Defense Centers of Excellence DCoE

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• Defense Centers of Excellence (DCoE)
• for Psychological Health and
• Traumatic Brain Injury
• Overview Briefing
• CAPT (s) Gail Davis, Ph.D.
• CDR Jerry OToole, Psy.D.
• LCDR Nicole Frazer, Ph.D.
• 4 June 2009

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DCoE Vision and Mission
Vision Lead the nation in resilience, recovery,
and reintegration for warriors and their families
in all areas related to PH and TBI
Mission DCoE assesses, validates, oversees,
identifies, and facilitates prevention,
resilience, screening, treatment, outreach,
rehabilitation, and reintegration programs for PH
and TBI to ensure the Department of Defense meets
the needs of the nations warriors, families, and
military communities
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Overall Context
DCoE Commenced Initial Operations
9/11 Attack GWOT Begins
OIF Insurgency adopts Improvised Explosive
Devices (IED) as main tactic
WRAMC Series in Washington Post
Line of Action 2 formed Red Cell stood up
2002
2004
2005
2006
2007
2001
2003
NDAA Mental Health Task Force Established
OEF Begins
OIF Begins
Senior Oversight Committee Formed
Commissions Recommendations Establishment of
Center of Excellence for PH TBI
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Lines of Action
Disability Evaluation System
LOA1
Traumatic Brain Injury and Psychological Health

• Formed in June of 2007, to develop, coordinate,
  and implement DoD policies, programs and
  oversight in the critical areas of TBI and
  Psychological Health
• Started with PTSD, changed to psychological
  health
• Red Cell consisted of 2 subject matter experts
  from each of the Services, plus 2 VA reps

Case Management
DoD/VA Data Sharing
Facilities
Clean Sheet Review
Legislative and Public Affairs
Personnel, Pay and Financial Support
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DCoE Ramp-up
Timeline for establishment of DCoE for
Psychological Health (PH) and Traumatic Brain
Injury (TBI)

• Sep 2007 Center Director named
• Nov 2007 Center doors opened in Rosslyn
• June 2008 Acting Deputy Director (VA) named
• July 2008 All key leaders onboard and all
  Directorates stand up
• Aug 2008 Split operations began with staff
  co-located in both Rosslyn and Silver Spring
• JAN 2009 VA Deputy confirmed Hiring 2
  additional VA liaisons

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Governance and Authority
DCoE reports to the TMA Director (dual-hatted
as ASD (HA))
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DCoE Headquarters
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Campaign Plan Framework
1.1. Facilitate improved access to PH and TBI
quality care for Warriors, Families and military
communities regardless of Service, Component,
status or geographic location
Objective 1 Maximize opportunities for warriors
and families to thrive in their community of
choice through facilitating practices that
promote PH/TBI resilience, recovery, and
reintegration (R3)
2.4. Lead and assist in developing initiatives,
including standards of care and clinical practice
guidelines, and finding solutions to enhance PH
and TBI programs when evidence based
recommendations do not exist
2.1. Collaborate within the DoD, VA and the
community at large, both nationally and globally,
to provide visible leadership for PH and TBI
programs and initiatives and promote a culture of
support for Warriors and Families
Objective 2 Develop a national collaborative
network, including a telehealth network, which
will coordinate with existing medical, academic,
research, and advocacy assets of the Military
Departments, the Departments of Health and Human
Services, other federal agencies, and academia
2.3. Consult on PH and TBI initiatives related to
prevention, resilience, screening, treatment,
outreach, rehabilitation and reintegration to
ensure the highest quality and promotion of
positive outcomes
2.2. Identify, disseminate, and facilitate the
implementation of standards of care, including PH
and TBI clinical practice guidelines across the
continuum of care
Objective 3 Advance the state of medical science
in those areas of most pressing need and
relevance to today's battlefield experience,
particularly in the area of mental health and
traumatic brain injury
3.1. Sponsor and conduct basic science and
translational research, and facilitate the
acquisition, prioritization, and distribution of
resources to create successful PH and TBI
programs and initiatives to ensure sustainable
excellence
Agility
Proliferation
Synchronization
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LoA2 (PH/TBI Program) Strategic Approach -
Overview
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DCoE Collaborations
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Center of Centers
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Building a Culture of Resilience
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DCoE 1st Year Accomplishments

• Dec 07 Dec 08

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DCoE Executive and Coordinating Staff
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Defense and Veterans Brain Injury Center (DVBIC)
Mission To serve Active Duty military, their
dependents and veterans with traumatic brain
injury through state of the art medical care,
innovative clinical research initiatives, and
educational programs.

