – Yoga (8; 47%), Meditation (6; 35%), Massage (5; 29%), and Acupuncture (4;24%) 4 Occupational Ther 4 Physical Ther 0 5 10 Number of Programs 15 16 Outcome Measures Most Common No Commonality The following instruments are used by more than one program: Over 20 other instruments or procedures: PCL (15 (15; 88%) BSI; CAPS; CD-RISC; ISI; MMPI2 SCIC; 2; SCIC URICA, URICA etc. t PHQ-9 (7; 41%) AUDIT ((6; 35%)) Instruments Measuring: g BDI (6; 35%) Depression; PTSD; Anxiety BAI (5; 29%) Function OQ 45 (5; OQ-45 (5 29%) P i Pain GAD-7 (3; 18%) Trauma PSQI (2; 12%) Personality Relationships 17 Suggested / Recommended Core Elements of Specialty Care Programs • Multi-disciplinary, multi-modal approach • Staff-to-patient ratio is sufficient to ensure necessary therapeutic services • P Professional f i l monitoring it i and d fforce h health lth protection t ti th through h ongoing risk assessment • Command consultation – liaison • Family (or significant support person) involvement in treatment • Case management with coordinated transition and follow-up • Continuing C education and professional f development off staff ff 18 Next Steps Continue to build TrIOPS infrastructure D t collection Data ll ti ttools l and d procedures d Capacity to store and analyze program data Reporting and monitoring systems Continue to inventory programs Fill identified information gaps Build rapport and knowledge base Discover emerging g g programs g and markets 19 Fixsen, Naoom, Blasé, Friedman, and Wallace (2005) “Letting Letting it happen” happen –researchers researchers publish results; it is up to the providers to make it happen “Helping it happen” –research findings result in toolkits designed for providers “Making it happen” – implementation teams directly help providers to effectively implement programs 20 Contact Us Division Chief: Commander Jerry O’Toole Jerry.M.O’[email protected] 22