2012 Pacific Regional Behavioral Health SummitAnswering the Call: Addressing the Challenges of Behavioral

Health within the Pacific Rim

September 13-14, 2012

Kyser Auditorium and Conference RoomsTripler Army Medical Center

1

OverviewThe mission of the conference is to highlight available resources and best practices across a broad spectrum of behavioral health in order to bridge current gaps between clinical care and research to assist Service Members, families, and their communities to maintain readiness through multidimensional wholeness and balance.

PurposeThe purpose of this conference is to share experiences and provide leading and best practices in order to build readiness skills. Currently, there are numerous evidence-based practices and trainings ready for implementation in clinical practice; however, providers and clinicians may not be aware of available resources. This conference aims to close this gap by increasing knowledge among clinicians and providers by enhancing skill sets and teaching practical tools and programs that are ready for implementation.

Conference TracksClinical, Research and Practical ApplicationAttendees will have the opportunity to engage in three breakout sessions during the conference. Session highlights include:

ClinicalApplying practical tools and solutions for implementing evidence-based assessment, management, treatment and after-care approaches in clinical settings.

Practical ApplicationBuilding cooperative opportunities between and within the DoD, VA and the community at large to assist in implementing and making available effective behavioral health prevention strategies.

ResearchIdentifying and interpreting suicide risk and protective factors based on the latest evidence from research being conducted in the DoD and VA.

Objectives

Objective 1: Discuss the latest tactics, strategies, technologies, systems, treatments, processes and services for patient care. Objective 2: Integrate advancements in medical care for military personnel and their families into existing treatments/programs. Objective 3: Create a multidisciplinary approach for combating post-deployment behavioral health problems of service members. Objective 4: Participants and presenters work together to identify areas for future research on the spectrum of behavioral health and its impact on service members, veterans, their families, caregivers and health care providers. Objective 5: Provide participants an opportunity to learn implementation strategies for evidence-based practice. Objective 6: Generate opportunity for line leaders to engage in experiential workshop breakout sessions that will provide concrete information, practical training and tools that can be implemented in any operational environment.

2

Acknowledgements

Planning Committee:

David G. Brown Suzie Martin Stephanie LeongRussell Lane Christopher Wilson Vicki OlsonRaymond Folen Derrick Arincorayan Jan ClarkGenie Joseph Cherie Mar Pat Mencias Howard Reyes Richard Ries Vivian Rinehart Diana Yoshida

Technical Support:

Marlowe Gungab Netha Smoot Stephanie RushStephanie Bryant Nicholas Haraguchi Sam Bethea

Legal Support:Jake Yu

Special Guests:

Wayne BoydLeilani Kupahu-MarinoDaniel Rodriguez

3

PRESENTATIONS

ACT RESILIENT – LAUGHTER & EXPRESSIVE ARTS FOR WELLNESS (Practical Application Track)

Genie Joseph, MA, MFA

Documentary short film to be shown on an evidence-rooted, cutting edge method of using laughter, humor, improvisational comedy, expressive arts and other methods to address the symptoms and help prevent provider fatigue. This presentation outlines these methods currently being used at TAMC and Schofield. The relationship of humor to wellness has been shown in over 500 studies (1) Humor can be a part of any physical or behavioral health program, and can be instrumental in addressing the symptoms of trauma. Laughter can also be useful for providers working with patients (2). Health care providers who maintain their sense of humor function at a higher level with patients, get along better with co-workers, and have greater connection and get better compliance from patients.

AN OVERVIEW OF “THE PRINCIPLES OF MEDICAL ETHICS” WITH ANNOTATIONS ESPECIALLY APPLICABLE TO PSYCHIATRY (Clinical Track)

Wayne David Levy, M.D.

This presentation provides historic examples of severe ethical violations by Psychiatrists, and then has a series of case vignettes where the audience is asked to vote on whether or not the conduct would be considered to be ethical. Following the voting, the appropriate APA ethic guideline is reviewed.

