Clinical Military Psychologists

1. Clinical Military Psychologists Jan 18 Ch 5,6

2. Disclaimer Information and opinions expressed by Maj Dhillon and other military/government employees providing lectures are not intended/should not be taken as representing the policies and views of the Department of Defense, its component services, or the US Government.

3. Overview • Clinical Psychologists • Pediatric Psychologists • Forensic Psychologists • Prescribing Psychologists • Behavioral Health Consultants • Clinical Health Psychologists • Neuropsychologists • Military Mental Health Technicians

4. Clinical Psychologists • Doctoral Level • American Psychological Association (APA) accredited program • Pathway: • APA internship • Direct accession • Retention bonus • Board Certification Bonus • Licensed in any state • Must be able to do any job, anywhere, with anyone

5. Pediatric Psychologists • Same as clinical but completed post doctoral fellowship in child psychology • Specifier on job code designating specialty • Highly sought for overseas assignments and stateside big military medical facilities

6. Forensic Psychologists • Same as clinical but completed post doctoral fellowship in forensic psychology • Fellowship can include working with criminal investigation arm of their service • Testify as expert witness in UCMJ cases • Mental status during criminal act, capacity to understand and participate in proceedings, opinion on insanity defense, etc. • Conduct evaluations for UCMJ cases • Job code specifier after training

7. Prescribing Psychologists • Same as clinical but obtained M.S. in psychopharmacology and supervised prescribing hours before certification • Specifier on job code • Born from operational necessity due to critical shortage of psychiatrists and psychiatric nurse practitioners

8. Behavioral Health Consultants • Any Mental Health provider except psychiatry • 4 weeks of training • Located within primary care clinic • Consult with primary care managers (PCMs) on patient cases involving behavioral component such as: • Weight management, Smoking cessation, Prescription adherence, Chronic Pain Management, sleep problems… • 50% of formal mental health care conducted in primary care • 15-30 min appointments, behavior and functioning focused, patient belongs to PCM, BHC gives feedback on consultation to PCM

9. Clinical Health Psychologists • “applies scientific knowledge of the interrelationships among behavioral, emotional, cognitive, social and biological components in health and disease to the promotion and maintenance of health; the prevention, treatment, and rehabilitation of illness and disability, and the improvement of the health care system.

10. Clinical Health Psychologists • Specifically focus on physical health conditions where behavioral factors play a primary or secondary role • Population Health Management • Survey health of population, provide preventative care and interventions, disease management and outcome measurement • Primary prevention: prevent onset of a condition • Secondary prevention: identify those at risk • Tertiary prevention: treat symptomatic patients

11. Clinical Health Psychologists Post doctoral fellowship training 1-2 years Job code identifier Primarily assigned to big military medical facilities AF is a major post doc fellowship training site Biofeedback certification Provide: Tobacco cessation, weight management, chronic pain management, insomnia management, • assessment/management of chronic disease and illness • Health maintenance via prevention • Evaluate intervention effectiveness • Interdisciplinary collaboration • Disease management team development • Develop a population health approach • Conduct applied clinical research

12. Neuropsychologists • 2 year post doc fellowship • Focused on brain-behavior relationships • Evaluate members of their service based on the regulations for that service • Army and AF have different regulations when it comes to aviators and medication • Job code specifier • Most frequently placed in larger military medical facilities

13. Neuropsychologists • Differs from civilian neuropsychology • Readily available baseline assessment data for most mil members • ASVAB • AFOQT • Service member records • Neuropsych measures developed for specific military populations (i.e., Armstrong Laboratory Aviator Personality Survey)

14. Neuropsychologists • Fitness for Duty Evaluations • Assess type, level, an prognosis of neurological impairment • Traumatic Brain Injury • Mil mbrs at high risk due to training, environment, and combat • Cognitive, emotional, behavioral, physical deficits • Significantly impact knowledge, skills, and abilities required of technical jobs in military • In combat concussive blasts more common than penetrating ones and cause cerebral damage but are more difficult to identify