• Network of 16 sites
• -10 MTF, 4 VA, 2 civilian
• Develops and provides advanced TBI-specific
  evaluation, treatment and follow-up care for all
  military personnel, their dependents and veterans
  with brain injury
• Conducts clinical research that defines optimal
  care and treatment for individuals with TBI
• Develops and delivers effective educational
  materials for the prevention, treatment of TBI
  and management of its long-term effects

• Clinical Initiative NDAA Clinical Taskers
• DoD Office of Responsibility for TBI Surveillance
• DoD Office of Responsibility for TBI Surveillance
  for Pre-Deployment Cognitive Testing
• Clinicians in theater can consult
  recommendations are made within 4 hrs

• Key Partnerships SAMHSA, DoD, VA

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Center for Deployment Psychology (CDP)
Mission To train military and civilian
psychologists and other mental health
professionals to provide high quality
deployment-related behavioral health services to
military personnel and their Families.

• Offers a two week intensive course covering
• The deployment cycle
• Trauma and Resilience
• Behavioral Health Care of the Seriously Medically
  Injured
• Deployment and Families
• Conducts Continuing Education Seminars throughout
  the Military Health System

• Key Partnerships Service Branches, CSTS,
  American Psychiatric Association, American Red
  Cross, CDC, Department of Defense, Purdue
  University, Military One Source, National Center
  for PTSD, National Military Family Association,
  Office of Military Community and Family Policy

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Deployment Health Clinical Center (DHCC)
Mission To improve deployment-related health by
providing caring assistance and medical advocacy
for military personnel and Families with
deployment-related health concerns.

• Assists military members, veterans and families
  with deployment health concerns or military
  related exposures after deployment
• Assist unit commanders and leaders to mitigate
  deployment health risks and provide
  post-deployment healthcare
• Maintains RESPECT MIL, which enhances recognition
  and treatment of PTSD in the primary care setting

• Key Partnerships Service Branches, Agency for
  Healthcare Research and Quality, American Academy
  of Family Physicians, American Medical
  Association, CDC, DoD, DoS, DHS, HHS, VA, Emory
  University, RAND, SAMHSA, University of Iowa,
  University of Texas, National Library of
  Medicine, WHO, National Center for PTSD

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Center for the Study of Traumatic Stress (CSTS)
Mission To provide knowledge, leadership, and
applications for preparing for, responding to,
and recovering from the consequences of disaster
and trauma.

• Key Partnerships USUHS, VA, CDC, NIH, and NCPTSD

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National Intrepid Center of Excellence (NICoE)
Mission To steadfastly advance evidence based
practices in the assessment, diagnosis, research,
treatment planning, education, and long term
follow-up for those Warriors who have sustained
TBI, PTSDs, or other psychological injuries as
they served and sacrificed in the service of our
nation.

• Key Partnerships Fisher House Foundation, DoD,
  VA, NIH, U.S. Medicine Information Central, USUHS

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Telehealth Technology (T2)
Mission To advance world class care through
innovation. The T2 Center is a coordinating body
that works with external partners and other
stakeholders such as the VA and civilian
organizations working to apply technology to the
areas of PH and TBI.

• Key Partnerships VA, Services, CDC, AMEDD,
  Academia

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Recent Accomplishments

• Commenced Initial DCoE operations in NOV 2007
• Held NICoE Groundbreaking ceremony in JUN 2008
  construction underway
• Established Strategic Advisory Board with Service
  Vice Chiefs
• Led Common Data Elements Workshop
• Developed multiple innovative web-based 2.0 and
  3.0 tools, e.g., afterdeployment.org
• Partnered with WETA to develop brainline, an
  on-line source focused on brain health
• Collaborated with DoL and VA on Americas Heroes
  at Work Campaign
• Co-chaired Federal Partners Priority Work Group
  on Returning Service Members and Their Families
• Revised / developed mTBI clinical practice
  guidelines with VA currently revising VA/DoD
  PTSD guidelines and Post Deployment guidelines
• Cosponsored / hosted multiple strategic,
  scientific and educational conferences (Trauma
  Spectrum Disorders, Suicide Prevention, Warrior
  Resilience, Paving the Way Home, TBI Care)
• Launched 24/7 Outreach Call Center (866-966-1020)
• Facilitated Sesame Workshop Partnership Talk,
  Listen Connect reaching several hundred
  thousand military families
• Initiated Real Warriors public health awareness
  campaign
• Sponsored monthly global VTCs and DCoE Newsletter
  with national and international reach

