DCoE Overview and Accomplishments BIAC Conference September 30-October 2, 2010

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1 DCoE Overview and Accomplishments BIAC Conference September 30-October 2, 2010 Lolita O Donnell, PhD, RN Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) Clearinghouse, Outreach and Advocacy Directorate acting director

2 Agenda Background Audiences Products Programs 2

3 What is DCoE? DCoE opened its doors in November 2007 and has since led a groundbreaking collaborative effort with the VA, civilian agencies, community leaders, advocacy groups, clinical experts and academic institutions to promote the resilience, recovery and reintegration of service members, veterans and their families facing concerns related to psychological health (PH) and traumatic brain injury (TBI). DCoE has embraced its mission to assess, validate, oversee and facilitate prevention, resilience, identification, treatment, outreach, rehabilitation and reintegration programs for PH and TBI to ensure the Department of Defense (DoD) meets the needs of service members, veterans, military families and communities. Our Core Messages You are not alone. Treatment works. The earlier the intervention, the better. Reaching out is an act of courage and strength. 3

4 We Support Service members Active Duty Guard and Reserve Veterans Families Military leaders Health care providers Researchers Employers Caregivers Chaplains DoD Civilians 4

5 DCoE Products Clinical Practice Guidelines Co-occurring Conditions Toolkit Web-based Case Studies for Mild TBI TBI Mobile Application Mild TBI Pocket Guide ICD-9 Coding Pocket Guide Major Depressive Disorder (MDD) Toolkit Substance Use Disorder (SUD) Toolkit Future Product: 5

6 Clinical Practice Guidelines Created clinical practice guidelines for management and treatment of concussed patients in theater Developed evidence-based guidelines for comprehensive care for severe injuries and developed clinical guidance related to cognitive rehabilitation Collaborate with the DoD/VA guidelines committee to develop and update clinical practice guidelines 6

Co-occurring Conditions Toolkit Assists primary care providers with assessing and managing patients with co-occurring TBI and psychological health (PH) disorders Toolkit combines clinical practice

7 Co-occurring Conditions Toolkit Assists primary care providers with assessing and managing patients with co-occurring TBI and psychological health (PH) disorders Toolkit combines clinical practice guidelines from VA, DoD, and SMEs in areas including: o Concussion o Post-traumatic Stress o Depression o Chronic Opioid Therapy o Substance Use Disorder Provides guidance on: o Tips for an effective first appointment o Clinical assessment and treatment of symptoms (sleep, mood, attention, and chronic pain) o Patient education tips o Additional provider resources Toolkit development is a joint collaboration between DCoE TBI and PH Directorates Copies will be available through the Defense and Veterans Brain Injury Center (DVBIC) in late September

Mild TBI Pocket Guide Quick-reference, all-encompassing resource on the treatment and management of individuals with mild Traumatic Brain Injury (mtbi) and related symptoms Major content of the Mild

8 Mild TBI Pocket Guide Quick-reference, all-encompassing resource on the treatment and management of individuals with mild Traumatic Brain Injury (mtbi) and related symptoms Major content of the Mild TBI Pocket Guide includes: o Summary of the VA/DoD Clinical Practice Guideline for mild TBI(2009) and the DoD mild TBI Updated Clinical Guidance (2008) o Evidence based recommendations of the assessment, referral and treatment for common symptoms associated with mild TBI o ICD-9 coding guidance for TBI o Summary of clinical recommendations for cognitive rehabilitation in mild TBI o Clinical recommendations on assessing ability to drive safely following TBI o Patient education materials o Clinical tools and resources Free copies of the Pocket Guide can be ordered through the DCoE Website ( 8

