Transcript Life Transitions from Military to Civilians Modeling Public Policy

Life Transitions from Military to Civilians:
Modeling Public Policy Implications
Alexander V. Libin, PhD; Manon M. Schladen, Ed, Julie C. Chapman, PhD,
Banks Nathaniel,BS, Miriam I. Philmon, BS, Sunil Sen-Gupta, PhD.
1. Georgetown University; 2. MedStar Health Research Institute; 3. George
Washington University; 4. DC VAMC, Washington, DC, USA
Email: [email protected]
Improving the Effectiveness of Public Services
APPAM, Moscow, June 28-29, 2011
LIFE TRANSITIONS
LIFE TRANSITIONS FOR VULNERABLE POPULATIONS:
FROM REHABILIATION TO COOMMUNITY INTEGRATION
Interdisciplinary Psychosocial Research Program
Objectives
Based on the course:
PSYCHOLOGICAL HEALTH: A DEFINITION
In 2007, the
Defense Centers of
Excellence for
Psychological
Health and
Traumatic Brain
Injury was founded
as a historical
partnership
between
DoD and the VA.
Message from the Secretary
"As we mark the 85th year of VA's research program, we celebrate our innovative
researchers who helped turn so many hopes into realities. VA's forward-looking
contributions to medical research continue to bring life-improving treatments and
pharmaceuticals to our Veterans and the nation. We will maintain our steadfast
commitment to lead the way as we transform VA into a 21st century organization."
Eric K. Shinseki, Secretary, Department of Veterans Affairs
COMMUNITY INTEGRATION: A DEFINITION
Community-integration oriented rehabilitation focuses not only on reducing typical
problems with behavioral disinhibition or initiation (executive function), but also on
redeveloping social skills, basic problem-solving, safety awareness, and the abilities
required for a specific job (RR&D, March, 2010).
VA Centers for Excellency objectives:
(4) Social Reintegration and Vocational-Work Rehabilitation. Research in these high priority areas is encouraged
in the following domains for veterans with all types of disabilities:
(a) Development of appropriate outcome measures to determine the efficacy of interventions with disabled
veterans;
(b) Development of empirically validated interventions that optimize enduring work participation for disabled
veterans; and
(c) Maximization of social, economic and personal well-being using appropriate validated outcome measures.
LIFE TRANSITIONS: FROM MILITARY TO CIVILIAN
The main research and training goals of the
proposed District of Columbia Collaborative
Network for Community Integration and
Psychological Health in Homeless Veterans
(COMPASShome) are:
to establish new practices and enhance
services related to the timely detection and
management of Post-traumatic Stress Disorder
(PTSD) and Traumatic Brain Injury (TBI) in
homeless Veterans
 to promote Veterans’ psychological health
 to foster Veterans’ reintegration back into the
community
The main collaborative mechanism is:
interdisciplinary research and training program
which is a network comprised of top-ranked
rehabilitation research (National Rehabilitation
Hospital, MedStar Health Research Institute,
National Institutes of Health) and academic
(Georgetown University, Uniformed Services
University of the Health Sciences, Catholic
University of America) facilities.
Variety of research designs:
Standardization vs. Inclusiveness vs. Flexibility
Experiment/RCT
Survey/Correlational
Designs
Diversity of
Standardization
Mixed Method
Designs
-Sampling
-Data collection
-Data analysis
Qualitative/Ethnography
Longitudinal/
Repeated Measures
Synthesis and Translation:
-Impairments
-Environments
-Accommodation
needs/Interventions
A Comparative Effectiveness Research
Why Do Unmet Needs Exist?
Abnormal conditions
Individual needs
– Physiological - pain,
agitation, physical
discomfort
– Safety uncomfortable
environmental
conditions
– Love and belonging need for social
contacts
– Esteem- type of
stimulation
– Self-actualization level of stimulation
Libin, Alexander
Differential Psychology
5ed, 2009 – 580 pp.
– Unable to
communicate needs
– Unaware of needs of
self
– Unable to use prior
coping mechanisms
– Unable to obtain the
means for meeting
the needs
– Environment does
not comprehend the
needs
– Environment does
not provide the
needs
TRANSITION OF CARE: FROM HOSPSITAL TO HOME
NON-MEDICAL CARE MODEL:
Transitional Aspects
Coordinating communication
between providers
Frequent follow-ups with families
and discharge planners
Medication reminders
Transportation
ADL assistance
Psychosocial and Edutainment Interventions for
Patients with Neurologic Trauma
:
T1
da
on
k
or f
tw n o
ne tio
e n ns
rc ve tio
o u re d i
es p on
l r nd y c
ua a r
i r t i se n d a
: V e r c co
T4 ex se
Individuals with acute &
subacute neurologic trauma
on
ec
s
s
of n
n tio
it o lica
en p
e v co m
r
P
ry
RRTC
Researchers
Health educators and social
networks
,
re
ca
th
a l se ,
h e r ci
to e
s ex
er , on
rri ns ati
ba ditio nic
on n u
n co m
tio ry om
ca d a d c
du on an
: E se c
T2
e
ce i e v
e n ch n g s
r
i
fe a d
on to in
C ns h f pts
e i o rc
n c i t a ce
i e o n d e se co n
c
S c R
e y - ng
th dar CI ini
f
o on S tra
h
e
at sec wit tive
t
S g g va
:
n in
T3 nti liv nno
e y i
v
e lth d
Pr ea an
h
Consumers with
Neurologic Disorders
Clinicians, advocates, and
policymakers
Health care professionals
MONITORING:
Computerized Motor Performance Assessment of Executive
Dysfunction (COMPASSED)
The COMPASSED platform will employ a computerized assessment of executive functioning based
on dual cognitive-motor tasks performance in people with neurologic impairments such as
Traumatic Brain Injury and Spinal Cord Injury, Stroke, and Parkinson’s disease.
