Life Transitions from Military to Civilians: Modeling Public Policy Implications

1. Life Transitions from Military to Civilians: Modeling Public Policy Implications • Alexander V. Libin, PhD; Manon M. Schladen, Ed, Julie C. Chapman, PhD, Banks Nathaniel,BS, Miriam I. Philmon, BS, Sunil Sen-Gupta, PhD. • Georgetown University; 2. MedStar Health Research Institute; 3. George Washington University; 4. DC VAMC, Washington, DC, USA • Email: Alexander.Libin@MedStar.net Improving the Effectiveness of Public Services APPAM, Moscow, June 28-29, 2011

2. LIFE TRANSITIONS

3. LIFE TRANSITIONS FOR VULNERABLE POPULATIONS:FROM REHABILIATION TO COOMMUNITY INTEGRATIONInterdisciplinary Psychosocial Research Program

4. Based on the course: Objectives

5. PSYCHOLOGICAL HEALTH: A DEFINITION In 2007, the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury was founded as a historical partnership between DoD and the VA. Message from the Secretary "As we mark the 85th year of VA's research program, we celebrate our innovative researchers who helped turn so many hopes into realities. VA's forward-looking contributions to medical research continue to bring life-improving treatments and pharmaceuticals to our Veterans and the nation. We will maintain our steadfast commitment to lead the way as we transform VA into a 21st century organization." Eric K. Shinseki, Secretary, Department of Veterans Affairs

6. COMMUNITY INTEGRATION: A DEFINITION Community-integration oriented rehabilitation focuses not only on reducing typical problems with behavioral disinhibition or initiation (executive function), but also on redeveloping social skills, basic problem-solving, safety awareness, and the abilities required for a specific job (RR&D, March, 2010). VA Centers for Excellency objectives: (4) Social Reintegration and Vocational-Work Rehabilitation. Research in these high priority areas is encouraged in the following domains for veterans with all types of disabilities: (a) Development of appropriate outcome measures to determine the efficacy of interventions with disabled veterans; (b) Development of empirically validated interventions that optimize enduring work participation for disabled veterans; and (c) Maximization of social, economic and personal well-being using appropriate validated outcome measures.

7. LIFE TRANSITIONS: FROM MILITARY TO CIVILIAN

8. The main research and training goals of the proposed District of Columbia Collaborative Network for Community Integration and Psychological Health in Homeless Veterans (COMPASShome) are: • to establish new practices and enhance services related to the timely detection and management of Post-traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) in homeless Veterans • to promote Veterans’ psychological health • to foster Veterans’ reintegration back into the community • The main collaborative mechanism is: • interdisciplinary research and training program which is a network comprised of top-ranked rehabilitation research (National Rehabilitation Hospital, MedStar Health Research Institute, National Institutes of Health) and academic (Georgetown University, Uniformed Services University of the Health Sciences, Catholic University of America) facilities.

9. Standardization • Sampling • Data collection • Data analysis • Diversity of • Impairments • Environments • Accommodation needs/Interventions Survey/Correlational Designs Qualitative/Ethnography Mixed Method Designs Longitudinal/ Repeated Measures Variety of research designs:Standardization vs. Inclusiveness vs. Flexibility Experiment/RCT Synthesis and Translation: A Comparative Effectiveness Research

10. Physiological - pain, agitation, physical discomfort Safety - uncomfortable environmental conditions Love and belonging - need for social contacts Esteem- type of stimulation Self-actualization - level of stimulation Unable to communicate needs Unaware of needs of self Unable to use prior coping mechanisms Unable to obtain the means for meeting the needs Environment does not comprehend the needs Environment does not provide the needs Why Do Unmet Needs Exist? Abnormal conditions Individual needs Libin, Alexander Differential Psychology 5ed, 2009 – 580 pp.

11. TRANSITION OF CARE: FROM HOSPSITAL TO HOME NON-MEDICAL CARE MODEL: Transitional AspectsCoordinating communication between providersFrequent follow-ups with families and discharge plannersMedication remindersTransportationADL assistance

12. Psychosocial and Edutainment Interventions for Patients with Neurologic Trauma Health educators and social networks Individuals with acute & subacute neurologic trauma Clinicians, advocates, and policymakers Health care professionals

13. MONITORING: Computerized Motor Performance Assessment of Executive Dysfunction (COMPASSED) The COMPASSED platform will employ a computerized assessment of executive functioning based on dual cognitive-motor tasks performance in people with neurologic impairments such as Traumatic Brain Injury and Spinal Cord Injury, Stroke, and Parkinson’s disease.

