Practice-Based Implementation Network: Behavioral Health Technician Optimization Pilot Lessons Learned.

Introduction: Between June 2021 and December 2022, the Practice-Based Implementation (PBI) Network conducted a pilot to study the optimization of behavioral health technicians (BHTs) within military behavioral health (BH) care system specialty BH clinics. Behavioral health technicians are paraprofessionals found in all branches of the military, and with training across a variety of clinic functions. Behavioral health technicians support BH specialty providers in many clinic functions (i.

The associations of opioid and benzodiazepine prescriptions with injuries among US military service members.

Given the high rates of physical trauma and pain among service members, opioid-prescribing practices and use patterns have significant implications for the well-being of service members and can affect military medicine and personnel readiness. This study measured the association between prescribed opioid and benzodiazepine medications and subsequently reported injuries (accidental, alcohol and drug related, self-inflicted, and violence related) among active duty military members. Participants were service members who entered the military between January 1, 2005, and June 30, 2010.

Combat and operational stress programs and interventions: A scoping review using a tiered prevention framework.

Beginning in 1999, Department of Defense policy directed the military services to develop Combat and Operational Stress Control (COSC) programs to address prevention, early identification, and management of the negative effects of combat and operational stress. The aim of this study is to provide a narrative review of COSC programs and organize them into a prevention framework to clarify gaps and future directions. A systematic search was conducted to identify studies between 2001 and 2020 in peer-reviewed articles or government-sponsored reports describing an evaluation of COSC programs.

The Management of Posttraumatic Stress Disorder and Acute Stress Disorder: Synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline.

Description: The U.S. Department of Veterans Affairs (VA) and Department of Defense (DoD) worked together to revise the 2017 VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder.

Outcome metrics utilized in evaluations of programs and interventions for combat and operational stress: A review of psychometric properties.

The Department of Defense has mandated combat and operational stress control (COSC) efforts for the Services since 1999. Although several COSC-related programs have been implemented, few have undergone evaluation, and no standardized metrics have been established to assess their effectiveness and utility. The purpose of this review was to characterize the content and psychometrics of measures that have been utilized as outcome metrics in evaluations of COSC-related programs and interventions.

Evidence-based telehealth interventions for posttraumatic stress disorder, depression, and anxiety: A systematic review and meta-analysis.

Introduction: The goal of this systematic review was to examine the efficacy of behavioral health care treatments for posttraumatic stress disorder (PTSD), depression, and anxiety delivered via telehealth.

Methods: We searched a combination of keywords related to telehealth, relevant mental health disorders, and evidence-based psychotherapies in three databases (PubMed, PsycInfo, and Embase) from database inception to April 2022. We included randomized controlled trials published in English wherein at least one arm received an evidence-based psychotherapy via telehealth.

A pilot study of trauma-sensitive yoga and Breathe2Relax among service members in an intensive outpatient program.

Emerging research indicates that yoga is a promising adjunct to psychological trauma treatment. The current pilot study examined the associations between psychophysiological stress, diaphragmatic breathing (DB), and a trauma-sensitive yoga (TSY) regimen developed specifically for trauma-exposed service members in alignment with recent calls for precision in reporting therapeutic yoga protocols. Participants were 31 service members enrolled in a trauma-focused intensive outpatient program (IOP).

The Design and Application of a Health Behavioral Change (HBC) Roadmap.

Introduction: To assist in addressing medical readiness challenges, the DOD has established various Centers of Excellence to focus efforts to protect, treat, train, and educate service members concerning risks and potential injuries. Using the hearing health domain as a pilot, this effort used DOD methods to evaluate all facets of successful health behavior change (HBC) practices within a military environment and developed a framework and pathway for HBC.

Methods: The DOD uses the Joint Capabilities Integration and Development System (JCIDS) to ensure new DOD capabilities are identified and fielded in a manner that is interoperable, resilient, and supportables.

In-Theater Mental Health Disorders Among U.S. Soldiers Deployed Between 2008 and 2013.

Deployed service members regularly undergo demanding and stressful experiences that can contribute to mental health difficulties; however, there is a scarcity of studies examining rates of mental health disorders in-theater. The current study examined case rates of mental health disorders among deployed U.S.

Design and methods of a randomized controlled trial evaluating the effects of the PE Coach mobile application on prolonged exposure among veterans with PTSD.

Background: Little is known about the impact of mobile applications (apps) designed to support patients progressing through an evidence-based psychotherapy. Prolonged exposure (PE) is an efficacious treatment for posttraumatic stress disorder (PTSD) and PE Coach is a treatment companion app that may increase patient engagement with the active components of PE, thereby supporting recovery.

Methods: This paper describes a randomized clinical trial that will evaluate PE delivered with and without PE Coach at post-treatment, and 1-month and 4-months post-treatment.

