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March 2010 Quarterly

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					                                                                                                                                                                                             March 2010 Quarterly
                                                                                                                                     COMMUNITY
AHLTA              FIRST-STEPS                                         ACADEMIC   SPOTLIGHT        BUSINESS           LETTERS          NEWS


         BUSINESS CASE                                                                    GREETINGS FROM THE DIRECTOR                                                  FIRST-STEPS TO PAPERLESS
                                                                                                                                                                          CARE FACILITATION
        DOLLARS and “SENSE”                                                                             Our RESPECT-Mil community con-
                                                                                                                                                                 NEWSLETTER TIP #1 – CLOSING a SNAPSHOT: Use the SNAPSHOT ESTIMATE button only!

         & the Bottom Line                                                                              tinues to grow and mature as we
                                                                                                        develop into a cohesive team of
The almighty and somewhat elu-                                                                          providers, and we are honored to
sive Relative Value Unit (RVU) has
                                                                                                        have you as part of the team.
significant impact on resources in
our medical community. At a time                                                                    We intend for this newsletter to be
when providers are being asked to                                                                   a source of information, a commu-
do more with less, there has never                                                                  nication instrument and a place to
been more of a need for an RVU                                                    celebrate our providers. This newsletter also provides                                 CAUTION – The CLOSE tab closes the EPISODE! Only CLOSE an EPISODE when the Soldier will
“Force Multiplier.”                                                               the opportunity for members of the RESPECT-Mil team                                    not be participating in RESPECT-Mil.




The Business Model developed at                                                   to learn from one another.                                                    Our new electronic case tracking
Fort Stewart targets the Behavioral                                                                                                                             system for care facilitation docu-
                                                                                  During the first two years of RESPECT-Mil, you have
Health Consultant role for RESPECT-                                                                                                                             mentation is known as FIRST-STEPS.
                                                                                  collectively screened over 300,000 primary care visits
Mil. The model is designed to en-                                                                                                                               Care Facilitators have begun
                                                                                  at nearly 40 clinics around the world. Nearly 2,500 visits
hance patient care by a thorough                                                                                                                                entering newly referred cases as
                                                                                  involve the identification of suicidal thoughts. We
review of the patient records, dis-                                                                                                                             of September 2009 in version 2.0 of
                                                                                  routinely hear stories from the field regarding important
cussion of the case with the Care                                                                                                                               FIRST-STEPS. This change results in
Facilitator (Registered Nurse), and                                               “saves” (i.e., suicide screens resulting in essential acute
                                                                                                                                                                an essentially paperless system for
a clearly documented Electronic                                                   changes to a Soldier’s treatment plan). YOU are an
                                                                                                                                                                our busy Care Facilitators!
Health Records (AHLTA) summary                                                    essential member of this life-sustaining program.
with recommendations for patient                                                                                                                                FIRST-STEPS Version 2.1 is antici-
                                                                                  Our geographic distance from each other means
care. This process can net 2.4                                                                                                                                  pated for release in about four
                                                                                  that, up until now, we regularly interact as colleagues
RVU’s per staffed patient and can                                                                                                                               months. Version 2.1 will have
                                                                                  primarily during our site calls or in site visits. You are an
take as little as 10 minutes per pa-                                                                                                                            many automated features such
                                                                                  integral part of the RESPECT-Mil community, and we
tient. If you staff 100-200 patients                                                                                                                            as scheduling and automatic
                                                                                  would like to assist you in expanding communications
a month the work load generated                                                                                                                                 creation of staffing agenda with
can be impressive.                                                                among you and your colleagues and between you
                                                                                                                                                                cases prioritized based on risk and
                                                                                  and the Implementation team. This newsletter allows
                                                                                                                                                                lack of progress toward remission.
This optional staffing resource                                                   you to join us for updates and information at your
admittedly takes slightly more time                                               convenience.                                                                  The FIRST-STEPS corner of this news-
then a verbal staffing encoun-                                                                                                                                  letter will contain tips for use by
ter. However, it has the added                                                    We promise that each newsletter will deliver up-to-
                                                                                                                                                                Care Facilitators and Behavioral
benefit of educating primary care                                                 date information about RESPECT-Mil, inform you about
                                                                                                                                                                Health Champions as they staff
providers on some basic principles                                                program developments, and offer essential program
                                                                                                                                                                cases. This edition’s tip is included
of psychiatric care. I believe that                                               facts and figures. We will use the newsletter to an-
                                                                                                                                                                below:
this process results in better patient                                            nounce and review key decisions, actions and revisions
care, which really is our bottom                                                  in program procedures. The newsletter will help to                            #1 To close a SNAPSHOT – use the
line. Finally, I challenge primary                                                build new relationships between people, sites, teams                          “SNAPSHOT ESTIMATE” button on
care champions to develop a simi-                                                 and disciplines. It will offer success stories, ultra-brief                   the left navigation bar. If you se-
lar RVU business model for primary                                                literature reviews, and helpful program hints from the                        lect the black “CLOSE” button on
care and share your idea with                                                     field. To print those stories we must first hear them from                    the summary page you will close
the group. If you have questions                                                  you, so I ask you and your local team to examine your                         the EPISODE! Please use caution
please do not hesitate to contact                                                 RESPECT-Mil experiences for material of interest to                           and close only Snapshots as soon
me:                                                                               your colleagues worldwide. Each newsletter will also                          as possible after the contact. If
David Dobson, MD, Psychiatrist                                                    recognize teams and individuals making noteworthy                             you accidentally close an EPI-
RESPECT-Mil, Behavioral Health                                                    program efforts and contributions.                                            SODE, call Sheila for instructions.
Proponent
                                                                                  This month we spotlight a Care Facilitator at Fort Bragg,                     #2 Since FIRST-STEPS resides on a
david.l.dobson@us.army.mil                                                        Kim Cruse, who has served the program since its initia-                       server rather than being a down-

