AfterDeployment.org Community of Practice - Sept 2013
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Transcript of AfterDeployment.org Community of Practice - Sept 2013
AfterDeployment.org Community of Practice
September 10, 2013
Agenda
• Introducing AfterDeployment.org Providers Manual: David Bradshaw, PhD, and Robert Ciulla, PhD
• Using AfterDeployment.org in a VA primary care treatment setting: Annabel Prins, PhD
• AfterDeployment Community of Practice on LinkedIn: David Bradshaw, PhD
• Announcing two new websites for military, veterans, and families: Pamela Murphy, PsyD
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Web Tools Resource Guide: A Manual for
ProvidersRobert Ciulla, Ph.D.
Joint Base Lewis-McChord/ Tacoma, WA
10 September 2013
Agenda
• Introduction to the Providers Manual for AD.org
• Organization of the Manual
• Overview of manual content/features
• A clinical example
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Our mission is to use web-based technologies to help service members, veterans, and their loved ones manage the challenges they face following a deployment and beyond.
AfterDeployment.org
Introduction and Background
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• Why this manual?– AD.org developed for self-care but also may
be useful for providers– Provider Portal provides additional resources– How can providers use AD.org tools to
support clinical care?
Document Structure
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Manual
Overview and Features
Clinical Case Example
FAQs
Glossary
Bibliography
Introduction and Background
Clinical Case Example
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• Describes how to use the material on the website during a clinical encounter
• Uses the Post-Traumatic Stress topic• Step-by-step example of a clinician
working with a patient using AfterDeployment.org resources
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Multi-Modal Content
Topics are organized to provide:• Coach-driven instruction/guidance• Immersive video/text-based educational tools• Standardized assessments/tailored feedback• Peer-based, experiential accounts• Interactive exercises• Additional resources (links, books, FAQ’s)• Persistent progress indicators
Session 1 – Introduction
“Sgt. Smith, do you have Internet access… Do you ever check into health-related websites to get information about a problem you’re having?... Have you ever heard of a website called AfterDeployment.org?... It was developed by…”
Session 1 – Focus on PTS
“AD.org has several topics that are very pertinent to what you are going through. The one that I want you to look at between now and your next appointment is the topic called Post-Traumatic Stress.”
The PTS Home Page
“When you click on the Post-Traumatic Stress icon from the Home page, you go to the Post-Traumatic Stress section of the site. There are videos that discuss post-traumatic stress, an online booklet that you and your spouse can read through, and personal stories from other service members and veterans about their deployment experiences.”
Between-Session Homework:Video-Based Education
“Before your next appointment, I want you to click on ‘Start Here’ and listen to the overview [1:30]. Then I want you to view the first two video documentaries, the one called “Introduction to PTS” [3:50] and the one called “Reactions and Triggers [0:35] Here, I’ve written these down for you.”
Between-Session Homework: Personal Stories
“Also, I want you to click on the Personal Stories tab and look through these videos—I also wrote this section down on your assignment sheet. I’m sure you’ll find that many other service members have had some experiences that are similar to yours.”
Self-Assessment
“Now, there’s one more exercise that I want you to do on the site—and that’s also on your assignment sheet. See this tab, the one named PTS Assessments? I want you to take the PTS assessment and bring your results to our next session.”
Next Session: Introducing the Interactive Workbook
“Good work. You viewed the coach’s introduction, and the educational videos, and you heard from other service members and families about their deployment experiences. I have a new assignment that I want you to complete between now and next week. I want you to log on to the website’s workbook. Let me show you.”
Workbook Features
“The workbook has a number of features. In the upper right corner you will see a progress bar that tells you how many sessions you’ve completed. You can also check in on the exercises that you have completed in the My Work tab. In order for the website to save your information from one session to the next, be sure to sign up - registration is anonymous. On the bar at the bottom of the page, you can track your session progress.”
Workbook Coach
“A persistent feature throughout the workbook is the coach. The coach provides information about the topic. And the coach serves as a guide through the sessions.”
Workbook Session #1: Trauma Triggers
“While you can view the sessions in any order, the best approach is to start at the beginning and use the sessions in sequence. After you pull out the menu tab, click on the first session, ‘Trauma Triggers’. This workbook session will teach you about trauma triggers and how they affect your emotions and stress level.”