Diagnostic and functional outcomes of adjustment disorder in U.S. active duty service members.

Background: Adjustment disorder (AD) is a commonly diagnosed psychiatric disorder. However, little is known about its course, predictors of its diagnostic outcomes, or its association with functional impairment. Our primary aim was to examine diagnostic transitions of service members with an incident AD diagnosis (IADx) to one of three states: 1) another psychiatric diagnosis, 2) chronic AD, or 3) no psychiatric diagnosis.

Outcomes and prognosis of adjustment disorder in adults: A systematic review.

Adjustment disorder (AD) is one of the most commonly diagnosed mental health disorders and is generally conceptualized to be mild and short-lived. Despite the frequent use of AD in clinical settings, little is known about the prognosis of this condition. Our goal was to systematically review research on a range of AD outcomes in order to provide a broad characterization of AD prognosis.

Evaluation of Posttraumatic Stress Disorder and Acute Stress Disorder VA/DoD Clinical Practice Guidelines Training.

Introduction: This study evaluated the use of an online learning platform [Joint Knowledge Online (JKO)] for dissemination of the Veterans Affairs and Department of Defense Clinical Practice Guidelines for Management of Posttraumatic Stress Disorder (PTSD) and Acute Stress Disorder (ASD). User satisfaction with the training program was assessed, users were asked to estimate their knowledge base about PTSD and ASD, and users provided comments about how they might use the course material in their clinical practice.

Materials And Methods: A total of 4,442 users took at least one of three courses offered via JKO related to the PTSD Clinical Practice Guidelines (CPG) between July 1, 2019 and June 25, 2020.

Millon Behavioral Medicine Diagnostic Scales Do Not Predict Long-term Weight Loss Outcomes in Bariatric Surgery Patients.

Background: Psychological factors identified during presurgical screening have the potential to identify which patients may respond better to bariatric surgery, and which patients may need additional assistance. Previous research has validated a number of potential instruments for use in presurgical screening.

Method: This study evaluated archival data for 224 patients for a 60-month period following bariatric surgery to examine how presurgical scores on the Millon Behavioral Medicine Diagnostic predict body mass index (BMI) over time.

Military chaplains and mental health clinicians: Overlapping roles and collaborative opportunities.

Military chaplains and mental health clinicians have unique professional roles and functions within the Department of Defense. However, they also have intersecting roles in delivering care to service members with mental health issues. Although diagnosis and treatment of clinical disorders is the primary focus of mental health clinicians, military chaplains are often the first contact made by service members seeking help for mental health concerns, due in part to issues of greater accessibility, ensured confidentiality, and less stigma.

Assessing the Clinical Utility of a Wearable Device for Physiological Monitoring of Heart Rate Variability in Military Service Members with Traumatic Brain Injury.

Autonomic dysfunction has been implicated as a consequence of traumatic brain injury (TBI). Heart rate variability (HRV) may be a viable measure of autonomic dysfunction that could enhance rehabilitative interventions for individuals with TBI. This pilot study sought to assess the feasibility and validity of using the Zeriscope™ platform system in a real-world clinical setting to measure HRV in active-duty service members with TBI who were participating in an intensive outpatient program.

Systematic review and meta-analysis of predictors of adjustment disorders in adults.

Background: The diagnosis of adjustment disorder is common in clinical practice, yet there is lack of research on the etiology and epidemiology of adjustment disorders. The goal of this systematic review was to evaluate predictors of adjustment disorders in adults.

Methods: We conducted systematic searches in MEDLINE, EMBASE, and PsycINFO.

Pilot outcomes of cognitive processing therapy implementation in military health system outpatient behavioral health clinics.

Enterprise data indicates that U.S. service members (SMs) with posttraumatic stress disorder (PTSD) may not receive an evidence-based treatment (EBT) or may receive an EBT with low fidelity to the core components.

The relationship of presurgical Personality Assessment Inventory scales to BMI following bariatric surgery.

Objective: Notwithstanding the efficacy of bariatric surgery in reducing the negative sequelae of obesity, psychological factors may play a significant role in long-term weight maintenance following surgery. Previous research on these factors has shown mixed outcomes, indicating the need for further study in samples undergoing bariatric surgery.

Method: This study evaluated archival data for 194 patients from a single-payer system for a 60-month period following bariatric surgery to examine how presurgical scores on the Personality Assessment Inventory predict body mass index (BMI) over time.

Mental Health Stigma in Department of Defense Policies: Analysis, Recommendations, and Outcomes.

Introduction: Mental health stigma is one of the most frequently reported barriers to mental health help-seeking in the military. Previous research has identified that stigma-increasing language in the United States military policies was a potential deterrent to treatment-seeking. In response to a 2016 Government Accountability Office report recommendation, the current study conducted a comprehensive review of Department of Defense and military service-specific policies to identify stigmatizing language provisions and recommend appropriate language changes.