~ Evidence-Based Treatment of PTSD

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THE WAY AHEAD

• Fund training and certification programs for providers,

integrate requirements into contracts
• Prioritize joint training efforts with DoDNA through DCoE, not
just an Army issue
• Balance standardization with innovation

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l(b)(6) I Slide 11 of 10 7 Aug 08

 Evidence-Based Treatment of PTSD

BACK UP SLIDES

Ilb)(6) Slide 12 of 10 7 Aug 08

 Evidence-Based Treatment of PTSD

INTERVENTION TRACKS AT WBAMC

R&RCENTER
• Agoraphobia/Claustrophobia Reduction
• Cognitive Error Remediation
• Memory Function Rehabilitation
• Emotional/Grief Work
• Sleep Improvement
• Military Reintegration
• Physical Arousal Reduction
• Re-Socialization/Family Reintegration
• Spiritual Healing

l<b)(6) Slide 13 of 10 7 Aug 08

 Evidence-Based Treatment of PTSD

WBAMC R&R CENTER

• Comprehensive residential treatment program

• Uses a milieu/therapeutic community treatment model
incorporating EMDR, CPT, pharmacotherapy, and groups, as
well as complementary/alternative medicine strategies
• IRB protocols, standardized outcome measures
• Only cases severe enough that MEB >300/0 likely, reported
RTD rate of 61 0/0
• Cost-effectiveness based on projected cost per soldier RTD of
$22,950

Il b)(6) Slide 14 of 10 7 Aug 08

 flf~~~ Evidence-Based Treatment of PTSD 1I~11
• i·li,. ~~. ' ~ ";,.-~========.,j~ s .... ..
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~·.~~.'cl.V, PTSD
_ . F~_II~w- U p C
areRate ~ ;;...
-_..- oistrl~~I\B&~lQkQl.e ~l.!~fMt,16"r)Jil§...ing Measure Ad vocate: l(b)(6) I
Diagnosisof PTSO over period 2002-2008 DCoE
14.000 Mo nitoring : Monthly
Data Source : MDR(SADR, SIDR .
~:;
f i '- L.-,_ _--,- --,- ----1 TEDI, TEDN I), DMDC CTS roster
¥ '- Other Reporting : None currently
-t
~ 1--.,-----,-----,-------1 Assessment C r iter ia
..'
. .~ ..' _ tbd

G) tbd
o
2 3 4 5 6-10
Number of Vi sits with Ox of PTSO
11-25 26-50 >50
o tbd

Wh at are we measuring?: This measures the total number of visits recorded for a service member who received a diagnosis of PT SD
after being deployed. If a person received their care in the VA or if the provider did not record that the visit was for PTSD, or if an initial
diagno sis of PTSD chang ed to another diagnosis. the visits would not be captured. so this may be an underestimate of the amount of care
provided.

Why is it im porta nt ?: We want to be sure that everyone with PTSD receives adequate treatm ent. The best available evidence sugg ests
that a person with appropriately diagnosed PTSD should receive 10 psychotherapy visits. If we are identifying PTSD but patients are not
gelling appropriate treatment , then patients could fail to recover and we would not be accomplishing our mission of rehabilitation and
reintegration to the force for people with mental disorders.

Wh at does our perfo rm ance t ell us?: Ther e have been a total of appro ximately 44,000 service members who have been diagnosed with
PTSD following a deplo yment of >30 days since 2002. Of these , less tha n half have documentation of more than 6 visits for PTSD. We w ill
need more data to de termine if this is a true reflection of the care that is actually being provided. The Armed Forces Health Surveillance
Center is now conducting such a study of available data.
Reference: In stitute of Medicine. Treatment of PTSl): All
Asscsa me u t of the Ev id e n ce. '\Vash D C. N 4\t "'c a ll Pn' s!\..
2007.

l(b)(6) Slid e 15 of 10 7 Aug Oil

 Mental Health Specialty
a --
Soldiers with D0279 6 R eferred for Clini c Care ..... ---- --
o R eferred S o ld ie rs R e c ei vi ng Care in C lin ic w ithin 30d of 00279 6
J
o R e fe rre d SOldi e rs R e c e iving Care in C linic with in 30d o f D 02796 and With N o P rio r Rete.rra ts

8 ,000 -r===== =iN:':l======================1 Total 002796

Form s
Comp leted
7 ,000
Tota l Active Arm y 469,5 04

North Atlantic RMC 83,683

Great Plains RMC 150,9 06

Southeas t RMC 82,967

4 ,000
W estern RMC 38,692

3 ,000
Pacific RMC 22,43 0

2 ,000 Europe RMC 59 ,59 9

1 -
1,000
r.::I;;;-,-,-I?J ~
o- ':;~ I~ J'
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I -,-;,---L--'-__
N o rth A tl a n t ic Great P l a in s Sou the a st W e s t e rn RM C Paci f ic RMC Europe RM C
RMC RMC RMC
Notes:
• Perce ntages are based off of total referr al rate per RMC
• Reflects most recent 002796 pe r service member ; each for m may ha ve multiple re ferra ls
• Referral Pattern from Post Deploymen t Health Assessm ent Source: Defens e Medical Surveillance Systern (D MSS)
'~J:1 e FCh 3003 As of 20-June 2008

l(b)(6) Slide 16 of 10 7 Aug 0 8

 Evidence-Based Treatment of PTSD
e- ~ -

Year to Date PDHRA Referrals

Mental Health Specialty
o Total Active Duty Referred. R eferred to Mental Health Specialty &i Encounters at Mental Health Specialty

68,682
70,000
C
- -- ~

"
Army
Active Duly
.. .
_~ - - --. _ .

60,000 1--- -- - - - - - - -- - - -SMwith

completed 213.517
0 02900"
50,000
40,000
30,000 • 33 % of Solders completing DO 2900 forms
were referred for follow up.
• 12 % of all SM's Referred were to Mental
20,000 Health Specialty care
• 65 % of soldiers Referred to Mental Health
8066 Specialty Car e h ave be en seen for
10,000 treatment
• Additional 9,245 Soldiers coded for
o Behavioral Health in a Primary Care with no
encou nter data.
Notes:
• Refle cts most recent 002900 per service member; each form may have multiple referrals
• Refe rral Pattern from Post D eployment Health Re assessment Source: Oelense Medical Surveillance System (OMSS)
(POHRA I 0 0 2900). lromg~wam start oI 10-Ma r-200S As of 05 May 2008
= .
11b)(6 ) Slide 17 of 10 7 Aug 08