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Revised Respect Mil Power Point Presentation 2009 Updated 081209

Revised Respect Mil Power Point Presentation 2009 Updated 081209






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

    • RESPECT-Mil
      Re-Engineering Systems for the
      Primary Care Treatment of
      Depression and PTSD in the Military
    • 2
      They Gave so Selflessly
    • 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
    • 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
    • Blanchfield Army Community Hospital Fort Campbell, KY
      Home of the Screaming Eagles
      101st Airborne Division
    • Blue and
      White Clinics
      Blanchfield Army Community Hospital, Fort Campbell, KY
      LaPointe Health Clinic
      (Ashau Valley & Bastogne)
      Aviation Health Clinic
      Carentan Health Clinic
    • 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- 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
    • 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
    • Statistics
      Suicide Risk Level
    • Suicide Risk Level
    • Suicide Risk Level
    • 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
    • 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
    • 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
    • Prevalence & Impact
      DEPPRESSIVE 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)
    • 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
    • Common Treatment Options
      Primary Care Providers
      RESPECT Mil Care Facilitators, RN
      Behavioral Health Specialist
    • Usual Treatment Options
      • Antidepressant medications
      • Self management plans
      • Referral for psychological counseling and/or RESPECT Mil Care Facilitation
      Combinations of any or all of the above
    • RESPECT Mil
      Adult Behavioral Health
      Within the Clinics at
      Fort Campbell, KY
    • 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
    • 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
    • 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
    • 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
    • General Statistics ( March 08- July 09)
    • 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”
    • 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
    • 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