Respect-Mil BACHFort Campbell Kentucky

Jennifer Hanley, DNP F/PMHNP-BC

Behavioral Health ChampionAdult Behavioral Health

WTB

Objectives• Overview of RESPECT-MIL

Fort Campbell, Kentucky• Our Mission• Key Players• Where we stand• Where we are going• Challenges

Key Players• Desiree Allen, RN (T) RCF • Robin Sloan, RCF (N)• Sarah Merkle, Medical Clerk (V)• Jennifer Hanley, DNP BHC ABH• LTC Tamara Lafrancois,

• Primary Care Champion• COL Wasserman DCCS• Carenton Clinic -Working

Fort Campbell Specs• 101st Airborne Division• 5th Special Forces Group (ABN)• 160th Spec Ops Aviation Regimen• US Army Medical Activity• TN Valley District Corps of Engineers• Veterinary Command• US Army Dental Activity• Families• Multiple Clinics-Plans to

reformat/Expand

A 26-year old Ft. Campbell-based Army sergeant with the 1st Battalion, 30th Infantry Regiment, 3rd Brigade, who'd enlisted after 9/11 doing three tours in Iraq, committed suicide in Clarksville, TN seven weeks after coming home. After his second tour, he answered 'yes' to the PTSD identifiers on his post-deployment questionnaire, writing in that "he had combat-related nightmares, felt down or hopeless at times, and had mood swings." Diagnosed with PTSD and unfit to deploy, two days later he was sent back to Iraq for his third tour. When he returned, family say he was a changed man, and believed he had been trying to get killed after speaking to men from his unit at his funeral. He would "flip on a dime," paranoid and anxious. His wife reported his "condition … 'spiraled fast…‘ including an incident that led to his arrest and a charge of domestic assault." He was found face down in a local park with a shotgun at his side. 115 36 50 29 2007

Source: Inter Press News Service Agency [2007-09-10]

Our SoldiersSoldiers deployed from Fort Campbell have served up to 15-month stints and have fought in heavy combat zones such as Basra, Mosul and Al An bar province. Some (many) soldiers, have been deployed multiple times since the war began. Nov 26 2008Since the beginning of November, more than 10,000 soldiers have returned to Fort Campbell - 9,000 coming back from Iraq and about 90 from Afghanistan. 3,000 soldiers from the 101st Airborne are going to Afghanistan and 450 are being sent to Iraq. In January, another 1,200 from Fort Campbell will be deployed to Iraq. ASSOCIATED PRESS 2008 November

Behavioral Health• SF- Testing, Psychiatrist, NP/ADHD/resilience

Rare.• ASAP-Gatekeeper inpatient• TBI- Funded OT PT Psych, Sleep Lab• CAPS<17, FAP (RPOC• Dept SW Services• Inpatient Referrals- CH, LT, Vanderbilt• Off post med providers/repetition services

Army One-6 Visits FRC Volunteers • ABH- Walk in/appt. Family members (acute) Redeployments/SRP/Planes

• WTB- SWs, NCMs, BH, groups-slimming

PATIENT VISITS 1395 March 2007- April 2008PATIENTS SCREENED 1318POSITIVE SCREENS 226PERCENT SCREENED 94.48%PERCENT POSITIVE 16.20%

POSITIVE SCREENS 226POSITIVE FOR DEPRESSION 95 42.04%POSITIVE FOR PTSD 35 15.49%POSITIVE FOR PTSD&DEPRESSION 96 42.48%FALSE POSITIVE 55 24.34%POSITIVE SCREENS 226POSITIVE SCREENS ALREADY IN RESPECT MIL 9POSITIVE SCREENS ALREADY IN ABH 96