15. Neuropsychologists • Medevac process from theater to Continental US (CONUS): • Injury on battlefield • Self Aid and Buddy Care on battlefield • Rapid medical response by medical technicians • Battlefield hospital care stabilizes member • Aerovac to Landstuhl Regional Medical Center in Germany for further care • Transfer to CONUS military/VA medical center • Defense Veterans Brain Injury Center (DVBIC) for specific treatment and rehabilitation for TBI

16. Neuropsychologists • Attention Deficit Hyperactivity Disorder & Learning Disorders • No entry to military service w/history of ADHD, unsatisfactory academic performance and /or current NEED for medication • If diagnosis made after member is in military, retention in service possible only if symptoms do not interfere with ability to do job • Accommodations are not possible in military environment • Inability to perform results in an administrative discharge as opposed to a medical discharge

17. Neuropsychology • Military Aerospace Neuropsychology • Branch of clinical neuropsych managing assessment, selection, and disposition of military and NASA members on flying status • Integrates clinical-, aviation-, and neuro-psych • 90% of air mishaps are due to human factors • Must assess and integrate interplay of cognitive, information processing, sleep/fatigue, stress, ergonomics, toxicity, personality factors on flying

18. Neuropsychology • AF School of Aerospace Medicine inaugurated by President Kennedy the day before his assassination at Brooks AFB in San Antonio now moved to Wright Patterson AFB, OH • Also address issues like airsickness, gravity loss of consciousness, hypoxia, mishap investigation, human factors research, stress reactions to flying, motivation to fly, air traffic control, reverse malingerers

19. Neuropsychology • Multidimensional Aptitude Battery (MAB-II) • Different norms for pilots, (look at drop in performance as opposed to impairment defined by regular norms on measures like IQ) • FS IQ=120.8, SD=8.2, • Impaired performance is 2 SDs below mean • Avg IQ is actually an impairment for pilots

20. Neuropsychologists • MicroCog-Generalizes well to common neuropsychconditions • Reaction Time and Information Processing Speeds are especially important in assessing high performance aircraft pilots • Armstrong Laboratory Aviator Personality Survey • Produced and standardized by AF gives profile of flyers in Personality, Psychopathology, and Crew Interaction domains

21. Neuropsychologists • NEO PI-R Personality measure on 5 factors • Neuroticism (low), Extraversion (high), Openness (middle), Agreeableness (low), and Conscientiousness (high) • Critical components of aviator neuropsych assessment: speed/accuracy; attention/ concentration; vigilance; memory; working memory; auditory, spatial, and kinesthetic processing; new learning; multi-tasking; cognitive flexibility, problem solving

22. Neuropsychologists • Aviator profiles • The Right Stuff—fighter pilot: aggressive, dominant, exhibitionistic, impulsive, playful • The Company Man—transport pilot: high achievement, endurance, affiliation, and orderliness • The Wrong Stuff—low exhibition, understanding, affiliation, and orderliness • High somatization due to high defensiveness and denial of psychological problems • Most pilots are RTD due to high resiliency and achievement orientation

23. AF Mental Health Techs • Per AFMAN 36-2108, 4Cs are supposed to be able to: Support MH svcs in psychiatry, psychology, social work, FAP, ADAPT, & MHC. • Assist pro-staff w DEVELOPING & IMPLEMENTING tx plans. • PERFORMS specified MH tx. • REPORTS & DOCUMENTS pt care.

24. Military Mental Health Techs • Conduct/assist in individual & group tx. • Perform initial, basic, & standard psych assessment, clinical interviewing, MSEs • Assist in: dx, tx, pteducation, & disposition planning. • Observe, monitor, record, & report ptprogress. • Assist in or arrange ptreferral to public, private or mil community agencies.

25. Military Mental Health Techs • Training • Tech School--MH Apprentice: • 3 mos training DSM-IV-TR diagnostic criteria • How to do an intake interview • Operations of MH elements • EXPERIENCE to obtain--MH Journeyman: • Administering, scoring & reporting psych testing; • Interviewing pts for biopsychosocialhx& personal info; • ASSISTING pro staff to carry out prescribed tx plan • EXPERIENCE to obtain--MH Craftsman: • Conducting briefings. • Performing or supervising Psych assessment. • Interviewing pts and assisting in tx or substance abuse prevention & counseling