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As the United States officially ends its war in Iraq and thousands of service members return home this month, researchers at Vanderbilt University are working with the Department of Defense to ensure mental health concerns from deployments are not overlooked.
Funded by the U.S. Army Medical Research and Acquisition Activity, faculty and staff from Vanderbilt’s Peabody College of education and human development and the School of Medicine are conducting workshops for military health care providers with a goal of enhancing provider communication with service members to promote early identification of mental health concerns and subsequent referrals to address those needs.
In a cooperative agreement with Force Health Protection and Readiness, the DoD office responsible for department policies, programs and activities related to deployment medicine, Peabody’s Susan Douglas Kelley and Leonard Bickman received a three-year grant to develop a training program for military and civilian providers who screen returning service members for deployment-related health problems. They targeted a specific point of time after the service members’ return – the Post-Deployment Health Reassessment, or PDHRA – for the study.
Service members complete the PDHRA 90–180 days after redeployment to the U.S. The first step is a new and comprehensive DoD written questionnaire, typically completed online, which is followed by a one-on-one interview with a health care provider by phone, video conference or in person to review the responses and make referrals for further assessment when warranted.
“It’s such an important time in the deployment cycle to assess mental health needs,” said Kelley, senior research associate, deputy director of Peabody’s Center for Evaluation and Program Improvement and the study’s co-primary investigator. “There are so many competing demands when service members first get home. Three to six months after coming home, they’ve had time to experience many issues that are going to come up as they are reintegrating into their lives, and they also might be anticipating a next deployment.”
Kelley collaborated with Vanderbilt School of Medicine’s Lynn Webb, who helps Vanderbilt physicians improve their communication with patients and staff, to create a workshop to teach military providers patient-centered communication skills – techniques used to build patient trust and compliance.
Kelley and Webb conducted training exercises with providers at three U.S. military treatment facilities to teach these skills. They say that incorporating these techniques into the PDHRA interview could enhance the relationship between the provider and service member, thus potentially increasing the likelihood a service member will disclose more information that could lead to a referral for follow-up consultation if needed.
Webb recognized significant differences between a traditional physician-patient encounter and the PDHRA interview, which is typically 15 minutes or less in length.
“With the average interview so short, relationship-building with the patient becomes even more important because you have to do very specific things in a brief interview to enhance the chance that the soldier will feel comfortable divulging something that he or she probably doesn’t want to divulge in the first place,” said Webb, assistant dean for faculty development in the Vanderbilt School of Medicine. “Soldiers generally don’t want to disclose symptoms for fear of the stigma that will make them seem they are not ready for combat, which is unlike typical patients.”
Rather than a typical lecture-based seminar, the workshop emphasizes active discussion and hands-on practice to enhance participant engagement and skill-building. To conclude the workshop, the providers practice the patient-centered communication techniques with standardized patients, which are actors trained to simulate real patients, or in this case, returning soldiers. This simulation was conducted via live video streaming from Vanderbilt’s Center for Experiential Learning and Assessment (CELA).
“If we can increase the sensitivity of the PDHRA interview, over and above the service member’s self-report questionnaire, to pick up on new issues of the service member, that’s our goal,” Kelley said. “[rquote]We want to show that training in patient-centered communication is feasible and can be effective in increasing identification of soldiers with mental health concerns and their subsequent compliance with provider recommendations.”[/rquote]
Cmdr. Nicole Frazer, the Force Health Protection and Readiness liaison for the study, agrees.
“Maintaining and enhancing the psychological health of service members is a top priority of DoD — screening for mental health conditions before and after deployment on a periodic basis is essential for force health protection and readiness and for the well-being of service members,” Frazer said. “We’ve greatly enhanced the mental health components of these assessments and training to administer them in the past year. PDHRAs are completed to identify and assess Post-Traumatic Stress Disorder, depression, suicidality, alcohol use and other mental health conditions, along with any other medical risks and concerns. Improving the likelihood that a service member would disclose any mental health concerns they may have is very beneficial to the psychological health of the service member.”
Kelley and Bickman are leading the evaluation team conducting research on the feasibility and efficacy of the workshop in enhancing soldier disclosure and compliance with referrals. Results will be reported to U.S. Army Medical Research and Acquisition Activity in the fall of 2012.
This study builds on a previous DoD-funded comprehensive evaluation of the PDHRA process completed by Kelley and Bickman, Betts Chair and Professor of Psychology, in 2009.