ANSWERING THE CALL: ADDRESSING THE CHALLENGES OF BEHAVIORAL HEALTH WITHIN THE PACIFIC RIM (Clinical Track)

LT Sherry J. Gracey, PsyD LCDR Eduardo Cua, PsyD

The Telebehavioral Health and Surge Support (TBHSS) clinic utilizes technology to provide healthcare access to eligible beneficiaries to providers who are able to identify and treat their clinical needs. The behavioral health (BH) services are provided through the utilization of secured video technology which enables TBHSS access to locations worldwide. The partnership across sites increases the access to care as patient sites are able to augment their current resources with TBHSS providers, providing ongoing therapy, consultation, administrative evaluations, and both neuropsychological and psychological assessments. Utilizing telehealth technologies enables our providers a unique opportunity to provide evidence based treatment approaches to address a variety of concerns.

ARE SUICIDES CONTAGIOUS? HOW MEDIA COVERAGE AND DISCUSSION OF SUICIDES MAY INFLUENCE BEHAVIOR (Practical Application Track)

Caroline Miles, MS

Recent mainstream media coverage of military suicides has resurfaced a critical question: are suicides contagious? Humans are biologically predisposed to imitate behaviors of others, learning through social engagement.1 Suicide contagion occurs when certain types of media coverage appear to influence subsequent suicide imitation.2,3A multitude of studies have explored media influence on suicides indicating that prominent, persistent and/or sensationalized coverage can proportionately “increase the likelihood of suicide in vulnerable individuals.” In a review of 240 military and civilian media reports, nearly all violated at least one Suicide Prevention Resource Center guideline for responsible reporting.6 Strategic communications for the Navy Suicide Prevention program aim to foster responsible discussion

4

of suicide while conquering public misconceptions and encouraging help-seeking behavior. Guidelines for meaningful reporting will be interactively communicated during this presentation, including recommendations for media outlets and general subject matter discussion.

ARMY SOCIAL WORK IN THE PACIFIC RIM: LATEST INITIATIVES IN IDENTIFYING AND TREATING SOLDIERS AND FAMILIES INVOLVED IN INTIMATE PARTNER ABUSE INCIDENTS (Clinical Track)

LTC Darren Fong, LCSW, BCD, ACSW, BCPCLTC Ralph T. Jenkins, Jr., CSW, BCD, ACSWLCDR Cole Weeks, BCD, LCSW

The Army’s Expeditionary Mission has placed an increasing strain on the lives of Soldiers and their Families as they move through the Army Forces Generation (ARFORGEN) Cycle(i.e., Three phases that include Reset, Train and Deploy, etc.) across Continental United States Installations. In the last five years the Soldier and Family strain experienced in Hawaii Combat units moving through the ARFORGEN has been alarming with intimate partner abuse and child abuse incident rates nearly twice the Army average and higher than other Force Command rates. The Department of Social Work, Tripler Army Medical Center recognizing that these rates were unacceptable developed and implemented several initiatives with the goal to reduce the above rates. This presentation will discuss the Department of Social Work (DSW) Initiatives: Military Police (MP) Station and Department of Social Work Partnership Program, unit and provider alignment, and the presence of Social Workers on the Tarmac upon Soldiers return from deployment.

BEHAVIORAL HEALTH SERVICE LINE AND SPEND PLAN (Practical Application Track)

LTC Edward Brusher

An information briefing from the US Army Office of the Surgeon General, Behavioral Health Division on the Behavioral Health (BH) Service Line. Includes information on the Commander’s intent, goals, execution, standardized ARFORGEN screening touchpoints, BH Program structure, enterprise BH programs and way ahead. Also touches on Embedded BH, BH Data Platform and Army BH efforts.

CARING FOR OUR WARRIORS AND THEIR OHANA (Practical Application Track)

Stanley Whitsett, PhDKarl KiyokawaCOL C.J. Diebold, MDKenneth Hirsch, MDRaymond Folen, PhD

Recognize the challenge of providing comprehensive behavioral health care for Military Service Members, Veterans, and their Families throughout the Pacific Region. Understand the vast potential benefit of utilizing telehealth in providing behavioral health services to Military Beneficiaries in remote locations. Appreciate the positive impact of providing behavioral health services for children directly within the schools. Identify major areas of focus for the treatment of Post Traumatic Stress Disorder in the Military and Veteran populations. Discover community and institutional resources available to assist in the treatment of returning Veterans.