9 Mild TBI Mobile Application Provides the military health community of healthcare providers with mission critical content that helps them diagnose, treat and educate patients with mild TBI symptoms Offers links and resources to mild TBI content available on the Internet as well as important behavioral health information related to combat stress and post-traumatic stress disorder Optimizes content from the mild TBI pocket guide for mobile devices Diagnostic Tools and Checklists VA/DoD Clinical Practice Guidelines Database of ICD-9 Codes Patient Education Symptom Management Pharmacologic Tables Driving Guidelines Cognitive Rehabilitation Accessible on mobile devices, such as the iphone, ipad, Android and Blackberry In development 9

Web-based Case Studies for Mild TBI Covers topics within the VA/DoD Concussion/Mild TBI Clinical Practice Guidelines (2009) and the DoD s Updated Mild TBI Clinical Guidance (2008) Developed in

10 Web-based Case Studies for Mild TBI Covers topics within the VA/DoD Concussion/Mild TBI Clinical Practice Guidelines (2009) and the DoD s Updated Mild TBI Clinical Guidance (2008) Developed in partnership with MHS Learn and the VA Employee Education System Free CEUs, 1 CEU per month for 12 months Target audiences: Physicians Physician Assistants and Nurse Practitioners Psychologists Nurses Medics/Corpsmen The modules will be available to DoD, VA and civilian healthcare professionals via online training at: DoD (MHS Learn) - VA - Civilian (MHS Learn)

11 ICD-9 Coding Guidance Ensure that TBIs are consistently and accurately diagnosed, documented and ultimately, tracked Primary audiences include primary care providers and other TBI healthcare providers in Military Treatment Facilities (MTFs) and Department of Veterans Affairs (VA) Facilities caring for Service members and Veterans with TBI: Primary care providers (physicians, physician assistants, nurse practitioners) Psychological health providers (psychologist, psychiatrists) Physical, Occupational, and Speech Therapists Available for download on the DCoE Web site at To order hard copies of the ICD-9 Pocket Cards, contact DVBIC at or call (800) ICD-9 Coding Training is under development through the Army training modules that will be available via MHS Learn 11

Major Depressive Disorder (MDD) Toolkit Main purpose is to assist primary care providers on assessing and managing Major Depressive Disorder (MDD) for service members The

matter experts as needed Provides guidance on: Initial assessment and differential diagnosis Risk factors, perceived causes and clinical outcomes Treatment models and

12 Major Depressive Disorder (MDD) Toolkit Main purpose is to assist primary care providers on assessing and managing Major Depressive Disorder (MDD) for service members The clinical guidance presented in the toolkit resulted from combining VA/DoD clinical practice guidelines on Major Depressive Disorder with additional input from subject matter experts as needed Provides guidance on: Initial assessment and differential diagnosis Risk factors, perceived causes and clinical outcomes Treatment models and patient education tips Additional provider resources Toolkit development is a joint, collaborative initiative by DCoE and its Component Centers, VA and US Army Medical Command 12

Substance Use Disorder (SUD) Toolkit Provides evidence-based recommendations to help providers in the decision-making process for patients with substance use disorder (SUD) DoD and VA clinical

intervention for 5 interrelated aspects of SUD care: Screening and initial assessment for substance use Management of SUD in specialty SUD care Management of SUD in general healthcare

13 Substance Use Disorder (SUD) Toolkit Provides evidence-based recommendations to help providers in the decision-making process for patients with substance use disorder (SUD) DoD and VA clinical experts, with specialties in primary care, research, psychiatry, psychology and pharmacy, developed the toolkit s clinical guidance Step-by-step process of the clinical decision-making and intervention for 5 interrelated aspects of SUD care: Screening and initial assessment for substance use Management of SUD in specialty SUD care Management of SUD in general healthcare Addiction-focused pharmacotherapy Stabilization and withdrawal management Draft toolkit was revised based on current Clinical Practice Guidelines; a VA/DoD working group will convene to refine the toolkit in Fall

14 Future Product: 2009 Trauma Spectrum Disorders Conference Article to be Published To be published in Fall 2011 in the Journal of Loss & Trauma Summarizes findings from 2009 Trauma Spectrum Disorders Conference Recent research on the impact of trauma spectrum disorders on military and veteran families and caregivers during deployment, homecoming and reintegration 14

