Deployment Health Clinic

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VA Puget Sound Health Care System

• Deployment Health Clinic
• Outreach
• Post-Combat Evaluations
• Follow-up Care

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Unique OIF/OEF Veterans TreatedVA Puget Sound
Health Care System
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VA PSHCS Mental Health Services for OIF/OEF
Veterans Organizational Diagram
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Integrated Care for Combat Veterans Common
Barriers to Treatment

• Lack of information on available services
• Perceived/actual problems with access to services
  (dropped cases referred to specialty clinics)
• Stigma against receiving care (mental or
  physical)
• Lack of information on health risks
• Low priority of care compared to getting back to
  normal life

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Deployment Health Clinic Integrated Care for
Combat Veterans

• We recommend a comprehensive post-combat
  evaluation to establish a baseline snapshot of
  how you are functioning now
• Physical exam and mental health evaluation with
  attention to pertinent deployment
  experiences/environmental risks
• Ongoing care to provide necessary treatment and
  monitoring for any emerging combat related
  conditions.
• Education regarding available benefits/sources of
  support for the veteran and his/her family to
  ease transition

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• Deployment Health Clinic

The Deployment Health Clinic is dedicated to the
care of veterans who are experiencing mental or
physical health concerns related to a specific
deployment (Gulf War I, Peace-Keeping
Deployments, OIF/OEF) A philosophy of mind-body
relationships is adopted in which medical and
mental health concerns are presumed to
interrelate
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VA Puget Sound Health Care System Deployment
Health Clinic

• The purpose of the Deployment Health Clinic is
  to
• Provide Outreach and Community Educational
  Services
• Address and support the veteran in all aspects of
  life which have been affected by their combat
  experience.
• Provide that support in an accessible and
  integrated format
• Provide support in an ongoing way for as long as
  it is needed

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VA Puget Sound Health Care System Deployment
Health Clinic
The objective of the Deployment Health Clinic is
to Provide the support necessary for the veteran
and his/her family to readjust, recover and be
optimally functioning in all realms as soon as
possible after return from combat and for the
long term.
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VA Puget Sound Health Care SystemDeployment
Health Clinic

• Staff Members
• Primary Care Physician
• Registered Nurse Practioner
• Clinical Psychologist
• Masters-level mental health counselor
• Psychiatrist

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Integrated Care for Combat Veterans Primary
Treatment Interventions

• Deployment Health Clinic Services
• Integrated mental health and medical post combat
  care
• Preventive/health promotion based care
• Family involvement in care
• Innovative psychiatric medication treatments
  (i.e., prazosin)
• Innovative Cognitive Behavioral Interventions
  (Brief Motivational Interviewing, BA, ACT,
  Mindfulness)
• Referrals to inpatient/outpatient mental health
  services (PTSD, substance abuse, general mental
  health services) or specialty medical clinics
  within the VA Medical System

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VA Puget Sound Health Care System Deployment
Health Clinic
Post-combat care Using the two years of
post-combat priority eligibility proactively as a
period for assessment, monitoring and utilization
of appropriate services directed towards optimal
recovery, rehabilitation and reintegration into
post-combat, non-military life.
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• Mental Health Problems and Clinical Services for
  OIF/OEF Veterans

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Common Post-Deployment Readjustment Reactions

• Problems with finances, employment, and housing
• Preoccupation with news about the war
• Worry about friends still deployed overseas
• Missed excitement of combat with urges to return
• Adjustment to civilian norms
• Altered schedule for sleeping and eating
• Marital conflict and family reintegration
  problems

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Integrated Deployment Clinic Care Presenting
Psychosocial Health Concerns

• Redefined familial roles
• Marital/parenting issues
• Public Social Functioning
• Occupational/financial concerns
• Separation from military social support
• Risk of re-deployment

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Common Mental Health Disorders

• Anxiety disorders
• Adjustment Disorder, Generalized Anxiety, Panic
  Disorders, PTSD (or PTSD-like syndromes)
• Depressive Disorders
• Adjustment Disorder, Dysthymia, Major Depressive
  Disorder
• Substance Misuse, Abuse, and Dependency

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Mental Health Profiles of returning OIF/OEF
Veterans Presenting to the Deployment Health
Clinic (N 128)

• Demographics Mean age was 32.2 years, 95.3 were
  male, 72.2 Caucasian, and 50.8 were married.
• Measures
• The PTSD Checklist Military Version (PCL-M)
  (Weathers, Huska, and Keane, 1991)
• The PRIME-MD Patient Health Questionnaire (PHQ)
  (Spitzer, Kroenke, and Williams, 1999)
• depression (major depressive disorder),
• anxiety (any anxiety disorder except panic
  disorder)
• alcohol misuse (abuse or dependence)
• Barriers to Mental Health Care (Hoge et al., 2004)

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Combat Exposure

• Event (Percentage)
• stationed close to enemy lines (87.0),
• faced an extreme threat to their personal safety
  (86.9)
• received incoming fire from mortars, rockets, or
  artillery (74.2).
• one or more firefight (59.8)
• mines or booby traps (55.2)
• sniper or sapper fire (51.2).
• witnessed an accidental death (31.7)
• took care of someone whos life wasnt saved
  (28.8)
• were responsible for someone elses death (11.2)
• observed the death of a close friend (10.1)

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Rates of Mental Health Disorders
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Rates of Mental Health Disorders (continued)
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Barriers to Receiving Mental Health Care

• The most frequently cited barriers to accessing
  mental health services
• financial (35.4)
• fear of being perceived as weak (30.8)
• fear of being treated differently by unit
  leadership or employers (26.2).

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Deployment Health Clinic Integrated Care for
Combat Veterans

• Question Does routine delivery of mental health
  assessment/ treatment in the primary care setting
  reduce stigma, improve satisfaction with care,
  and/or increase utilization of mental health
  services among soldiers returning from OIF/OEF?