POSITIVE SCREENS 226REFERRED TO R.M. 35REFERRED TO ABH. 40REFERRED TO OTHER SOURCE 15

METRICS FOR RESPECT-MIL PRGRAM07 MARCH - 25 APRIL 08

PATIENT VISITS 1395PATIENTS SCREENED 1318POSITIVE SCREENS 226PERCENT SCREENED 94.48%PERCENT POSITIVE 16.20%

POSITIVE SCREENS 226POSITIVE FOR DEPRESSION 95 42.04%POSITIVE FOR PTSD 35 15.49%POSITIVE FOR PTSD&DEPRESSION 96 42.48%FALSE POSITIVE 55 24.34%

PATIENT VISITS PATIENTS SCREENED POSITIVE SCREENS0

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PATIENT VISITS/SCREENING

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POSITIVE DX

RESCPECT-MIL CASE LOAD04 FEB 08 THRU 30 APR 08

TOTAL REFERALS 59

CURRENT ACTIVE CASE LOAD 25CLOSED CASES 30

DEPLOYED INACTIVE CASES 4

TOTAL CASES CLOSED 30

TRANSFER TO SPECIALITY CARE 8ETS 2

SERVICE MEMBER WITHDREW 15

UNABLE TO CONTACT PATIENT 3

OTHER (NONCOMPLIANCE) 2

TOTAL REFERALS CURRENT ACTIVE CASE LOAD

CLOSED CASES DEPLOYED IN-ACTIVE CASES

010203040506070 59

25 30

4

RESPECT-MIL CASE REFERALS

TOTAL CASES CLOSED

TRANSFER TO SPECIALITY CARE

ETS SERVICE MEMBER WITHDREW

UNABLE TO CONTACT PA-

TIENT

OTHER (NON-COMPLIANCE)

0

5

10

15

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25

30

35

30

8

2

15

32

BREAKDOWN OF CLOSED CASES

RESPECT-MIL

Program Standards

• Approach contained in “how to” guides

• Primary care providers undergo 2 hours of training

• Routine primary care PTSD & depression screening

• Positive screens followed by diagnosis & severity assessment

• Immediate care-facilitator assist and accountable, continuous follow-up to remission

• Weekly specialist input/supervision

BACH Performance

• Each provider has copies

• > 95% of PCM have received initial training

• > 95% of all routine visits in Carentan clinic receive screening

• 100% (Avg 14% of screens are positive for depression and/or PTSD)

• 93% of all patients referred to RESPECT- Mil were contacted by RCF

• 97 staffings conducted on 57 patients. Result: 56% had recommended treatment changes

1

Feb 08-April 08

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Suicide Risk Level

Low Intermediate High Total

4136 3996

576199

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Patient Visit Patients Screened Positive Screens Pos Sent toTreatment

Mar - Sep 08

PATIENT VISITS PATIENTS SCREENED POSITIVE SCREENS0

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PATIENT VISITS

POSITIVE SCREENS REFERRED TO R.M. REFERRED TO ABH. REFERRED TO OTHER SOURCE

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POSITIVE REFERRALS

METRICS FOR RESPECT-MIL PROGRAM07 MARCH - 25 APRIL 08

The Army has recorded 115 suicides in 2007, 36 during deployment, 50 previously deployed, 29 never deployed. At Fort Campbell, there have been five confirmed suicides this fiscal year. Army.Mil /News Oct. 2008SPC Carl B. McCoy, 23, a former Fort Campbell soldier who transferred in May from Fort Bragg, N.C., killed himself in July, a day after a scheduled mental health appointment at the hospital was canceled.

September 13, 2008 Nashville Tennessean

Expansion• Redeployments/Prevention• RCM Care Facilitator-Weekly/High

Risk, specific referral requests• F/T Intensive PTSD pilot program Jan

09 –Beverly Sivley, LCSW• Primary Care Champion/BHC

• Coordinated Plan of Introduction• Diagnosis PTSD work group • Buy-in: Turnover- Contractors, Clinic

changes, time issues c/t civilian practice

• Training –Stigma, on post need• Temp RCM position, volunteer and

p/t to 1 F/T RCM coordinator, blend efforts

Questions & Thoughts