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Real Warriors Campaign

• Real Warriors ? Real Battles ? Real Strength, a
  national outreach, public information campaign
  that emphasizes
• Resilience (bouncing back, prevention)
• Recovery (access to and positive response to care
  and support)
• Reintegration (re-establish sense of belonging)
• Goals dispel stigma normalize psychological
  health build a culture of psychological
  responsibility support for resilience, recovery
  reintegration across systems

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24/7 Outreach Support to Services

• DCoE Outreach Center able to connect the right
  resource to the right person at the right time
  for Services, components and locations
• DCoE Outreach Center Health Resource Consultants
  (HRCs) receive training on Service specific
  culture and customs
• Masters level coaching and support in the
  following areas
• Resilience programs
• Suicide prevention initiatives
• Family and relationship support
• Alcohol/substance use programs
• Psychological Health (PH) / Traumatic Brain
  Injury (TBI) programs
• Healthcare system navigation
• Resourced to assist National Guard, Reserve
  members and others with relevant information,
  tools, and resources
• Many HRCs have prior military experience or are
  military family members and draw on their
  experiences, along with their training, to best
  address Service specific issues

DCoE Outreach Center 866-966-1020
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DCoE Ongoing Initiatives
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Resilience and Prevention Initiatives

• Resilience and Prevention Directorate
• Suicide Prevention Conference in Jan 2009 next
  conference Jan 2010
• PH Clinical Standards of Care Directorate
• Identifying and disseminating prevention-oriented
  clinical guidelines and best practices
• TBI Clinical Standards of Care Directorate
• Developing guidelines for pre-deployment
  cognitive assessments
• Research Directorate
• Providing funds for prevention activities. Will
  also evaluate these activities.

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Access to Care Initiatives

• National Intrepid Center of Excellence
• Will provide world class consultation and care
  for complicated cases involving PH/TBI
  co-morbidity
• Will have expertise in mental health, neurology,
  social work, audiology, radiology, and primary
  care
• Deployment Health Clinical Centers
• Provides intensive two week program for patients
  with PTSD
• Coordinates RESPECT-MIL program provides
  immediate support to primary care clinics for
  mental health issues
• Tele-health
• Provides support to providers in remote areas
  concerning TBI and PH issues through use of an
  expanding technological network
• Automated Behavioral Healthcare Clinic Kiosk
  based assessment program placed at clinics
  throughout the country that are reviewed by
  providers as appropriate
• Defense and Veterans Brain Injury Center
• Network physicians and nurses provide routine
  screenings, evaluations, and treatment for
  research subjects

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Quality Initiatives

• PH Clinical Standards of Care Directorate
• Teams available for consultation and assistance
  to local MTFs per their request
• Can provide expertise in the areas of clinical
  care, clinic administration, and provider
  support.
• Will provide follow-up for site visits and
  on-going support via phone based services
• Working in partnership (DoD/VA) to update,
  develop and disseminate clinical practice
  guidelines to ensure consistent levels of quality
  care
• Beginning work towards development of DCoEs Best
  Practice Clearinghouse
• TBI Clinical Standards of Care Directorate
• Teams available for consultation and assistance
  to local MTFs per their request
• Can provide expertise in the areas of clinical
  care, clinic administration, and provider support
• Will Provide follow up for site visits and
  on-going support via phone based services
• Working in partnership (DoD/VA) to update,
  develop and disseminate clinical practice
  guidelines to ensure consistent levels of quality
  care

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Tele-Health and Technology (T2) Initiatives

• Afterdeployment.org Website
• A mental wellness resource for Service Members,
  Veterans and Military Families
• www.afterdeployment.org
• Sesame Workshop Videos
• Talk, Listen, Connect (TLC) Deployments,
  Homecomings, Changes
• www.sesameworkshop.org/tlc
• Virtual Reality (VR)/Advanced Technology Tools
• Mobile units travel to remote sites that do not
  have VR and train providers on the techniques to
  ensure proper, and wide use of this emerging and
  promising practice
• Creative development of a full range of new media
  applications and tools folks can use