Case Studies of eHealth2go
Personal Health Record Technology as a Tool
for Spinal Cord Injury Health Self-Management
•
Goals
– To explore the general utility and usability of a personal health record (PHR) in
meeting the health-related information needs of persons with spinal cord injury
(SCI);
– To explore information formats and PHR applications that may be of specific use
to persons with SCI in:
• Obtaining cardiometabolic risk screening;
• Self-managing diet for the prevention of obesity and cardiometabolic syndrome;
• Self-managing skin health and prevention of pressure ulcers
•
Methods
– Design: Case Study Series
– Location: National Rehabilitation Hospital and participants’ homes in the
Baltimore/Washington DC metropolitan area.
– Participants: 12 ethnically and racially diverse individuals of both genders with
SCI representing various levels of education and health literacy
– Process
• Health Information Needs Assessment
• Custom PHR Development
– Uses MedStar eHealth2go and Microsoft HealthVault
• PHR Use
• PHR Evaluation
HEALTHCARE NAVIGATOR FRAMEWORK
Sensitive adjustment
Based on individual profile
(preferences, needs, and abilities)
NAVIGATOR
Educational module Personal improvement through
training of learning processes
Entertainment-at-hands as
a form of communication
This project is funded by NIDRR grant H133N060028, The National Capital Spinal Cord Injury Model System
HEALTHCARE
NAVIGATOR
FRAMEWORK
NAVIGATOR
Self-monitoring
This project is funded by NIDRR grant H133N060028, The National Capital Spinal Cord Injury Model System
Role-playing Simulation as an Educational Tool for Health Care
Personnel: Developing an Embedded Assessment Framework
Mixed methodology
pre-post intervention
research design
Libin A, Lauderdale M, Millo Y, Shamloo C, Spencer R, Green B, Donnellan J,
Wellesley C, Groah S. Role-Playing Simulation as an Educational Tool for Health Care
Personnel: Developing an Embedded Assessment Framework. Cyberpsychol Behav.
and Social Network, 3, 2010
NIDRR grant #H133B031114, the Rehabilitation Research and Training Center on Secondary Conditions
CER future developments:
The VA Rehabilitation Research
“Nor is there one way of knowing, science; there are many such ways...Science itself has
conflicting parts with different strategies, results, metaphysical embroideries...(p.143)” Paul Feyerabend,
Killing Time (1995)
• Building the evidence base is an
iterative process involving
exploratory and confirmatory steps
• Research is context-bound:
experimental research conducted
in the laboratory produces different
types of evidence than field
experiments or experiential
research
• Rehabilitation Research is
population-bound
Campbell et al., BMJ 2007, 455-459
CER future developments:
The VA Rehabilitation Research
Research Design
• Participatory strategies (think about who is
“representative”; reflect what “participatory”
means)
• Mixed method strategies and designs
Sampling
• Going outside known channels; use wider
community outlets
• Think “social exclusion” in broader terms
CER future developments:
The VA Rehabilitation Research
• Critical appraisal of what constitutes ‘evidence’
• Facilitating communication between basic, clinical and
applied research
• Greater public involvement in the research process
• Replacing traditional linear models of knowledge
translation with iterative and interactive models of
knowledge diffusion
• Moving from ‘evidence-based’ to ‘evidence-influenced’
understanding of knowledge production
• Examination of the contextual, situational and personal
factors that determine clinical decision making
ACKNOWLEDGEMENTS
Supported in part by the Medstar Health Research Institute, a component of the
Georgetown-Howard Universities Center for Clinical and Translational Science
(GHUCCTS) and supported by Grant U54 RR026076-01 from the NCRR, a
component of the National Institutes of Health (NIH). Its contents are solely the
responsibility of the authors and do not necessarily represent the official views
of NCRR or NIH.
Supported in part by the NIDRR grant #H133B031114, Rehabilitation Research
and Training Center on SCI: Promoting Health and Preventing Complications
through Exercise, and by NIDRR grant # H133N060028, The National Capital
Spinal Cord Injury Model System
Collaborators
and Sponsors
THANK YOU!
TO BE CONTINUED….