With the official end of the U.S. war in Iraq and the return home of thousands of service members, Vanderbilt researchers are working with the Department of Defense to ensure mental health concerns associated with deployments are not overlooked.
Faculty and staff of Vanderbilt School of Medicine are conducting workshops for military health care providers—funded by the U.S. Army Medical Research and Acquisition Activity—with a goal of improving those providers’ communication with service members so any mental health concerns can be identified earlier and subsequent referrals can be made to address those needs.
Susan Douglas Kelley and Leonard Bickman of Vanderbilt Peabody College received a three-year grant to develop a training program for military and civilian health care providers who screen returning service members for deployment-related health problems. They also targeted a specific point of time for the study: during the Post-Deployment Health Reassessment, or PDHRA, which service members complete 90 to 180 days after returning to the U.S.
The first step is a comprehensive questionnaire, typically completed online, followed by a one-on-one interview with a health care provider by phone, videoconference or in person to review the responses and make referrals when warranted.
“It’s such an important time in the deployment cycle to assess mental health needs,” says 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 later, they’ve had time to experience many issues that are going to come up as they reintegrate 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 communication with patients and staff, to create a workshop that teaches military providers patient-centered communication skills—techniques used to build patient trust and compliance. They have conducted training exercises with providers at three military treatment facilities to teach these skills. The workshops emphasize active discussion and hands-on practice to enhance participant engagement and skill-building.
Webb recognized significant differences between a traditional physician–patient encounter and the PDHRA interview, which is typically 15 minutes or less in length.
“Soldiers generally don’t want to disclose symptoms for fear of the stigma that doing so will make them seem they’re not ready for combat.”
—Lynn Webb, assistant dean, Vanderbilt School of Medicine
“With the average interview so short, relationship-building with the patient becomes even more important. 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,” says Webb, assistant dean for faculty development and assistant professor of medical education and administration.
Kelley, MS’93, PhD’99, 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 evaluation of the PDHRA process completed in 2009 by Kelley and Bickman. Bickman is director of Peabody’s Center for Evaluation and Program Improvement, Betts Chair, and professor of psychology and human development, human and organizational development, and psychiatry.