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Training Initiatives

• Training and Education Directorate
• Developing and/or recommending guidelines/standard
  s for training of PH and TBI topics
• Center for Deployment Psychology
• Mobile training teams to travel to local levels
  to train any provider on PTSD and other aspects
  of deployment
• Intensive centralized training courses for mental
  health providers
• Deployment Health Clinical Center
• Intensive training for primary care providers on
  psychological health and the effects of
  Deployment
• Defense and Veterans Brain Injury Center
• Routine training conferences for as many as 800
  at a time on TBI awareness, prevention, and
  treatment
• Center for the Study of Traumatic Stress
• Post Doctoral training for research and program
  management in military mental health

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Research Surveillance Initiatives

• Defense and Veterans Brain Injury Center (DVBIC)
• TBI Registry At 7 lead DVBIC network sites.
  Only current ongoing registry for military/DVA
  TBI patients
• 15 Year study of long term effects of TBI
  incurred in OEF/OIF
• Head-to-Head Study to provide comparable
  psychometric data on 5 computerized cognitive
  test batteries
• Helmet Sensor Study to investigate a gold
  standard measure for TBI
• Research Directorate
• 45 Million RDTE funds
• Funding for proposals in the areas of
  Treatment/Intervention, Prevention,
  Screening/Diagnosis, Epidemiology, Family Care
  Givers, Neurobiology/Genetics, and Complimentary
  Alternative Medical Therapies
• Center for the Study of Traumatic Stress (CSTS)
• PTSD Brain Study
• Social epidemiology and risk models of trauma
  exposure
• NICOE
• Focus on emerging science especially as it
  relates to co-morbidity of PH issues and TBI

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Transition Initiatives

• TBI Directorate and DVBIC
• Developing Family Caregivers Guide for family
  members caring for Wounded, Ill and Injured
  Service Members
• Outreach and Advocacy Directorate
• Partnering with NGOs, Veterans Groups, and
  Federal Partners to improve transitions in care
• PH Clinical Standards of Care Directorate
• Developing toolkit for building community
  partnerships (estimated release date Sept 2009)

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Outreach Initiatives

• Outreach Center
• A 24/7 venue for service members to access
  comprehensive resources for PH/TBI
• To coordinate closely with national and global
  network
• PH/TBI Toolkits to Support Military Families
• Partnering with Services, NGOs and Federal
  Partners to develop audience-specific toolkits to
  support the PH/TBI needs of military families
  (release date Sept 09)

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Next Steps

• Accelerate implementation of evidence-based
  studies, tools and programs
• Rapid phasing for Real Warriors / Strategic
  communication campaign launch date May 2009
• Finalize DCoE authority, governance, roles and
  responsibilities to assure effective strategy
  execution
• Prepare for initiating NICoE operations

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DCoE Way AheadJan Dec 09
24 / 7 call center goes live
Conduct Simulation Exercise / Megacommunity
event Future care for Current Warriors
Resilience curriculum incorporated into Service
schools
Convene Psychological Health Council
Broaden provider training in evidence based care
from PTSD to other PH concerns
Complete review of policies/directives to
identify those which could contribute to stigma
Develop universal post-deployment PH screening
pilot proposal
Release Sesame Workshop DVD on Death and Loss
Establish DCoE Board of Governors
Implement effective provider-wellness program
Host DCoE Global VTC Provider Training
Education Programs
Market and Distribute PH/TBI Toolkits to Support
Military Veteran Families
Coordinate with RAND on study of Resilience-Based
Programs
Participate in VA consensus conference on PTSD /
TBI co-morbidity
Market and Distribute a set of practical /
relevant tools for Line Leaders
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Key DCoE Information

• DCoE Outreach Center
• 1-866-966-1020
• www.Resources_at_DCoEOutreach.org
• DCoE Website
• www.dcoe.health.mil
• DCoE Silver Spring HQ Office
• 301-295-3257

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QUESTIONS?

• Contact information
• Gail.davis_at_tma.osd.mil
• Jerry.otoole_at_tma.osd.mil
• Nicole.frazer_at_tma.osd.mil
• 301-295-3257

www.dcoe.health.mil
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