                                                                                                                              (Continued on page 3)                                                     (Continued on page 3)

                                                                                       RESPECT-Mil is a quarterly publication of the Deployment Health Clinical Center and RESPECT-Mil Center of Excellence.
                                                                                               The views and opinions express herein are not necessarily those of the DHCC, RESPECT-Mil or DoD.                                                                    1
            D E P LOY M E N T H E A LT H C L I N I C A L C E N T E R
               AHLTA TIPS                                                           PERSONNEL SPOTLIGHT
                                                                      My name is Dr. Melissa       Lt. Col. Mark Brown, the first Behavioral Health
                                                                      Molina and I am the          Champion, and I briefed our command and
         by Maj. Roger Duda, MD
                                                                      Primary Care Cham-           the providers to explain the overall program.
            Behavioral Health                                         pion for the RESPECT-Mil     The impetus to start the program on May 18,
            Proponent-Military                                        program at Fort Bliss, TX.   2008 was when, 3 weeks prior, we experienced
                                                                      I was introduced to the      a suicide of a 19-year-old AIT Soldier here. He
    With the update of Armed Forces                                   RESPECT-Mil community        shot himself in the head and had not sought
    Health Longitudinal Technology                                    at Fort Bragg, NC where,     help with any provider. It was indeed a sad
    Application (AHLTA) to version 3.3                                in a structured meeting, I   incident but like most unfortunate incidents,
    now rolling throughout the Depart-        learned about a new Army program designed            it served as the catalyst for the start of the
    ment of Defense (DoD), users may          to identify Soldiers with PTSD and depression        RESPECT-Mil program here.
    feel that they are not taking full        and get them the help they need and de-
    advantage of what AHLTA Build                                                                  We decided that to screen all active duty Sol-
                                              serve within the Primary Care setting.
    3.3 has to offer. For our inaugural                                                            diers we would give the MEDCOM 774s to all
    newsletter issue, we have gath-           The R-MIT team listened as I gave a mock             active duty Soldiers who presented to the front
    ered three websites that have             presentation (with slides) about Behavioral          desk to check-in. This worked out well and has
    great resources for AHLTA. Hope-          Health issues in the Army and how RESPECT-Mil        continued to give us success in reaching large
    fully, you will find what you are         could be incorporated into clinics. I remem-         numbers of Soldiers. We had two Nurse Care
    looking for as well as learn some-        ber thinking, “What have I gotten myself into?       Facilitators and no Administrative Assistants,
    thing new at these sites.                 Just one more thing I have to do in my clinic.”      but we couldn’t wait. Ms. Cordova and Ms.
                                              Over time, I became more interested in how           Rosales started seeing patients, while sharing
    AHLTA 3.3 Information, How To’s           this program could help Soldiers and how             an office, phones and supplies. Our AA, Ms.
    and FAQs, can be found at                 easily providers could do this while they were       Almager, arrived in October and everyone
    http://www.usafp.org/AHLTA-3_3-           seeing the Soldiers for their Primary Care visits.   stepped up to help. Now our program was
    Information-FAQs.htm. This site is a      I brainstormed with my admin officer about           running full-speed and providers and patients
    huge source of information from           incorporating this into my clinic by getting         felt comfortable talking about their behavioral
    the Uniformed Services Association        the providers to do a good job of screening.         health issues and receiving help.
    of Family Physicians. It is a useful      I knew that at Fort Bliss, TX we were in dire
    starting point for both general and                                                            We have screened over 42,000 Soldiers and
                                              need of behavioral health evaluations at the
    specific issues you may have.                                                                  there have been no suicides among the
                                              primary care level. We had very few psychia-
