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Military Behavioral Health Services

Military Behavioral Health Services. Alan Ogle, Maj, USAF, BSC Military Psychology PSY4990 University of West Florida, Spring 09.

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Military Behavioral Health Services

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  1. Military Behavioral Health Services Alan Ogle, Maj, USAF, BSC Military Psychology PSY4990 University of West Florida, Spring 09

  2. Disclaimer: information in this briefing was compiled from multiple sources in the US military medical services. Many have been modified or shortened to fit the educational purpose, format and training time available. Views expressed are those of the author and do not reflect the official policy or position of the United States Air Force, Department of Defense, or the U.S. Government.

  3. Why We Do What We Do

  4. Air Force Psychologists • 42P Career Field • Clinical Psychologist (AFI 44-119) • 204 Active duty • 9 Fellowships • 22 Residents • Current approx 70% manned

  5. Postdoctoral Fellowships • Child Psychology • Neuropsychology • Clinical Health Psychology • Forensic • Combat/Aviation Psychology • Psychopharmacology

  6. Scope of Practice • Clinical interviews and psychological assessment • Diagnose and treat mental disorders • Provide individual, marital, and group treatment • Recommend administrative and medical dispositions • Perform dangerousness assessments • Determine degree of impairment for military service • Serve on competency and sanity boards • Commander’s consultant on behavioral health issues

  7. Behavioral Health Services 7

  8. MENTAL HEALTH CLINIC: Voluntary Care Talk therapy: individual, marital, families Education classes: stress, anger, couples communication, seasonal “blues”, healthy alcohol use, suicide/violence prevention, others upon request Special evaluations: Command Directed, security clearance, fitness for special duty Confidentiality and limitations Risk of harm to self/others UCMJ Fitness for duty

  9. Patient Issues • Depressed Mood • Anxiety • Stress • Work or Life Events • Relationships • Parenting Concerns • Adjustment • Grief • Deployment-related issues

  10. ALCOHOL AND DRUG ABUSE PREVENTION AND TREATMENT (ADAPT Program ) • Promote readiness, health and wellness through prevention and treatment of substance abuse • Minimize negative consequences of substance abuse to individual, family, and organization • Provide education and treatment for individuals with substance abuse problems • Return patients to unrestricted duty status or assist them in transition to civilian life

  11. Substance Misuse: A Clear and Present Danger • AF average of ~ 5300 Alcohol Related Incidents/Year (e.g. DUI/DWI & underage drinking) • Alcohol misuse is involved in: • 33% of suicides • 57% sexual assaults • 28.5% domestic violence cases • 20-25% PMV accidents • “Alcoholism” should not be our sole focus! Substance misuse directly impacts mission effectiveness… PREVENTION + DETECTION + TREATMENT = SUCCESS

  12. ADAPT SERVICES: EVALUATION AND EDUCATION All Referrals Receive: Initial diagnostic evaluations 6-hour Substance Abuse Awareness Seminar (SAAS) Alcohol Brief Counseling, pilot testing at 15 bases 85+% success = No further ARM Education Topics - Military and civilian standards -Hazards of binge drinking - Individual responsibilities -Family Dynamics of substance abuse - Legal/administrative consequences -DUI/DWI education - Facts and statistics about alcohol -Drug abuse education - Physical and psychological effects -Values clarification - Impact on self, others, and community -Healthy stress management - Biopsychosocial Model of addiction -Decision-making and goal setting skills

  13. ADAPT Services: Treatment Patients with substance use disorder receive treatment Alcohol Abuse / Alcohol Dependence Treatment options: Outpatient, Intensive Outpatient, Partial or Full Hospitalization Programs as clinically indicated Family and unit involvement Duration ~4 - 24 months Successful completion of treatment is condition for continued employment “Treatment failure” AF rate = ~2%

  14. Behavioral Health in Primary Care • Act as consultant and member of Primary Care team • Support PCM decision making and build on PCM interventions • 1-3 brief (~20-30 min) patient consultation sessions: • Educate patient in self management skills • Improve provider-patient working relationship • Effective triage of patients in need of specialty behavioral health • Avoid MH stigma—not therapy, no mental health records

  15. General Mental Health Problems Clinical Health Problems Stress Insomnia, Headache Anxiety/Fears Chronic Pain Depression GI Problems (reflux, IBS) Anger COPD, Diabetes, ETOH use Relationship Problems Chronic Illness Management Grief or Bereavement Tobacco Use, Exercise, Diet Medication Adherence Typical Areas of Consultation

