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Revised Respect Mil Power Point Presentation 2009 Updated 081209
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Revised Respect Mil Power Point Presentation 2009 Updated 081209



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  • 1. RESPECT-Mil
    Re-Engineering Systems for the
    Primary Care Treatment of
    Depression and PTSD in the Military
  • 2. 2
    They Gave so Selflessly
  • 3. The RESPECT-Mil Team at Fort Campbell
    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
  • 4. The RESPECT-Mil Team at Fort CampbellContinued
    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)
    Mrs. Maria Matta AA
    Mrs. Charity King AA
    Mrs. LaShanda Harrison AA
  • 5. Blanchfield Army Community Hospital Fort Campbell, KY
    Home of the Screaming Eagles
    101st Airborne Division
  • 6. Blue and
    White Clinics
    Blanchfield Army Community Hospital, Fort Campbell, KY
    LaPointe Health Clinic
    (Ashau Valley & Bastogne)
    Aviation Health Clinic
    Carentan Health Clinic
  • 7. 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
  • 8. RESPECT- Mil
    Program from the Office of the Surgeon General
    Ft. 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
  • 9. Current Status of Program
    Clinics= 6
    (Carentan, Bastogne, Ashau, AHC,
    Blue, White)
    RCFs (RN) = 5
    Admin Assist (AA) = 3
    Training: All PCMs
    Training: Support staff
    Current Status
    6 Clinics
    5 RCF’s (RNs)
    3 AA
    60+ Providers trained
    50+Medics trained
    70+ Nurses trained
  • 10. Statistics
    Suicide Risk Level
  • 11. Suicide Risk Level
  • 12. Suicide Risk Level
  • 13. Suicide Risk Level
    Program 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
  • 15. 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.
    • 17. 10 % of men and 20% of women will suffer from a major depressive episode in their lifetimes.
    • 18. As many as 70% of those individuals were undiagnosed and untreated prior to RESPECT Mil
  • 19. Prevalence & Impact
    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)
  • 20. 18
    Twice as many
    sick call visits!!
    Post-Deployment Health Consequences
    2,863 Iraq War Veterans one-year post-deployment
    Hoge et al, AJP 2007
  • 21. Common Treatment Options
    Primary Care Providers
    RESPECT Mil Care Facilitators, RN
    Behavioral Health Specialist
  • 22. Usual Treatment Options
    • Antidepressant medications
    • 23. Self management plans
    • 24. Referral for psychological counseling and/or RESPECT Mil Care Facilitation
    Combinations of any or all of the above
  • 25. RESPECT Mil
    Adult Behavioral Health
    Within the Clinics at
    Fort Campbell, KY
  • 26. The Prepared Practice
    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
    Primary Care Providers
  • 27. 23
    Care Facilitation
    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
    Coordinates Communication
  • 28. The Behavioral Health Interface
    Consulting Psychiatrist and CounselorCare Facilitator Case Staffing Informal consultation with clinicians Formal patient consultation & treatment Psychological assessment & counseling recommendations
    Behavioral Health Specialist
  • 29. Support Staff
    RESPECT 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
    Support Staff
  • 30. General Statistics ( March 08- July 09)
  • 31.
  • 32.
  • 33.
  • 34. Advantages of RESPECT Mil Program
    Additional Resources (education, “tools” and additional Staff)
    Improved screening/identification
    Diagnostic tools add objectivity to treatment plan
    Improved Suicidal Risk Assessment
    Improved Communication between Primary Care and Specialty Care through RCF
    Facilitates a Primary Care “team approach”
  • 35. Advantages of Behavioral Health in Clinics
    Additional Resources
    Immediate evaluation for positive risk for suicide
    Decreased escorts via command
    Direct admit to inpatient status
    Improved counseling appointments kept
    Decreased stigma of Adult Behavioral Health
  • 36. Challenges at Fort Campbell
    Providers and staff see RESPECT-Mil as extra work
    Supervision of RCFs and AAs (HN or Champion)
    Contacting Soldiers by telephone during duty hours
    Providers understanding that RCFs do not counsel
    Follow-up Soldiers that are Inpatient, PCS, ETS
    Duplication of work (paper & electronic charting)
    Whether to screen every visit
    PCP diagnosis PTSD
    Dividing caseload for RCFs