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 3
4. The RESPECT-Mil Team at Fort CampbellContinued 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 AA Mrs. Charity King AA Mrs. LaShanda Harrison AA 4
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 Goal 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
14. RESPECT-MIL 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
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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 16
19. Prevalence & Impact 17 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)
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 19 Primary Care Providers Service Members RESPECT Mil Care Facilitators, RN Behavioral Health Specialist
24. Referral for psychological counseling and/or RESPECT Mil Care Facilitation Combinations of any or all of the above 20
25. RESPECT Mil & Adult Behavioral Health Within the Clinics at Fort Campbell, KY 21
26. The Prepared Practice 22 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 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 24 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 25 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
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