  16. Family Advocacy Program

  17. Family Advocacy Program OPR for the prevention and treatment of domestic violence Works to reduce the number and severity of family maltreatment incidents Prevent where possible…treat where needed All DoD personnel are mandatory reporters of domestic violence Assess and intervene: physical abuse, emotional abuse, neglect of spouse or child Promotes alliance between leadership, agencies and community to: Facilitate an atmosphere of nonviolence in work and home Encourage member and family asset and skill development Enhance victim safety Build member and family strengths Services provided through Outreach Prevention Program; New Parent Support Program; Treatment Intervention

  18. Drug Demand Reduction Program • All military members are subject to drug testing regardless of rank or status • Random selection • Maintain chain of custody • DDR supports administrative/UCMJ actions • All Active Duty Service Members Drug Positives FY03 % personnel with positive drug test(s) DoD Air Force Army Navy Marines 1.26% 0.41% 1.76% 1.21% 1.26%

  19. Community Education: Red Ribbon Campaign 2006“Stand Up and Be Counted!” • Displays at the BX, Commissary, Community Center, Youth Center, Post Office, Medical Clinic, and Library • OCTOBER 25,  WEDNESDAY • PUPPET SHOW--Kindergarten, grade 1, 2 and 3 • 08:40 -- 9:15 --Mrs.  Mailloux, Mrs. Lerner, Mrs.  Edwards, Ms. Beavers • 9:30 -- 10:00 -- Mrs. Becker, Mr. Becker, Ms. Glass, Mrs. Weiland • DISCUSSION/Question/Answer time Grade 4 and Grade 4/5 • 11:00 - 11:30 -- Dr. Westbrook and Ms. Sullivan • 11:30-1230 High school • 12:30-1:30 staffed table at high school • OCTOBER 27 FRIDAY • DISCUSSION/Question/Answer time Grades 5/6 • 9:15 -- 9:45 -- Ms. Henderson & Mrs. McVay • 10:00 -- 10:30 --Mrs. Wilson • 11:30-12:30 Middle School • 12:30-1:30 staffed table at middle school Tribase United Against Drugs & Alcohol Abuse

  20. Traumatic Stress Response Team Pre-Exposure Training Demobilizations Command Consultation Debriefings Pre-Incident During Operations Post-Incident Defusings On-Scene Support • Team of Mental Health, Chapel, and AFRC personnel • Provide support to units and community after traumatic events

  21. Command Consultation • Mental Health Issues • Suicide Prevention • Violence Prevention • Family Maltreatment Prevention • Hostage Negotiation Team Consultant • Community Issues

  22. Alcohol Prevention SME BASE LEVEL COMMUNITY LEVEL • Awareness • Education • Prevention • Intervention • Alternatives • Collaboration • Responsible • Alcohol • Service • Disciplinary • Control • Board INDIVIDUAL LEVEL • Education • Discipline • Pre-Screening • Treatment LEADERSHIP CULTURE OF RESPONSIBILITY

  23. Community Surveys

  24. Survey Results Example—Community Needs Assessment Top Community Concerns—issues in red targeted for intervention: • #1 Transportation when arrive (90 people) • #2 Long work hours (71) • #3 Finding housing (68) • #4 Sense of Community (67) • #5 Fitness facilities for parents with young children (60) • #6 Lack of childcare (59) • #7 Sponsorship program (56) • #8 Deployments (41) • #9 Heavy drinking (36) • #9 Marital problems (36) • #10 English culture (35) • #11 Financial management (30) • #12 Working in Joint environment (29) • #13 Fighting (23) • #13 Parenting Skills (23) • #14 New parents support (13) Items not CCAP targets referred to applicable agency

  25. Community Action Plan Progress Check Sponsorship training includes need for transportation Housing staff member assigned to provide transportation to find housing Develop directory of local area info POCs Develop UK adjustment seminar Educate community regarding current services for couples, parents, and families SMART Marriages will be offered at least once per year, funding permissible Mental health/family therapy services will be made available on RAF Alconbury SVS will train 2 home childcare providers Community Capacity Action Plan RAF Alconbury / Molesworth / Upwood, UK SVS will educate base on childcare options

  26. Deployments • Mental Health Rapid Response Team • Combat Operational Stress Control (COSC) • Behavioral Science Consultation Team (BSCT) • SOF Psych • 6 months duration • Currently Air Force has 17 mental health deployment missions (12 are Joint Expeditionary Taskings, i.e. for the Army)

  27. Resource Links • Defense Center of Excellence for Psychological Health and Traumatic Brain Injury • Army Behavioral Health page/ • Navy mental health information page • Deployment Medicine Research • PDHealth--Deployment/Postdeployment Health • http://www.afterdeployment.org/ • Deployment Health Clinicians Center • Air Force Suicide Prevention Program

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