                                                                                                   Soldiers that have been in the program. Our
    The Navy offers training at this          trists or other mental health providers. The
                                                                                                   success is due to the teamwork that our pro-
    website: www.navyahlta.com.               unique program concept focused on bringing
                                                                                                   gram has developed. Teamwork is the key! It
    You can get familiar with the site        mental health to the primary care practice,
                                                                                                   is of utmost importance for the success of any
    at http://www.navyahlta.com/              where it could be part of a clinical visit. I knew
                                                                                                   program. I thank my team often and know
    provider/managing-tcons.asp?mt            that Soldiers would feel more open telling their
                                                                                                   that they could survive on their own without
    f=0&clinic=&s=913781864&r=1. This         PCMs about their issues rather than wait for a
                                                                                                   me because of the relationships they have
    site also offers a training overview      consult and have to tell their “shrink” and risk
                                                                                                   forged with each other, the providers, and the
    on telephone consults.                    experiencing stigma and retaliation from their
                                                                                                   patients. I know that the RESPECT-Mil program
                                              units. I came away with eagerness to start the
    Finally, U.S. Army Medical Com-                                                                has saved many lives and has made a huge
                                              RESPECT-Mil program at Fort Bliss. Now, I had
    mand (MEDCOM) created a                                                                        contribution to military medicine and to over-
                                              to get my command and my providers to
    website to support its clinical                                                                all patient care!
                                              “buy in.”
    information systems. You can find
    information on AHLTA, DRAGON
    and As-u-type at https://vmc.                                                     COMMUNITy NEwS
    amedd.army.mil/.
                                                                       Johnnie Mae Alridge,        daughters are attending Georgia State in
    User-generated questions can be                                    our Administrative Assis-   Atlanta, GA and will graduate in May with
    answered in the forums here, as                                    tant at Fort Benning, GA,   accounting degrees. Her youngest daughter
    well.                                                              graduated September         will pursue a law degree. Her son, a junior in
                                                                       12, 2009, with a Bachelor   high school, is currently completing courses at
    Please email any specific ques-
                                                                       of Science in Business      Columbus State University.
    tions so we can discuss them in our
                                                                       Management. She be-
    next newsletter to roger.duda@                                                                 She and her children created a challenge
                                                                       gan the MBA program
    amedd.army.mil.                                                                                to see who could have the highest GPA in
                                                                       October 5, 2009 at the
                                                                                                   college. Currently, they all are holding a 3.4
                                              University of Phoenix.
                                                                                                   GPA!! Congratulations to Ms. Alridge and her
                                              Ms. Alridge has one 16 year old son, and two         family.
                                              daughters, who are 24 and 23 years old. Both

                                                                        QUOTE
                           It is our duty to embrace, care for and help heal those wounded warriors returning from battle.
                                   It is our solemn obligation to honor those who have given the ultimate sacrifice...
                                            And it is part of our oath to never leave a fallen comrade behind.