5

COMMAND DIRECTED MENTAL HEALTH EVALUATIONS; WHAT EVERY PROVIDER SHOULD KNOW (Clinical Track)

CPT Michelle Hill, DO LTC Stephanie Leong, MD

As active conflict has progressed and media attention has been drawn to the psychological wounds of this conflict, increasingly more Commanders are identifying possible mental illness in their Service Members and bringing them in for evaluation. The authors will review the Department of Defense directive 6490.1, Requirements for Mental Health Evaluations of Members of the Armed Forces. This will include the history and definition of 6490 command directed evaluations, criteria for emergent vs. non-emergent evaluations, how to conduct these evaluations, and what information is communicated to command. Participants will be presented with “real” cases from the Tripler Army Medical Center Emergency Department and outpatient clinic. Two discussants will talk about their conceptualizations of the cases and how they would proceed with the evaluation and recommendations.

FUSION CELL: CLOSING GAPS IN ARMY BEHAVIORAL HEALTHCARE (Research Track)

Ranilo Laygo, PhDErin Kappenberg, PhDShannon Harris, RN, MHA

Despite the increased quality of behavioral healthcare (BH) in the Army, many at-risk Soldiers remain unidentified. Furthermore, at-risk Soldiers are not consistently engaged in appropriate services at the optimal time. A recent report suggests that information gaps, poor relationships between Line and Military Treatment Facility (MTF) Leaders and Providers, and uncoordinated care can lead to such challenges. This 60-minute presentation will describe how the FC addresses each of the challenges described above. In addition, the presenters will discuss in detail the FC’s three primary processes: data collection and aggregation, report generation and dissemination, and conducting Collaboration Meetings with Commanders, Providers, and MTF personnel. Finally, preliminary outcome data demonstrating the impact of the FC will be presented.

HUMAN TRAFFICKING: FROM THE GLOBAL TO THE SPECIFIC (Clinical Track)

Judy B. Okawa, PhDNancy M. Sidum, PsyDNicole Littenberg, MD

Human trafficking is the second largest criminal industry in the world. It is a subject with relevance to the lives of servicemen, veterans, and family members, who may be unknowingly exposed to traffickers and victims, whether on military bases abroad or in Hawaii, where recruiters target young girls and boys and coerce them into forced labor or the sex trade. Research into the scope of trafficking offenses and their impact on survivors’ functioning is in its infancy. This symposium aims to provide all levels of practitioners with information about the threat of human trafficking so that they will be able to prevent future cases, identify potential survivors, and interview and treat them with sensitivity. Dr. Nancy Sidun will provide a global perspective of human trafficking with a description of its unique factors. Particular attention will be paid to the risks faced by adolescents of trafficking to the sex trade. Dr. Nicole Littenberg will describe human trafficking in Hawaii, giving case examples of labor and sex trafficking and providing a medical perspective on trafficking offenses. Dr. Judy Okawa will describe development and use of the Inventory of Trafficking Offenses (ITO) to assess the array of abuses experienced by human trafficking victims.

6

IMPROVING BH TREATMENT OUTCOME FOR SOLDIERS AND THEIR FAMILIES: THE ARMY'S BEHAVIORAL HEALTH DATA PLATFORM (BHDP) (Clinical Track)

LTC Millard Brown, MD

This 60-minute workshop will provide an overview of the Army’s Behavioral Health Data Platform (BHDP) and its role in improving BH care for Soldiers and their families. The BHDP is a new, computer-based assessment program that tracks “BH vital signs” for Soldiers and their family members across time using valid, self-report measures and other clinical and nonclinical data. Learning objectives for this workshop include:1. To understand how the Behavioral Health Data Platform (BHDP) supports the execution of the

MEDCOM Behavioral Health System of Care (BHSOCC). 2. Review the need for clinical metrics in behavioral health and how the BHDP provides a method

for measuring and improving treatment outcomes.3. Understand the core framework of the BHDP and its applications to clinical care.

This presentation is appropriate for anyone interested in the measurement of treatment outcomes in Army BH or computer-based assessment.

