PTSD: Pathways Through the Secret Door: Army Care for Mental Disorders Improves with Primary Care Involvement

By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on June 7, 2012

A proactive U.S. Army program uses technology and primary care to improve detection and treatment of depression and post-traumatic stress disorder (PTSD) among American soldiers.

The innovative initiative, termed RESPECT-Mil, involves behavioral health screening during all primary care visits. This approach currently works out to more than 100,000 screenings a month with rates expected to climb as providers become accustomed to the new strategy. A key component of the program includes care coordinators' use of a secure, web-based care management platform for following patients called FIRST-STEPS.

In the new software, care coordinators enter assessments and schedule appointments, while behavioral health providers use it to review case loads. The most acute cases receive immediate attention. The system also automatically flags patient records that don't show clinically significant improvement after eight weeks for review so providers may adjust treatment plans in a timely way, consistent with treatment guidelines.

The new inititaive levers technology to provide primary care clinicians web-based training on how to diagnose and treat PTSD and depression.

"Making behavioral health screening as standard as a blood pressure check helps defuse any perceived stigma around seeking help for symptoms of PTSD or depression," said Col. Charles Engel, M.D., M.P.H.

"Early intervention ensures soldiers get effective help sooner while reducing the use of clinical services for related symptoms like back pain or accidents and emergency room visits from hazardous drinking."

Since 2007, about 63,000 soldiers – accounting for 3 percent of all primary care visits – have been diagnosed with a previously unrecognized behavioral health need and received treatment. So far, results have been positive.

Researchers say that a review of cases between August 2009 and December 2010 showed that PTSD remissions overall have doubled over time, meaning that twice as many patients (starting at less than 10 percent and rising to more than 20 percent) experienced a clinically significant reduction in self-assessed PTSD symptoms.

Likewise, RESPECT-Mil data shows that as the number of contacts a care coordinator has with a patient rises, the PTSD and depression severity scores trend downwards in a clinically significant way – regardless of treatment method.

RESPECT-Mil has been rolled out in 88 of the Army's 96 targeted primary care clinics worldwide, with the remainder expected to be online by July. Approximately 100,000 behavioral health screenings now take place in these clinics each month – a rate expected to continue rising as clinics and providers gain experience.

Participating clinics follow a three-component model, with a care coordination manager ensuring continuity of care for the patient and ongoing communication between the primary care provider and a behavioral health specialist. The care coordinator follows up with patients at regular intervals, raising any patient concerns with their providers and ensuring patients follow their treatment plans.

"RESPECT-Mil has improved our clinic's efficiency in diagnosing and treating Soldiers with behavioral health concerns," said Melissa Molina, M.D., a family practice physician at Fort Bliss in El Paso, Texas. "We've had a significant reduction in the severity of symptoms of PTSD and depression in our patients. Because most Soldiers screen negative, 90 percent of clinic visits require no added provider time. But in cases where a Soldier does need attention, RESPECT-Mil gives us a proven, effective process to follow."

The Army will refine the RESPECT-Mil program to continue improvements in patient outcomes.

New enhancements will include telehealth augmented cognitive-behavioral therapy and a stepped approach of psychosocial modalities. Also under development is a five-year, randomized controlled trial in 18 clinics comparing the current approach to a modified approach that Col. Engel's RESPECT-Mil team hopes will offer even greater benefits for patients in need.

Currently the Army plans to make the program available to all military health system beneficiaries (including families) as care is transitioned to a concept known as Patient Centered Medical Homes.

Source: Weber Shandwick Worldwide