2
                                   PERSONNEL SPOTLIGHT (Continued from page 2)                                      FIRST-STEPS TO PAPERLESS
                                                                                                                       CARE FACILITATION
                       Kim Cruse feels blessed        Over the course of her work with the
                       to have been part of           RESPECT-Mil program at Fort Bragg, Kim’s                   (Continued from page 1)
                       the program as it grew         professional skills have resulted in frequent
                                                                                                                 loadable program, navigate within
                       from its original test site    opportunities to support service members
                                                                                                                 the blue box only. If you get lost
                       status to the program          through very difficult times. With her excep-
                                                                                                                 in the system, select HOME in the
                       it is today. Kim, a regis-     tional commitment to the program, Kim has
                                                                                                                 upper left corner to return to the
                       tered nurse, has served        improved the quality of the lives of many                  home page of the system. (If you
                       as a RESPECT-Mil Care          Soldiers, their families and their community.              get lost, go to Home.)
                       Facilitator at Fort Bragg      “I feel this is the ultimate gift any one person
for over two years. She is grateful to have           can give to another – to make a difference                 If you have questions or problems
the required tools and knowledge to meet              in someone’s life.” We thank you, Kim Cruse.               with the system, contact:
the needs of our military men and women.                                                                         Sheila Barry, Assistant Director,
                                                                                                                 Program Development & Training

                     Sweena Florian has               needed program for all service members.                    Office 603-763-2910
                     worked for the Carl R.           Her support and keen community awareness                   or Blackberry 202-731-9242
                     Darnall Army Medical             have been invaluable to the RESPECT-Mil                    sheila.barry1@us.army.mil
                     Center at Fort Hood,             Implementation Team. Ms. Florian is a single
                     TX (CRDAMC) for over             mother and is currently working on her Bach-
                     ten years, two of which          elor’s degree in Business from Texas A&M.                               LETTERS TO
                     have been as an                  She is a mom, maintains a full-time job, at-
                     administrator for the            tends school full-time and exercises regularly.                         THE EDITOR
                     RESPECT-Mil Program.             Sweena says she misses watching TV, and                    Greetings,
She enjoys working with Soldiers and consid-          asks “What’s going on with Grey’s Anatomy
ers RESPECT-Mil an important and much-                anyhow? “                                                  I am a Care Facilitator in the west
                                                                                                                 of the country. We have a num-
                                                                                                                 ber of patients here who are re-
                             GREETINGS FROM THE DIRECTOR (Continued from page 1)                                 questing alternative therapy along
                                                                                                                 with their medications. In particu-
tion in 2007. Dr. Melissa Molina, the long-           Other sections of our inaugural newsletter                 lar, they are asking about the use
serving primary care champion at Fort Bliss,          address FIRST-STEPS, our brand-new web-                    of an OMEGA-A dietary supple-
offers us key lessons learned around primary          based care facilitation tool, AHLTA tips, a be-            ment for relief from depression.
care screening. We also honor Fort Hood ad-           havioral health business model developed                   We want them to be comfortable
ministrative assistant Sweena Florian. Perhaps        by the Fort Stewart team, and other issues.                but we don’t want to confirm this
more than any other member of our extend-             As always, the RESPECT-Mil Implementation                  since we aren’t sure about it. Can
ed RESPECT-Mil family, Sweena has faced               Team, affectionately referred to around here               you help us with this?
and overcome program implementation                   as the R-MIT, appreciates everything you are               Contributor, RN, BSN
adversity. She has transcended that adver-            doing on behalf of men and women in uni-
sity and in so doing has earned my complete           form and their families. There is no greater               ANSWER:
admiration. Each of these people embodies             reward or honor.                                           “We were unaware of the an-
the “RESPECT-Mil total team spirit.”                                                                             swer to this question so we polled
                                                                                                                 experts and searched PubMed
                                                                                                                 (www.pubmed.gov). We identified
                                                                                                                 the following citation: This meta-
                                     ACADEMIC CORNER                                                             analysis suggested modest effi-
                                                                                                                 cacy in individuals taking Omega-
Optimized Antidepressant Therapy and Pain             JAMA. 2009;301(20):2099-2110.                              three fatty acids for depression.
Self-management in Primary Care. Patients                                                                        We believe Omega-three fatty
                                                      Kroenke and colleagues completed a
With Depression and Musculoskeletal Pain.                                                                        acids are perhaps best used as
                                                      multisite randomized controlled trial of
                                                                                                                 a therapeutic adjunct for mild or
A Randomized Controlled Trial                         collaborative care. They found clinically
                                                                                                                 moderate depression. The litera-
                                                      significant improvements of collabora-
Kurt Kroenke, MD; Matthew J. Bair, MD, MS;                                                                       ture in this area, while promising,
                                                      tive care over usual primary care in both
Teresa M. Damush, PhD; Jingwei Wu, MS;                                                                           remains nascent. Existing studies
                                                      depression and musculoskeletal pain. The
Shawn Hoke, BA; Jason Sutherland, PhD;                                                                           were noted to have several limita-
                                                      complete article is available upon R-MIT
Wanzhu Tu, PhD                                                                                                   tions, perhaps most importantly
                                                      request.
                                                                                                                 short periods of follow-up.”