INTEGRATIVE MINDFULNESS-BASED MODEL TO ADDRESS INTERNET SEX ADDICTION

Ewa Stamper Maddox, PhD

Internet sex addiction is a growing problem world-wide including its impact on military families. Treatment approaches are being developed to address this clinical issue, ranging from approaches based on 12-step programs and other addiction treatment models, to CBT, and to marital and sex therapy approaches. The model presented here integrates the above elements within the context of mindfulness-focused, Buddhist psychology derived framework, and places strong emphasis on couples therapy and support group for spouses. This significant focus on couples dynamics and support for spouses is necessitated by the fact that this form of addiction has a particularly profound and personal effect on the spouse and triggers almost universally a vicious and rapidly escalating spiral of mutual emotional reactivity. Also, given the particular nature of this type of addiction, couples treatment usually must balance family-based recovery work with protocols designed to treat affairs. In this model, individual and group support for spouses draws on principles of S-Anon, CODA and CBT, as well as mindfulness-based techniques designed to address negative emotional reactivity as well as to redefine in more adaptive ways concepts of trust, attachment and differentiation within a couple.This presentation will serve to increase participants' knowledge of the phenomenon of Internet sex addiction, familiarize them with a short overview of existing treatment approaches as well as with the author's emerging model of addressing this issue in military families.

MILD TBI IN MILITARY COMBAT (Clinical Track)

Marvin A. Oleshansky, MD

Mild Traumatic Brain Injury (TBI) in a military population can occur after blunt trauma, shearing forces of rapid acceleration/deceleration, and blast wave exposure associated with an explosion. A TBI sets off a neurometabolic cascade of events that leaves the brain in a state of neurophysiological disarray. A mild TBI is usually a transient process followed by spontaneous recovery. Cognitive functioning generally returns to normal within days to a week. Functional imaging studies in animals and humans have demonstrated that brain physiology may take slightly longer to return to baseline. While the natural history of mild TBI is recovery within weeks, a small percentage of individuals may have a persistent postconcussive syndrome (PCS) which can include physical, cognitive, and emotional symptoms. Given the context of brain injury in combat situations, PTSD is often co-morbid with PCS. Persistent symptoms of one or the other or both disorders may overlap. This can complicate diagnosis, treatment, and recovery of PCS and PTSD.

7

OPERATION SPENCER CAMPBELL AND BABY MANGINDIN: COORDINATING BEHAVIORAL HEALTH CARE FROM THE BATTLEFIELD TO THE HOME FRONT (Practical Application Track)

COL F. K. Arincorayan, PhD

In August of 2010, the Department of the Army directed all units to execute the Comprehensive Behavioral Health System of Care- Campaign Plan (CBHSOC-CP) Five Touch Point screening system via Executive Order 277-10. The intent of the behavioral health screening system was to identify Soldiers throughout the Army Forces Generation Cycle who may be at risk for behavioral health problems (i.e., Domestic violence, Depression, Post Traumatic Stress Disorder and Substance Abuse, etc.) and to coordinate access to care for these soldiers immediately upon identification. The Tripler Army Medical Center (TAMC), Dept of Social Work, Pacific Regional Medical Command, deployed a four man behavioral health team into Operation New Dawn, April–May 2011 and attached the team to the 2nd Advise and Assist Brigade( 2nd AAB), 25th Infantry Division thirty days before the 2nd AAB redeployed back to home station. Their mission included FAP/ASAP/BH command consultation, crisis intervention, and behavioral health screening augmentation to the Touch point 2 screening process of the CBHSOC-CP five touch point process. This presentation provides a review of coordinated care processes that the PRMC BH team executed, the soldier assessment information acquired during the screening and the way forward in providing follow up care for Soldiers and Families identified as moderate to high risk for Behavioral Health problems (i.e., Domestic Violence, Child Abuse, Substance abuse and suicide, etc.).

PHYSICIANS AS PATIENTS: UNDERSTANDING OUR PSYCHOLOGY, BARRIERS TO GETTING CARE AND WHAT TO DO ABOUT IT (Practical Application Track)

LTC Stephanie Leong, MDLTC Stephen Morris, MDCOL Scott Uithol, MD

Health care providers and mental health care providers specifically come into medicine with a variety of experiences, many of which influence their decision to care for others. Glenn Gabbard has written about the Psychological world of Physicians and the culture of medicine. We will be presenting this material followed by a review of the literature available on physician mental health, the impact of physician mental illness, physician access to care and physician suicide. The seminar will end with an exploration of the impact of a suicide on the clinician followed by current resources available and models for future care.

