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1 Patient- and Family-Centered Mind-Body Empowerment Programs in the Military: Guideline Development and Evaluation Katherine Smith, MPH Roxana Delgado,

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Presentation on theme: "1 Patient- and Family-Centered Mind-Body Empowerment Programs in the Military: Guideline Development and Evaluation Katherine Smith, MPH Roxana Delgado,"— Presentation transcript:

1 1 Patient- and Family-Centered Mind-Body Empowerment Programs in the Military: Guideline Development and Evaluation Katherine Smith, MPH Roxana Delgado, PhD Samueli Institute August 6, 2014

2 2 Investigators and Research Staff Brenda S. Hanson, PhDMilitary Principal Investigator Roxana E. Delgado, PhDSamueli Institute Principal Investigator Katherine Smith, MPHSamueli Institute Associate Investigator Vickie Thomas, PhDMilitary Associate Investigator Claudia Martin, LISWMilitary Associate Investigator Sandra Gordon, BSSamueli Institute Associate Investigator Michal BoyarsResearch Coordinator Ames DavisResearch Coordinator

3 3 Disclaimer “The views expressed in this document are those of the author(s) and do not reflect the official policy of William Beaumont Army Medical Center, the Department of the Army, or the United States Government.”

4 4 Samueli Institute Uncovers the Science of Healing THROUGHFORTO Improve Performance Reduce Chronic Symptoms Enhance Wellness RESEARCH INNOVATION EDUCATION INDIVIDUALS WARFIGHTERS SYSTEMS

5 5 Purpose of this Session Describe the Military Family Empowerment project. Provide an overview and results of Patient- and Family- Centered Mind-Body Program Guidelines. Describe and share results of a program evaluation of a military mind-body program. Discuss experiences involving patients and families in program development and evaluation.

6 6 Project Background and Rationale Increased need for ongoing, long-term heath care treatment Increased stress and trauma Improve resilience Empower patients and families Provide the DoD with an approach to care that empowers patients and families to increase their own ability to cope with health related stress and trauma

7 7 What are Mind-Body Family Empowerment Programs? Two important elements: 1) Family- and patient-centered principles of care delivery 2) Use of self-administered evidence-based mind-body practices Programs that empower individuals and families by equipping participants with evidence-based self-regulation tools and showing them how to integrate the skills into their lives independently of an outside provider.

8 8 What is the Evidence Based? Strong evidence based for: 1) Family- and patient-centered care 2) Use of mind-body practices Effective in clinical and non-clinical populations Benefits for patients, families, providers, hospitals, and payers

9 9 Evolution of Guidelines 3 expert panels and papers at IPFCC 5 th International Conference SME Working Group created draft Sent to DoD & 20 additional SME’s, patients, & program leaders for review Performed mixed-methods program evaluation of a military mind-body program & draft guidelines Revise and disseminate the guidelines

10 10 What do Guidelines recommend? Program design and development Program implementation Program evaluation Privacy and confidentiality considerations

11 11 Responses to Guidelines “These [guidelines] are invaluable to anyone attempting to start a program like this. I wish I had a guide such as this when I started my program.” LCDR Millegan Head, Mind Body Medicine “I find [the Guidelines] to be practical and feasible. Having a good set of guidelines (and widely disseminated) will help lend legitimacy to mind-body work and provide a standards-based assessment and acceptance of design, implementation, evaluation, and sustainment.” COL Brumage Deputy Commander for Clinical Services

12 12 “This is a first rate, comprehensive manual for establishing multi-modal mind-body program in a military setting. It provides a safe, reproducible road map for navigating through the complicated terrain of program development with tremendous attention to the details of its creation. It is very well written, well researched.” Audrey Schoomaker, RN, BSN, E-RYT Mind-Body Practitioner Former Army Nurse

13 13 Military Mind-Body Program Evaluation

14 14 Evaluating a Patient- and Family-Centered Mind-Body Military Program Collaboration Information Sharing Respect and Dignity Participation

15 15 Patient- and Family-Centered Mind-Body Military Program 4-weeks outpatient interdisciplinary program to treat posttraumatic stress disorder (PTSD) and depression Sample: active duty Service Members and their Family Mixed-Methods Approach Retrospective outcome measures (N= 228) Analysis: SPSS Experiential evidence- 30 interviews Analysis: RAPID Assessment

16 16 Using a Mixed-Methods Approach Outcome Measures (N=228) Treatment Motivation Questionnaire (TMQ) Post Traumatic Growth Inventory (PTGI) Patient Health Questionnaire 15 (PHQ- 15) General Anxiety Disorder (GAD-7) Patient Health Questionnaire-9 (PHQ-9) Pittsburgh Sleep Quality Index (PSQI) PCL-M (PTSD Check List-Military Version) World Health Organization Quality of Life (WHOQOL-BREF) Satisfaction Questionnaire 31 Interviews (Individual and Focus Groups) Service Members (n=12) Family Spouses (n=5) Staff (n=12) Leaders (n=2)

17 17 Quantitative Results: Outcome Measures PHQ9 and GAD7, were significantly lower and clinically represented a decrease of category from red flag to yellow flag Behavioral Health Measures Higher (p<.05) positive outcomes in the following domains: Relating to Others New Possibilities Personal Strengths Post Traumatic Growth Inventory Aft er 4 we ek s, qu alit y of life wa s sig nifi ca ntl y (p <.0 5) bet ter for all do ma ins (ex ce pt En vir on me nt). Quality of Life: World Health Organization Quality of Life High satisfaction with the program and the providers. Information was presented clear, concise and in a good pace. Participants anticipate using what they learned at the program. The majority of participants reported significant improvement in social (64%), emotional (61%) and psychological (76%) state. Satisfaction

18 18 PTSD and Depression Symptom Improvement (N=226)

19 19 Knowledge of PTSD Before the program, how would you rate your understanding of PTSD? Having completed the program, how would you rate your understanding of PTSD?