                                                            NAME THE NEwSLETTER
The R-MIT team is soliciting your ideas to           your car! This is a contest and there WILL          of names you submit. The winner and the
name our newsletter! This is your newslet-           be a winner. What’s the prize? The winner           new name will be announced in the next
ter and what better way to own it than to            can attend up to three days of Continuing           newsletter. Send your ideas to monica.
name it! You named your pet, you named               Education Sessions in their field. Send us          valdiviezwiley@us.army.mil.
your child, and let’s face it, you named             your ideas! There is no limit on the number

                                                                                                                                                       3
                                            FORCE HEALTH PROTECTION CONFERENCE 2009
                                                        By Victoria Bruner, LCSW, RN, BCETS
                                                     Associate Director for Clinical Education
                                                        Deployment Health Clinical Center

                                  The Deploy-       Additionally, the conference provided a          Army active duty personnel; the American
                                  ment Health       half-day workshop for RESPECT-Mil Cham-          Pain Foundation; the Vet Art Project; the
                                  Clinical Center   pions.                                           Substance Abuse and Mental Health Ser-
                                  (DHCC) spon-                                                       vices Administration (SAMHSA); the Naval
                                  sored its sev-    During the track’s plenary session, over 200     Research Center; the Uniformed Services
                                  enth successful   attendees viewed the “Theater of War,”           University of the Health Sciences; theater/
                                  conference        performed by The Philoctetes Project. This       documentary arts organizations; medical
                                  track at the      project presents readings of “Sophocles’”        schools; and eight other DoD agencies.
                                  annual Force      “Ajax” and “Philoctetes” to military com-
                                  Health Protec-    munities across the United States. These an-     The DHCC played a significant role in
                                  tion Confer-      cient plays timelessly and universally depict    support and planning of the Force Health
                                  ence August       the psychological and physical wounds            Protection Conference forum, The Soldier
                                  11-15, 2009 in    inflicted upon warriors by war.                  at Risk. Big Gen. Loree Sutton was the key-
                                  Albuquerque,                                                       note speaker for this program, which was
                                                    The goal of the presentations is to de-          a joint effort by the Army Substance Abuse
    New Mexico. Nearly 2,500 attendees from         stigmatize psychological injury and open a
    all health professions participated in the                                                       Program, the Behavioral Health Track, the
                                                    safe space for dialogue about the chal-          Deployment Healthcare Track, and the
    conference.                                     lenges faced by service members, veter-          Health Promotion for Readiness Track. The
    The Deployment Healthcare Track hosted          ans, and their caregivers and families.          three hour symposium featured four gradu-
    50 attendees during a two-day RESPECT-Mil       The “Lioness Team”, an 82-minute docu-           ates of DHCC’s Specialized Care Program
    workshop. The workshop “Building Resil-         mentary gives an up-close look at the            Track II for PTSD, who provided insight into
    ience: Rebounding from and Preventing           evolving role of women in the U.S. military      the experience of Soldiers and family mem-
    Compassion Fatigue” hosted 82 attendees.        -- not just in traditional roles as nurses and   bers seeking Behavioral Health services
                                                    support personnel but as weapon-toting           after deployment. More than 200 persons
                                                    frontline troops. This performance drew 210      attended the forum.
                                                    attendees.
                                                    Three sub-tracks were offered on: Military
                                                    Women’s Health Issues, The Millennium
                                                    Cohort Study, and Traumatic Brain Injury,
                                                    presented in collaboration with Defense
                                                    and Veterans Brain Injury Center.
                                                    Overall, the Deployment Healthcare
                                                    Track delivered a total of 80 presenters, 71
                                                    presentations and represented a collabo-
                                                    ration with VA staff; universities; volunteer/
                                                    non-profit initiatives; Navy, Air Force and