RESILIENCE AND POST-TRAUMATIC STRESS (Clinical Track)

Gregory Fricchione, MD

Introduce the Relaxation Response Resiliency Program (R3P) and its 3 components: eliciting the relaxation response, decreasing stress reactivity, and increasing connectedness to self and others through positivity. Relaxation Response (RR) Integrated into Daily Life and Sleep--Expand understanding of the relaxation response (RR). Identify the 4 Component Model of Stress—Focus on physical symptoms & negative cognitions. Identify the 4 Component Model of Stress—Focus on anger and positive behavioral reintegration activities. Empathy and Effective Communication Skills--Identify how positivity and empathy can increase resilience in the long-term. Meaning Making, Social Support, and Relapse Prevention.

8

RESILIENCE THROUGH EFFICACY: MEETING PACIFIC RIM DEPLOYMENT RETURN/REUNION BEHAVIORAL HEALTH CHALLENGES (Practical Application Track)

Chaplain (LT) Michael AndersonAn interactive presentation on post-deployment reintegration - unique stressors/behavioral health issues encountered, challenges faced by deploying service members and their families, and coping mechanisms required as families are reunited/reintegrated within our forward-deployed WESTPAC.

SUICIDE PREVENTION AS A BEHAVIORAL HEALTH INTERVENTION: UTILIZING PUBLIC HEALTH STRATEGIES TO DECREASE THE RATE OF SUICIDE IN HAWAII (Practical Application Track)

Nancy Kern, MPHDan Galanis, PhDDeb Goebert, PhDJeanelle Sugimoto-Matsuda, MS

Among Hawaii residents for the 5-year period from 2004-2008, suicide was the leading cause of fatal injuries, accounting for one-fifth of all fatal injuries. Nationwide, one American military member dies by suicide every day. This session will address suicide risk for Hawaii residents and members of the military by presenting the most current Hawaii suicide data. Research in this subject will be addressed though the presentation of two projects by staff of the Department of Psychiatry, Queen’s Medical Center: a pilot initiative with Tripler on the provision of behavioral/mental health services for at-risk youth; and Connect, an evidence-based public health approach to suicide prevention that encompasses the individual, family, community and society. Information will be shared on current efforts by the Department of Health to collaborate on suicide prevention efforts with the military in Hawaii, and comprehensive suicide prevention resources for Hawaii will be shared.

THE 7 - DIMENSION INTERVENTION - A HOLISTIC DIATHESIS-STRESS APPROACH TO STRESS-MANAGEMENT (Clinical Track)

James Slobodzien, PsyD, CSAC

The 7 Dimension Intervention - a unique stress-management assessment process will address the Clinical Track of the summit by discussing the utilization of the following three instruments - to systematically document and assist a client with visualizing their childhood vulnerabilities, current life stressors, and current positive activities that they are participating in to decrease stress, build resiliency, and improve their overall wellness to hopefully motivate them to develop and monitor a health and wellness plan for their lives: 1) Adverse Childhood Experiences (ACE) Questionnaire 2) 7 Dimensional - Psycho-social Stressor Inventory (7D-PSI) 3) 7 Dimensional - Therapeutic Activity Survey (7D-TAS). A 60 minute workshop teaching the applicability and utilization of these practical clinical tools will follow a 30 minute informational briefing highlighting the background and history of the 7 Dimensions and the ACE study combined.

9

THE APPLICATION OF YOGA PRACTICES TO PROMOTE WELLNESS AND RESILIENCY IN ARMY CARE PROVIDERS

Cherie B. Mar ERYT200hr Rev. Richard I. Ries, MSEd

An overview of current research and application of yoga asana (posture) and yoga therapeutic techniques such as prāņāyāma (breathing), yoga nidra (deep relaxation), dhāraņā (concentration/mindfulness) will be presented. Experiences of teaching therapeutic yoga techniques to the general population and to Care Providers at Tripler Army Medical Center and Schofield Barracks Health Center will be shared and discussed. Presenter will open a discussion for further areas of research concerning the application of yoga therapeutic techniques in medical and behavioral health settings. A 30-40 minute experiential session of basic yoga therapeutic techniques will be facilitated so that participants can utilize these skills personally for self-care and professionally when working with patients.