Identifying Triggers
“As you proceed through the workbook, you will be asked to answer questions and fill in information about how you’re coping. For example, you will see a checklist such as this one that prompts you to identify the things that trigger you. If you don’t find your trigger on the list, you can write it in the free text section. ”
Examples
“To help you understand this exercise, this session provides an example trigger record. Be sure to listen to the entire session. It has been developed to be engaging, and brief. In fact, this entire session takes about 20 minutes to complete.”
Getting Help
“If you get stuck, click on ‘help’. The coach will narrate an explanation of the section that you’re having difficulty with.”
Trigger Record
“After you have seen the example, the workbook will prompt you to fill in your own trigger record. As you gradually learn ways to manage your triggers, the remaining sessions in the workbook will use the responses that you provided in earlier sessions.”
Dealing with Avoidance
Because behavior change isn’t easy, the workbook has been designed to offer encouragement, ‘normalize’ the trauma, and deal with possible forms of resistance.
How Stressful Was That Exercise?
“Periodically, the workbook will check in with you, see how you’re doing. This is a check on your stress level. AfterDeployment.org also includes skills training to help with learning how to relax. Another time, we can talk about a mobile app called Breathe2Relax.”
“My Work”
My Work saves the user’s information within the workbook.
Session # 1: Summation
Like a good therapist would do at the end of a session, the workbook coach reviews the session, referencing the areas that were covered and the particular take-away’s from the session. The coach then references the next session in the series.
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Other Key Points
• The site is a collaborative effort• Not all workbooks have been revised• No capability to send/transmit data• The content is versatile/customizable• Co-occurring conditions• VA conducting group sessions• Providers’ clinical approach• Clinical studies underway
Annabel Prins, PhDClinical Psychologist/T2 Liaison
National Center for PTSD, Dissemination & Training DivisionNational Center for Telehealth and Technology (T2), ROI Division
Afterdeployment.org Community of Practice Call9/10/2013
Bringing afterdeployment.org into VA Primary Care
Agenda Introduction
VA Primary Care Mental Health Integration
Demonstration Project
Clinical Observations/Future Direction
Introduction Research activities
Evaluation of PTS workshops at SJSU (Bush et al., 2013)
Clinical support tool for providers○ ADAPT-T (PI-Jakupchak): telephone based
problem solving therapy for PTSD/substance abuse
○ TIDES/PTSD (PI-Felker): care management for depression and PTSD
Clinical activitiesPrimary-Care MH team: American Lake VA
VHA Handbook RequirementsSection 21. Integrating Mental Health Into Medical Care Settings VA medical centers and very large CBOCs (serving 10,000+
uniques) must have integrated mental health services that operate in their primary care clinics on a full-time basis.
Services need to utilize a blended model that includes co-located collaborative care and care management.
Similar requirements for Large CBOCs (serving 5,000-10,000) except hours and days of availability of integrated care services can vary depending upon the clinical needs of the patient population.
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PC-MHI Services Reporting, Percent, by Site Type and Year
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CCC & CMCCC Only CM Only Neither No Program
VAMC 2009 37% 34% 8% 11% 10%
2010 42% 39% 7% 9% 4%
2011 45% 42% 2% 4% 7%
2012 53% 41% 2% 0% 4%
VL CBOC 2010 24% 24% 4% 14% 33%
2011 27% 34% 9% 5% 25%
2012 41% 41% 2% 5% 11%
L CBOC 2011 27% 25% 12% 5% 30%
2012 28% 36% 2% 6% 28%
PC-MHI at American Lake VA Description of clinic
○ Staffing2.5 Psychologists2.5 part-time medication prescribers1.0 Care ManagerPsychology internsClosely tied to telemental health providers
○ ServicesSame day access clinicBrief assessment and treatment (4-6 sessions)Psychoeducation groupsIn-service trainings to PACT
Types of Groups
Description of ad.org group 4 sessions open group Referrals mostly from SDAC
OEF/OIF/OND Veteran Access to internet Not in MH treatment
Co-facilitators Russel McCann, PhD (T2 - VA) Psychology Interns
Support materials Provider portal for self-assessments/handouts Workshops for self-monitoring forms
Conference room (up to 8 people) Computer access/standard screen
Group Format (weekly) Introductions
Group MembersPast week experiences with ad.orgOverview of website (for new members)
Discussion Question Self-Assessment Video Stories Self-monitoring form Workbook recommendations and handouts
Introductions (weekly as needed) Members
How long with VABranch of service – deploymentsCurrent living arrangement
WebsiteHistory - T2 developmentcognitive-behavioral principles
FeaturesImportance of sign-up/sign-in: demoLocate, Chat, Call features
Sleep Introductions Discussion Questions (Board)
Why are sleep problems so common in returning veterans?