14. Case Studies of eHealth2go Personal Health Record Technology as a Tool for Spinal Cord Injury Health Self-Management • Goals • To explore the general utility and usability of a personal health record (PHR) in meeting the health-related information needs of persons with spinal cord injury (SCI); • To explore information formats and PHR applications that may be of specific use to persons with SCI in: • Obtaining cardiometabolic risk screening; • Self-managing diet for the prevention of obesity and cardiometabolic syndrome; • Self-managing skin health and prevention of pressure ulcers • Methods • Design: Case Study Series • Location: National Rehabilitation Hospital and participants’ homes in the Baltimore/Washington DC metropolitan area. • Participants: 12 ethnically and racially diverse individuals of both genders with SCI representing various levels of education and health literacy • Process • Health Information Needs Assessment • Custom PHR Development • Uses MedStar eHealth2go and Microsoft HealthVault • PHR Use • PHR Evaluation

15. HEALTHCARE NAVIGATOR FRAMEWORK Sensitive adjustment Based on individual profile (preferences, needs, and abilities) Testing module NAVIGATOR Educational module Personal improvement through training of learning processes Communication module Entertainment-at-hands as a form of communication This project is funded by NIDRR grant H133N060028, The National Capital Spinal Cord Injury Model System

16. HEALTHCARE NAVIGATOR FRAMEWORK ADL activities NAVIGATOR Self-monitoring Community Integration This project is funded by NIDRR grant H133N060028, The National Capital Spinal Cord Injury Model System

17. Role-playing Simulation as an Educational Tool for Health CarePersonnel: Developing an Embedded Assessment Framework Mixed methodology pre-post intervention research design Libin A, Lauderdale M, Millo Y, Shamloo C, Spencer R, Green B, Donnellan J, Wellesley C, Groah S. Role-Playing Simulation as an Educational Tool for Health Care Personnel: Developing an Embedded Assessment Framework. Cyberpsychol Behav. and Social Network, 3, 2010 NIDRR grant #H133B031114, the Rehabilitation Research and Training Center on Secondary Conditions

18. CER future developments: The VA Rehabilitation Research “Nor is there one way of knowing, science; there are many such ways...Science itself has conflicting parts with different strategies, results, metaphysical embroideries...(p.143)” Paul Feyerabend, Killing Time (1995) • Building the evidence base is an iterative process involving exploratory and confirmatory steps • Research is context-bound: experimental research conducted in the laboratory produces different types of evidence than field experiments or experiential research • Rehabilitation Research is population-bound Campbell et al., BMJ 2007, 455-459

19. CER future developments: The VA Rehabilitation Research Research Design • Participatory strategies (think about who is “representative”; reflect what “participatory” means) • Mixed method strategies and designs Sampling • Going outside known channels; use wider community outlets • Think “social exclusion” in broader terms

20. CER future developments: The VA Rehabilitation Research • Critical appraisal of what constitutes ‘evidence’ • Facilitating communication between basic, clinical and applied research • Greater public involvement in the research process • Replacing traditional linear models of knowledge translation with iterative and interactive models of knowledge diffusion • Moving from ‘evidence-based’ to ‘evidence-influenced’ understanding of knowledge production • Examination of the contextual, situational and personal factors that determine clinical decision making

21. ACKNOWLEDGEMENTS Supported in part by the Medstar Health Research Institute, a component of the Georgetown-Howard Universities Center for Clinical and Translational Science (GHUCCTS) and supported by Grant U54 RR026076-01 from the NCRR, a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NCRR or NIH. Supported in part by the NIDRR grant #H133B031114, Rehabilitation Research and Training Center on SCI: Promoting Health and Preventing Complications through Exercise, and by NIDRR grant # H133N060028, The National Capital Spinal Cord Injury Model System Collaborators and Sponsors

22. THANK YOU! TO BE CONTINUED….