THE IMPACT OF DEPLOYMENT, CONCUSSION, AND PSYCHOLOGICAL FACTORS ON COGNITIVE FUNCTIONING - IMPLICATIONS FOR CLINICAL ASSESSMENT IN THE FIELD AND FOR

REINTEGRATION (Research Track)

James L. Spira, PhD, MPH

Cross sectional analysis was conducted on 650 service members who were either never deployed, previously deployed, or recently deployed to Afghanistan. Service members were assessed using the DOD-funded Defense Automated Neurobehavioral Assessment device (DANA) for use by frontline providers under field conditions. DANA assesses neurocognitive and psychological functioning through 15 tests that can be utilized by frontline healthcare extenders through a rapid assessment of concussion in the field, a brief battery to assess dysfunction due to any cause in the field or clinic, or a standard battery to help licensed providers better understand the cause and severity of one's impairment. This presentation will discuss how deployment, concussion, PTSD, depression, postconcussive symptoms, and insomnia influence cognitive functioning (speed and accuracy, memory and attention, judgment and decision-making). Implications for use of DANA in the field and in the clinic for initial assessment and return to duty will be discussed.

THE NAVY COMMAND STRESS ASSESSMENT: OVERVIEW AND IMPLICATIONS FOR SUICIDE PREVENTION (Research Track)

Leanne Jane Braddock, LMFT

Navy Personnel Research Studies and Technology, OPNAV (N135) and the Defense Equal Opportunity Management Institute, collaboratively developed a short survey that was added to the Defense Equal Opportunity Command Climate Survey for Navy units. To date over 120,000 surveys have been completed. This tool is composed of 22 questions consisting of four factors associated with operational stress—personnel, work, coping and perception of stigma. The tool also measures sleep and uses the short version of the Cohen Perceived Stress Scale. High levels of stress were associated with decreased sleep, greater perception of stigma for seeking help and less ability to cope. Poor command climate (sexual harassment, racist behavior, poor unit cohesion, differential command behavior and poor job satisfaction) were also associated with high stress. Causal relationships have not been determined however implications for command and applicability to suicide prevention will be discussed.

10

THE PREVENTIVE POWER OF COMMUNITY: BEST PRACTICES FOR CULTIVATING “UNIT COHESION” IN CIVILIAN LIFE (Practical Application Track)

Joseph Bobrow, PhD

Coming Home™ Project retreats are a proven prototype that provide an optimal environment for connecting, learning and healing. They integrate small peer support groups, resilience practices, expressive arts, and vigorous recreation in teams in natural outdoor settings. They draw on the power of unit cohesion to build a sense of camaraderie, trust and community that provides a safe setting and social support networks critically important in preventing psychological distress and enhancing wellbeing. The upwelling of peer support and community harnessed during and subsequent to Coming Home™ retreats leverages an impact similar to that of unit cohesion during military service. Both draw on the well documented power of social supports. In concert with new resilience skills (including mindfulness meditation, yoga, qigong) and family life skills (including couples communication and parent education), practiced in this optimal environment for learning, they may provide a similarly preventive impact on the frequency of suicide among Guardsmen and women and reservists.

THE USEFULNESS OF TECHNOLOGY IN BEHAVIORAL HEALTH (Clinical Track)

LTC Melba C. Stetz, PhDRaymond A. Folen, PhD

This presentation will aim to share with the audience the “good, the bad, and the ugly” of using technology in behavioral health efforts. Some examples of this technology are: stressful and relaxing virtual reality scenarios, bio and neurofeedback, telehealth, smart phones, and emails. Some examples of the behavioral health areas being addressed with this technology are: combat stress, relaxation, cognitive performance, suicide ideations. Presenters will also give examples of ongoing clinical research protocols and quality improvement projects in this area.

TRANSCRANIAL MAGNETIC STIMULATION (TMS) AT TRIPLER ARMY MEDICAL CENTER (Clinical Track)

Helenna Nakama, M.DKendra O’Brien, Ph.D.