15 DCoE Programs DCoE Outreach Center DCoE Monthly Webinar Real Warriors Campaign AfterDeployment.org Sesame Workshop intransition Program 2010 Trauma Spectrum Disorders Conference 15

DCoE Outreach Center Established in January 2009 Available 24/7 Staffed by trained, professional Health Resource Consultants Connects the right resource to the right person at the right time Provides

16 DCoE Outreach Center Established in January 2009 Available 24/7 Staffed by trained, professional Health Resource Consultants Connects the right resource to the right person at the right time Provides information and resources Resilience programs Suicide prevention initiatives Family and relationship support Alcohol/substance use programs PH/TBI programs Healthcare system navigation Call 24/7:

17 DCoE Monthly Webinar Timely and relevant topics presented experts on a variety of PH and TBI topics Resilience, Recovery, and Reintegration Open to wide audience base including: Military Civilians Health Care Professionals Approximately 250+ participants Accessible through Defense Connect Online/Toll Free number Occur fourth Thursday of every month DCoE.MonthlyWebinar@tma.osd.mil Previous Presentations: Mobile Technologies for PH & TBI Support for Caregivers Recurrent Concussions Addressing Trauma, Grief and Loss in Military Children Reintegration: Adjusting to Life at Home After Deployment Reintegration Programs: Case Studies of Successful State Reintegration Programs October 28, 2010 Presentation: Understanding, Addressing and Combating Sigma Surrounding Seeking Help for Psychological Health Issues in Today s Military 17

Veterans Families/loved ones Health professionals Website features

cycle guidance and resources Links to resources including the 24/7 DCoE

18 Real Warriors Campaign Realwarriors.net, information for Active-duty service members Guard & Reserve Veterans Families/loved ones Health professionals Website features Articles/message board/blog Profiles featuring Real Warriors Deployment cycle guidance and resources Links to resources including the 24/7 DCoE Outreach Center, National Suicide Prevention Lifeline Multimedia products/campaign materials Call 24/7:

19 AfterDeployment.org AfterDeployment.org is a wellness resource for the entire military community to address postdeployment issues For service members, veterans and military families Focus on common post-deployment problems such as PTSD, depression, anger and relationship issues Take assessments, view video-based testimonials and access narrator-guided workshops 19

Photos and videos Printable coloring pages Family Connections Advice and FAQs on

20 Sesame Workshop Sesame Street: Talk, Listen, Connect Phase I: Deployments Phase II: Injured Parents / Return Home Phase III: Loss of a Parent Available resources Photos and videos Printable coloring pages Family Connections Advice and FAQs on how to talk to your children POC: CAPT Russell Shilling, russell.shilling@tma.osd.mil 20

Relocating to another assignment Returning from deployment Transitioning

21 intransition Program Created to support service members receiving mental health services as they transition between health care systems or providers Relocating to another assignment Returning from deployment Transitioning from active duty to reserve, reserve to active duty, or returning to civilian life 21

22 2010 Trauma Spectrum Disorders Conference Emerging Research on Polytrauma, Recovery and Reintegration of Service Members, Veterans and their Families December 7-8, 2010 Natcher Conference Center, National Institutes of Health, Bethesda, MD Enhance and promote continued collaboration among the DoD, NIH, VA and key stake holders such as researchers, academics, other federal partners and military and civilian personnel dedicated to improving the lives of Service members, Veterans and their families Focus on emerging polytrauma research and its impact on Service members, veterans and their families POC: Erika Elvander

23 Point of Contact Lolita T. O'Donnell, PhD, RN Acting Director of Clearinghouse, Outreach & Advocacy Directorate Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) Phone:

Update on DCOE Defense Health Board 8 March 2011

Update on DCOE Defense Health Board 8 March 2011 Captain Paul S. Hammer MC USN Director, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury Agenda History LoA #2 Congressional