                                                          R-MIT OFFICE LOCATIONS

                                                                                                             Schweinfurt, GE
    Fort Lewis, wA
                                                                                                             Katterbach, GE


                                                                                                                 Vilseck, GE
                                                                                                               Fort Drum, Ny
    Fort Carson, CO
                                                                                                                  Vicenza, IT


    Fort Riley, KS                                                                                        Fort Campbell, Ky
                                                                                                              Fort Bragg, NC
    Fort Polk, LA
                                                                                                           Fort Benning, GA
    Fort Bliss, TX
                                                                                                            Fort Stewart, GA
    Fort Hood, TX
    Schofield Barracks, HI


4
                      IMPROVING POST-DEPLOyMENT CARE                                            RESPECT-MIL IMPLEMENTATION

                                                busy Troop Medical Clinic (TMC) serving        The U.S. Army Surgeon General issued
                                                the medical needs of 82nd Airborne Divi-       Operational Order (OPORD 07-34) on
                                                sion Soldiers and families.                    January 3, 2007 directing (1) establish-
                                                Of the Soldiers screening positive for PTSD    ment of the implementation team; (2)
                                                or depression that enrolled in RESPECT-Mil,    universal primary care provider training
                                                two- thirds to three-fourths reported clini-   in PTSD, depression, and RESPECT-Mil;
                                                cally important improvements in status.        and (3) the 24 month roll-out of RESPECT-
                                                                                               Mil to 15 sites. This included four over-
                                                RESPECT-Mil disseminated using an inter-
                                                                                               seas, and 11 state-side sites, which also
                                                disciplinary implementation team, the
                                                                                               involved 39 primary care clinics.
                                                RESPECT-Mil Implementation Team or R-MIT,
                                                operating at Fort Bragg and Walter Reed        All 15 sites, and 36 of the 39 clinics, now
                                                Army Medical Center, involves a codi-          run RESPECT-Mil and have designated
                                                fied, structured, and highly accountable       Behavioral Health and Primary Care
                                                primary care strategy with written “how to”    “Champions.” Three additional sites in
                                                manuals and multimodal training and uni-       Europe have started at ERMC request
                                                versal Army provider web-training in PTSD/     and two other sites have requested sup-
                                                depression care (http://www.pdhealth.mil/      port for startup.
                                                respect-mil/index.asp).
                                                                                               Through the end of April 2009, 242,795
                                                •   Routine initial screening for depression   Primary Care “Champions” visits were
RESPECT-Mil is a program to improve the             and PTSD, and military appropriate         screened for PTSD and depression This
primary care (PC) of Army Soldiers re-              patient education materials. Validat-      represents 62% of Primary Care visits
turning from deployment. Nearly 20% of              ed, primary care relevant diagnostic       to participating clinics since program
recently deployed Soldiers screen positive          and severity aids for use in patients      inception. These figures are rising steadily
for a major mental disorder. Of these Sol-          with positive initial screen.              each month. Of screened visits, 9.2%
diers, 78% acknowledge a need for help,         •   Routine suicide screen for patients        result in a primary care diagnosis of de-
but less than a fourth pursue mental health         with positive initial screen and routine   pression, possible PTSD, or both.