Transcranial Magnetic Stimulation (TMS) is a new and effective method for treatment of depression. In addition, although TMS is only indicated for treatment resistant depression, the literature shows evidence that TMS has been effective for a variety of other disorders. Tripler Army Medical Center (TAMC) obtained the first TMS machine in the state of Hawaii. We have treated over 15 patients (ages 17-74) with depression, anxiety, and PTSD. In our presentation, we will describe TMS, offer a brief literature overview, discuss current indications, and share the results of our population treated. In addition, we will describe the potential for future clinical and research applications of TMS within our military population and their dependents.

11

USPHS IN THE PRMC: PROTECTING, PROMOTING AND ADVANCING THE BEHAVIORAL HEALTH OF OUR PACIFIC REGION (Practical Application Track)

LCDR Eduardo Cua, PsyDCAPT Rafael Salas, PsyD

The Department of Health and Human Services (HHS) announced in 2008 a 10 year agreement between the Department of Defense (DoD) and the United States Public Health Service (PHS) Commissioned Corps to increase behavioral health services available to military service members, their family members, and veterans. This established the DoD-PHS Partners in Mental Health: Supporting Our Service Members and Their Families initiative. At the halfway mark of the agreement, we presently have 271 PHS Officers detailed to this MOA. Behavioral health officers are detailed to Army, Navy and Air Force medical treatment facilities across the United States and OCONUS to treat service members who are returning from overseas deployment, as well as retirees and family members. At TAMC, we have 9 USPHS Officers currently who serve in a variety of roles to meet the needs of the PRMC. This talk will highlight the partnership between the organizations and the benefits to the warfighters and their dependents. This presentation will discuss the unique contributions of these 9 officers and the impact they have made in the region, the mission of the MOA as well as the mission of the USPHS.

WARRIOR TRANSITION BATTALION BEHAVIORAL HEALTH CARE MANAGEMENT (Practical Application Track)

Donna Gatewood, LCSWCOL Linda Ross, PhD

This presentation will discuss what we believe are the critical components in the development of best practices for Soldiers-in-Transition with complex behavioral health issues. The importance of a Comprehensive Transition Plan, an individually tailored continuum of behavioral health care from entry to exit, and a coordinated management plan for high-risk Soldiers is essential for both ensuring their safety and providing the optimal care that will maximize our Soldiers' successful return-to-duty or medical retirement.

WHAT'S IN YOUR SEABAG? THE IMPORTANCE OF HELPING SAILORS RECOGNIZE AND NAVIGATE STRESS ON THE HOME FRONT (Practical Application Track)

Rose Riggs, PhD

According to the latest behavioral quick poll, stress in their personal lives resulting from deployment is a primary source of stress for many Sailors. The goals of the OSC Program include preventing stress injuries by building solid psychological resilience in Sailors, their families, and their units, and helping them foster effective responses to stress reactions. To reach these goals, it is important that Sailors and their families understand how to identify stress and stress reactions, and where to get help. An overview of the OSC Stress Continuum Model will be presented through video clips. The videos that will be presented in this session depict a family’s journey from the Green Zone before deployment to the Red Zone after deployment. Participants will be asked to identify characteristics of each zone that are evident in the videos, and then consider possible solutions. OSC team members will guide the discussion to appropriate solutions.

12

POSTER PRESENTATIONS

EVALUATION OF A COGNITIVE-BEHAVIORAL SOCIAL SKILLS GROUP FOR MILITARY YOUTH WITH SOCIAL FUNCTIONING DIFFICULTIES

Geoffrey Chung, PhD, ABPP

The proposed retrospective study aims to evaluate the benefits of a cognitive-behavioral social skills group for youth with difficulties in social functioning. These groups were developed in response to the hospital’s need of a treatment to improve the behavior and communication skills of a large number of youth with an array of diagnoses. The current study looks at pre-post effects on measures of youth behavioral problems, depression, anxiety, social functioning, and coping, as well as parental stress.