What are most common reasons for sleep problems? Complete 10-item American Academy of Sleep Medicine:
Rate Your Sleep Scale Review Video Stories (at least 3 out of 5) Review Sleep Diary (for one week) Developing Good Sleep Habits Handout Workbook exercises
Must sign-up/sign-in to access If not, sleep library for reading
Depression Introductions Discussion Question (Board)
What is depression?How is depression different from sadness?
Complete PHQ-9 (SI item) Review Video Stories (1,2 and 4) Review Depression Monitoring Form Workbook exercises/selection
Behavior and Mood for help with monitoring form Depression triggers for help with behavioral activation Challenging negative thoughts for changing cognitions
PTS Introductions Discussion Question (Board)
What is PTS?How is PTS different from PTSD?
Complete PCL-M Review Video Stories (all 5) Review Trigger Record Workbook exercises/selection
RID tool – managing triggers PLAN tool – planning for triggers Writing tool – addressing “haunting” experiences
PTSD Coach (RID and Plan tool)
Anger Introductions Discussion Question (Board)
How is anger different from anxiety and depression? (Different triggers and what we think, feel, and do)
Complete Dimensions of Anger (DAR) scale NO video stories – examples of defining features
on board along with coping strategies Handouts
Create an Anger Control Plan How to Use a Time out
Charting Background information Presenting Problem
Problem list and/or VCODE: Hx of military deployment
Description of group/topic Individual issues
Completed exercises in past week Results of self-assessment (acuity level) Most salient (most bothersome) feature Group participation level – engagement Insight
Risk Assessment Plan
Recommended workbook activities Specialty care referral
Clinical Observations
Best “fit” for groupRecently retired/discharged veteranNew to VASymptomatic but functioningLooking for support from other veteransFamiliar with online materials (e.g., student)Not sure about MH treatment
○ Medications○ Psychotherapy
Clinical Observations Possible outcomes
Drop-out rateSatisfaction with group (feedback)
○ Appreciate online resource/phone app too○ Learned more about postdeployment issues○ Support from others
Referral to specialty care○ Participation in orientation○ Engagement into treatment (EBT)
“Sweet spot” for clinical benefit○ Baseline level of distress○ Engagement/practice with workbook
Future Direction
Establish network of PCMHI providers interested in group
Identify technological challenges Develop provider manual for group Develop ways to support exercises with
mobile apps Develop “research enabled” feature on
ad.org
AD.org Community of Practice LinkedIn Group
• Objective:– To provide a forum for health care providers
currently using or interested in learning about the tools available on the AfterDeployment.org website as part of the care they provide.
– To promote discussion about health care practice using AD.org tools, mobile apps, and other technology-based methods
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Who Can Join?
• Current members of the AD.org Community of Practice
• Any health care providers who:– Provide care to the military community: active
duty, guard and reserves, veterans, and military families.
– Are interested in using AD.org tools and resources in their clinical practice.
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How Do I Join? Current COP Participants
• Look for email from LinkedIn inviting you to join the AD.org COP group
• Click the link to accept the invitation and follow the directions
• If you don’t have a LinkedIn account you will need to create one prior to accepting the invitation (www.LinkedIn.com)
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How Do I Join? Non-COP Members
• Sign in to LinkedIn– If you do not have a LinkedIn account, you will need
to create one: www.LinkedIn.com
• Search list of LinkedIn groups for AfterDeployment Community of Practice
• Click “Join” on the group page• You will receive a confirmation message
once your request to join is accepted
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IMHS Integrated Mental Health Strategy
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StartMovingForward.org
A web-based self-help training that teaches problem solving skills to help individuals better handle life’s challenges.
MilitaryParenting.org VeteranParenting.org
A web-based course that provides parenting information and strategies for service member and veteran parents.
IMHS is a DoD-VA initiative to advance a coordinated public health model to improve mental health services for members of the DoD and VA. T2 was tasked with actions to promote access to web technologies and self-help strategies.
Contacts and Links
• Today’s presenters:– Robert Ciulla, PhD [email protected]– Annabel Prins, PhD [email protected]– David Bradshaw, PhD
[email protected]– Pam Murphy, PsyD
• For a copy of today’s presentations:www.slideshare.net/t2health
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