specialty care.                                     semi-structured suicide risk assessment    Two-thirds of visits associated with previ-
Soldiers screening positive for post-deploy-        when suicide screen is positive or as      ously unrecognized, unmet needs (7,286
ment depression or anxiety are highly likely        otherwise clinically appropriate. Op-      visits to date, 3% of screened visits)
to perceive barriers to specialty care such         tion of specialist guided, nurse care      are linked to enhanced mental health
as stigma, poor access, mistrust and/or             management and primary care sup-           services, and only 11% of screen positive
possible harm to their military career.             port for those with PTSD or depression.    visits decline enhanced mental health
Systems-level, or “collaborative” primary       •   Timely treatment adjustment for partial    services.
care approaches to mental health service            response in accordance with optimal
                                                                                               1,856 visits (0.7%) involve identified
delivery, such as “Re-Engineering Systems           evidence-based guidelines.                 suicidality with no suicide comple-
of Primary Care Treatment for Depression,”      •   Ongoing mental health specialist           tions to date. The DoD National Quality
are more effective than usual primary               review and reinforced primary care-        Management Program independently
care in several large, multisite, randomized        mental health specialist collaboration.    assessed RESPECT-Mil versus control
controlled scientific trials.                       Shared mental health referral deci-        care, concluding that RESPECT-Mil is
RESPECT-Mil uses this model to incorporate          sions when clinically indicated or the     “effective…for screening, evaluation,
management of PTSD and depression us-               patient prefers.                           referral and treatment for mental illness
ing applicable DoD/VA practice guide-           RESPECT-Mil Care Facilitators, registered      in primary care… [and] warrants expan-
lines.                                          nurses, are essential to program success.      sion…”
With 90-95% of Soldiers accessing primary       These Care Facilitators monitor symptom        A 17-site Army expansion and DoD
care in the Military Health System each         severity, treatment adherence, and clini-      development of triservice demonstration
year, primary care affords opportunities to     cal risk using a State-Of-The-Science web-     sites is planned for Fiscal Year 2010. The
reduce mental health stigma, improve ac-        based care management technology,              DoD Deployment-Related Medical Re-
cess to high quality mental health services,    “FIRST-STEPS.”                                 search Program competitively awarded
increase the dispersal of “best practices”      They assist patients with problem solving,     a $15M, five-year, six-site randomized
in PTSD and depression care, and assist Sol-    goal setting, and active coping during         controlled trial (n=1500) of an enhanced
diers earlier using a more preventive focus.    regular scheduled phone contacts. They         RESPECT-Mil protocol that involves cen-
                                                strengthen and enhance specialist-pa-          tralized care management and prefer-
A 2005-2006 demonstration project re-
                                                tient-primary care contact, communica-         ence-based stepped care (“STEPS-UP”,
vealed high primary care provider satisfac-
                                                tion, and treatment planning.                  or Stepped Treatment Enhancements to
tion and acceptance of RESPECT-Mil at a
                                                                                               PTSD Services Using Primary care). The
                                                                                               Deployment Health Clinical Center/USU
This inaugural issue of the RESPECT-Mil news-   Beverly was a warm and wonderful human         and the Henry M. Jackson Foundation
letter is dedicated to Beverly Coleman-Mill-    being with a genuine gift of focusing on       for the Advancement of Military Medi-
er, MD. Beverly was the first Medical Direc-    the strengths of each person she met. The      cine are initiating principals, RAND and
tor of The RESPECT-Mil Program. She started     creation of this newsletter was one of her     RTI are partnering principals, and the
with us on December 22, 2008 and passed         many contributions. She will most certainly    University of WA (Seattle) and Boston Uni-
                                                                                               versity are collaborators. Funding started
away at her home in Philadelphia, PA with       be missed.
                                                                                               September 1, 2010.
her family at her side December 8, 2009.