PSYCHIATRIC CONTINUITY OF CARE SERVICE (PCCS)

LTC Lynette J. Heppner, P/MHNP

The Psychiatric Continuity of Care Service (PCCS) formerly known as the Intensive Outpatient Program (IOP) is an outpatient, time limited, intensive treatment program for adult active duty, retiree and military family members located in Tripler Army Medical Center, Wing 4D. PCCS is a program that bridges the gap for those individuals who do not need the structure of psychiatric inpatient care but have a need for more intense treatment than is offered in the outpatient setting. It focuses on psychiatric treatment for various psychiatric diagnoses in a program format that includes individual and group psychotherapy, medication management, psycho-educational classes, yoga, Tai Chi and therapeutic outings. Treatment lasts 4 weeks for 7-8 hours per day, 5 days per week except weekends and holidays. Individual treatment plans are formulated and a case manager coordinates follow up appointments as patients transition to traditional outpatient care. A weekly 2-hour after care group (lasting for 4 weeks) is also provided to patients who have completed the program to aid in transition. The treatment team consists of one psychiatrist, one psychiatric nurse practitioner, two licensed clinical social workers, one registered nurse, one occupational therapist, one psychiatric technician and one administrative support staff member. Referrals are made by inpatient and outpatient behavioral health providers from anywhere in the Pacific Region. Goals for this program are stabilization of symptoms in preparation for traditional outpatient therapy and transition back to duty/work, WTB or out of the military.

TAMC PACIFIC REGIONAL MEDICAL COMMAND RESILIENCY TRAINING FEEDBACK

Rev. Richard I. Ries, MSEdLTC Melba C. Stetz, PhDHoward L. Reyes, LCSWCherie B. Mar, BA, E-RYT 200Eugenie S. Joseph, MFA, MAAbby Wolverton, BSRaymond Folen, PhD, ABPP

This poster presentation will highlight results from collaboration between Research Psychology and the Care Provider Support Program in which Course Evaluation survey data were treated. Results indicate high endorsement by trainees of increase in resiliency knowledge (4.31 on a 5 point scale), and provider fatigue/burnout awareness (4.38). Results also show a comparatively lower endorsement of an item expressing confidence that management will consider the trainee’s suggestions for organizational improvements (3.71). The presentation will also highlight ways in which the program has responded to requests from medical providers to enhance resiliency at Tripler Army Medical Center.

13

TOBACCO TIME BOMBS: DETECTING PATTERNS IN SELF-DESTRUCTIVE ADDICTIVE HABITS AMONG SOLDIERS

David Bremer, PhD, MPH

Tobacco use is known to increase during deployment (Bondurant & Wedge, 2009; Nelson et al., 2009; Smith et al., 2008). Tobacco is addictive and once started is often difficult to stop (Anda et al, 2005; Faue et al., 1997; Severson et al., 2009) and deleterious effects on health are pervasive and well-documented (Altarac et al., 2000; Lightwood et al., 2009). The incidence of tobacco use is known to be higher among people with post-traumatic stress disorder and other maladjustment than in normal populations (Baker & Joseph, 2007; Brook et al. 2008; Miller et al., 2000; Op et al., 2002). Hoffman et al., 2008 suggested that better understanding of factors related to tobacco use in the military may enable development of more effective approaches to prevent and treat tobacco use.The poster visually displays associations between tobacco use and such variables as combat exposure, trauma symptoms, physical and behavioral health indices, personal history, demographics, etc. The IRB-approved study analyzed a de-identified database derived from archival Automated Behavioral Health Clinic (ABHC) records of 2316 male soldiers completed in post-deployment screening 3 to 7 months after returning from a 15-month deployment in Iraq.

WEARY WARRIORS: UNDERSTANDING POST-DEPLOYMENT INSOMNIA

David Bremer, PhD, MPH

Deployment schedules and stressors may increase incidence of insomnia (Seelig et al, 2010), and sleep disturbance is among the cardinal symptoms of post-traumatic stress disorder (Mellman, 2008). The poster visually displays associations between insomnia and such variables as combat exposure, trauma symptoms, physical and behavioral health indices (e.g., depression, anger, substance use), soldier morale, personal history, demographics, etc. The IRB-approved study analyzed a de-identified database derived from archival Automated Behavioral Health Clinic (ABHC) records of 2316 male soldiers completed in post-deployment screening 3 to 7 months after returning from a 15-month deployment in Iraq.

14