20 20 Treatment Motivation Questionnaire Internalized Reasons Pre-Intervention4 WeeksPost-Intervention I came for treatment at the clinic because: I really want to make some changes in my life. I won't feel good about myself if I don't get some help. I feel so guilty about my problem that I have to do something about it. It is important to me personally to solve my problems.

21 21 Treatment Motivation Questionnaire Help Seeking I want to openly relate with others in the program. I want to share some of my concerns and feelings with others. It will be important for me to work closely with others in solving my problem. I look forward to relating to others who have similar problems. It will be a relief for me to share my concerns with other program participants. I accept the fact that I need some help and support from others to beat my problem. Pre-Intervention4 WeeksPost-Intervention

22 22 Treatment Motivation Questionnaire Confidence I am not sure this program will work for me. I am confident this program will work for me. I'm not convinced that this program will help me stop drinking. I doubt that this program will solve my problems. I am not very confident that I will get results from treatment this time. Pre-Intervention4 WeeksPost-Intervention

23 23 Qualitative Results: Findings from Experiential Evidence ProcessStructure Outcomes Maintain Gains in Health

24 24 Qualitative Results: Findings from Experiential Evidence ProcessStructure Outcomes Maintain Gains in Health THEMES: Quality of Care Providers Treatments Environment Command Support Stigma Treatment Modalities Reiki Art Massage Yoga/Movement Individual Groups InVivo

25 25 Qualitative Results: Findings from Experiential Evidence ProcessStructure Outcomes Maintain Gains in Health THEMES: Aftercare Critical BH can’t help – too busy Longer is better Transitioning Too abrupt No chance to practice Pay It Forward Volunteering to help with WRC Want to help other Soldiers

26 26 Qualitative Results: Findings from Experiential Evidence ProcessStructure Outcomes Maintain Gains in Health THEMES: Program Awareness Referrals (EBH) Command Support General support of EBH Family Involvement Weekly support group Treatments Childcare Awareness Barriers Post-Program Support Aftercare Appointments groups Treatments IM Experience No previous Some previous Future plans

27 27 Qualitative Results: Findings from Experiential Evidence ProcessStructure Outcomes Maintain Gains in Health THEMES: Overall Experience Last Resort Group Impact Quality of Life Shared Experience Empowerment Self-Awareness Growth Social Family Work Recreation Emotional Recognize triggers Anger Calm/quiet Physical Sleep Pain Energy

28 28 Themes from Interviews Structure Program Awareness Referrals (EBH) Command Support General support of EBH Family Involvement Weekly support group Treatments Childcare Awareness Barriers Post-Program Support Aftercare appointments groups treatments IM Experience No previous Some previous Future plans Process Quality of Care Providers Treatments Environment Command Support Stigma Treatment Modalities Reiki Art Massage Yoga/Movement Individual Groups InVivo Outcomes Overall Experience Last Resort Group Impact Quality of Life Shared Experience Empowerment Self-Awareness Growth Social Family Work Recreation Physical Sleep Pain Energy Emotional Recognize triggers Anger Calm/quiet Maintain Gains in Health Aftercare Critical BH can’t help – too busy Longer is better Transitioning Too abrupt No chance to practice Pay It Forward Volunteering to help with WRC Want to help other Soldiers

29 29 LESSONS LEARNED

30 30 Barriers and Facilitators in Implementation Barriers Lack of resources Leadership buy-in & turnover Finding a champion Perceptions of CAM/IM Modality choice Time, $, planning for evaluation Support during re-entry (military) Follow-up care Family engagement Facilitators Benefactor/resources Local champion Choice of evidence-based modalities Experiential sessions for providers Family involvement in treatment options/goals Regular patient/family feedback Ongoing aftercare Participants as referrals

31 31 Patient and Family Involvement Project focus on empowerment of patients and families Role in panel presentations at IPFCC 5 th International Conference Involvement in writing Guidelines Participation in reviewing Guidelines Role on WRC program evaluation team

32 32 Patient and Family Involvement Conference (Fish Bowl Panelists) Study Participation Guidelines Development and Review Military MB Program Evaluation Design and Execution

33 33 Questions? www.SamueliInstitute.org/Guidelines ACCESS GUIDELINES:

34 34 www.SamueliInstitute.org/Guidelines ACCESS GUIDELINES: “They can manage their anger, their anger doesn’t manage them. They can manage their anxiety, their anxiety doesn’t manage them.” Staff and Leaders “When I'm about to lose it, I remember what I learned and calm myself...I think first and I can walk away [from anger].” Participant “This place has saved marriages and lives.” Family Member “Four weeks at WRC program helped more than a year of counseling could have.” Participant


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