                                                                                                                                              5
    Respect- Mil
    Deployment Health Clinical Center
    Walter Reed Army Medical Center
    6900 Georgia Ave., NW
    Bldg T-2, Rm 245
    Washington, DC 20307-5001




                                                       HAILS AND FAREwELLS!
HAILS!                                          Fort Carson, CO:                             Vilseck, GE:
RESPECT-Mil Implementation Team:                Lori Peterson, Care Facilitator              Maj. Joseph Dougherty, BH Champion
Barbara Charles, Administrative Assistant       Robin Vest, Administrative Assistant         Dina Williams, Administrative Assistant
David Dobson, M.D., Tri-service Behavioral      Fort Drum, Ny:                               Bamberg, GE:
Health Proponent                                Maj. Michael Regal, M.D., BH Champion        Maj. Vahag Vartanian, M.D., BH Champion
Timothy McCarthy, Deputy Director, R-MIT        Capt. Jamey Brown, MD, PC Champion
Kelly Williams, RN, Nurse Educator              Fort Hood, TX:                               FAREwELLS!
Fort Benning, GA:                               Yvette Levingston, NP, PC Champion           RESPECT-Mil Implementation Team:
Sharon Maxwell, M.D., PC Champion               Arlene Mayotte, Care Facilitator             Patrice Stewart-Carter
Angelita Jenkins, Care Facilitator              Fort Lewis, wA:                              Patricia Forney-Stewart
Johnnie Mae Alridge, Administrative Assistant   Capt. Susan Opar, M.D., PC Champion          Fort Benning, GA:
Fort Bliss, TX:                                 Donna Buckmore, Care Facilitator             Maj. Dengane Baruti, PC Champion
Maj. David Paris, NP, BH Champion               Kelli Blaine, Administrative Assistant       Glorian Chehade, Care Facilitator
Carol Smith, Care Facilitator                   Fort Polk, LA:                               Fort Bragg, NC:
Griselda (Gracie) Bermudez, Care Facilitator    Maj. Blanca Osorio, M.D., BH Champion        Kim Cruse, Care Facilitator
Fort Bragg, NC:                                 Gail Clemons, Administrative Assistant       Brenda Melvin, Care Facilitator
Cpt. Lillie Walker, PA, PC Champion             Fort Riley, KA:                              Charlene Dula, Administrative Assistant
Jane Schwarting, Care Facilitator               Mark Weis, M.D., PC Champion                 Fort Drum, Ny:
Lillian Rivera, Administrative Assistant        Fort Stewart, GA:                            Maj. Matthew Barry, M.D., BH Champion
Crystal Amaye, Care Facilitator                 Maj. Christopher Warner, M.D., BH Champion   Capt. Svetlana Lazaro, M.D., PC Champion
Fort Campbell, Ky:                              Michelle Bartley, Care Facilitator           Fort Campbell, Ky:
Maj. Anthony Rhea, M.D., PC Champion            Carmen Castro-Byrd, Care Facilitator         Robin Slone, Care Facilitator
Jennifer Hanley, Ph.D., BH Champion             Letitia Wootson, Care Facilitator            Fort Polk, LA:
Desiree Allen, Care Facilitator                 Katterbach, GE:                              Doug Pieritz, Care Facilitator
Kathy Parish, Care Facilitator                  Maj. Martha Culpepper, M.D., BH Champion     Schofield Barracks, HI:
Tina Robertson, Care Faciltator                 Kimberly Croese, Care Facilitator            Kenneth Kooser, M.D., PC Champion
Brenda Tanner, Care Facilitator                 Schofield Barracks, HI:                      Vincenza, Italy:
Shannon Young, Care Faciltator                  Ross Newmann, PA, PC Champion                Kathryn Morse, Care Facilitator
Maria Matta, Administrative Assistant           Todd Elwynn, M.D., BH Champion               Estella Gonsales, Administrative Assistant
Charity King, Administrative Assistant          Losi Vaa, Administrative Assistant
LaShanda Harrison, Administrative Assistant

				
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posted:1/5/2012
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