1. Clinical Military Psychologists Jan 18 Ch 5,6

2. Disclaimer Information and opinions expressed by Maj Dhillon and other military/government employees providing lectures are not intended/should not be taken as representing the policies and views of the Department of Defense, its component services, or the US Government.

3. Overview Clinical Psychologists Pediatric Psychologists Forensic Psychologists Prescribing Psychologists Behavioral Health Consultants Clinical Health Psychologists Neuropsychologists Military Mental Health Technicians

4. Clinical Psychologists Doctoral Level American Psychological Association (APA) accredited program Pathway: – APA internship – Direct accession Retention bonus Board Certification Bonus Licensed in any state Must be able to do any job, anywhere, with anyone

5. Pediatric Psychologists Same as clinical but completed post doctoral fellowship in child psychology Specifier on job code designating specialty Highly sought for overseas assignments and stateside big military medical facilities

6. Forensic Psychologists Same as clinical but completed post doctoral fellowship in forensic psychology Fellowship can include working with criminal investigation arm of their service Testify as expert witness in UCMJ cases – Mental status during criminal act, capacity to understand and participate in proceedings, opinion on insanity defense, etc. Conduct evaluations for UCMJ cases Job code specifier after training

7. Prescribing Psychologists Same as clinical but obtained M.S. in psychopharmacology and supervised prescribing hours before certification Specifier on job code Born from operational necessity due to critical shortage of psychiatrists and psychiatric nurse practitioners

8. Behavioral Health Consultants Any Mental Health provider except psychiatry 4 weeks of training Located within primary care clinic Consult with primary care managers (PCMs) on patient cases involving behavioral component such as: – Weight management, Smoking cessation, Prescription adherence, Chronic Pain Management, sleep problems… 50% of formal mental health care conducted in primary care 15-30 min appointments, behavior and functioning focused, patient belongs to PCM, BHC gives feedback on consultation to PCM

9. Clinical Health Psychologists “applies scientific knowledge of the interrelationships among behavioral, emotional, cognitive, social and biological components in health and disease to the promotion and maintenance of health; the prevention, treatment, and rehabilitation of illness and disability, and the improvement of the health care system.

10. Clinical Health Psychologists Specifically focus on physical health conditions where behavioral factors play a primary or secondary role Population Health Management – Survey health of population, provide preventative care and interventions, disease management and outcome measurement – Primary prevention: prevent onset of a condition – Secondary prevention: identify those at risk – Tertiary prevention: treat symptomatic patients

11. Clinical Health Psychologists Post doctoral fellowship training 1-2 years – assessment/management of chronic disease and illness – Health maintenance via prevention – Evaluate intervention effectiveness – Interdisciplinary collaboration – Disease management team development – Develop a population health approach – Conduct applied clinical research Job code identifier Primarily assigned to big military medical facilities AF is a major post doc fellowship training site Biofeedback certification Provide: – Tobacco cessation, weight management, chronic pain management, insomnia management,

12. Neuropsychologists 2 year post doc fellowship Focused on brain-behavior relationships Evaluate members of their service based on the regulations for that service – Army and AF have different regulations when it comes to aviators and medication Job code specifier Most frequently placed in larger military medical facilities

13. Neuropsychologists Differs from civilian neuropsychology – Readily available baseline assessment data for most mil members ASVAB AFOQT Service member records – Neuropsych measures developed for specific military populations (i.e., Armstrong Laboratory Aviator Personality Survey)

14. Neuropsychologists Fitness for Duty Evaluations – Assess type, level, an prognosis of neurological impairment – Traumatic Brain Injury Mil mbrs at high risk due to training, environment, and combat Cognitive, emotional, behavioral, physical deficits Significantly impact knowledge, skills, and abilities required of technical jobs in military In combat concussive blasts more common than penetrating ones and cause cerebral damage but are more difficult to identify

15. Neuropsychologists – Medevac process from theater to Continental US (CONUS): Injury on battlefield Self Aid and Buddy Care on battlefield Rapid medical response by medical technicians Battlefield hospital care stabilizes member Aerovac to Landstuhl Regional Medical Center in Germany for further care Transfer to CONUS military/VA medical center Defense Veterans Brain Injury Center (DVBIC) for specific treatment and rehabilitation for TBI

16. Neuropsychologists – Attention Deficit Hyperactivity Disorder & Learning Disorders No entry to military service w/history of ADHD, unsatisfactory academic performance and /or current NEED for medication If diagnosis made after member is in military, retention in service possible only if symptoms do not interfere with ability to do job Accommodations are not possible in military environment Inability to perform results in an administrative discharge as opposed to a medical discharge

17. Neuropsychology Military Aerospace Neuropsychology – Branch of clinical neuropsych managing assessment, selection, and disposition of military and NASA members on flying status – Integrates clinical-, aviation-, and neuro-psych – 90% of air mishaps are due to human factors – Must assess and integrate interplay of cognitive, information processing, sleep/fatigue, stress, ergonomics, toxicity, personality factors on flying

18. Neuropsychology – AF School of Aerospace Medicine inaugurated by President Kennedy the day before his assassination at Brooks AFB in San Antonio now moved to Wright Patterson AFB, OH – Also address issues like airsickness, gravity loss of consciousness, hypoxia, mishap investigation, human factors research, stress reactions to flying, motivation to fly, air traffic control, reverse malingerers

19. Neuropsychology Multidimensional Aptitude Battery (MAB-II) – Different norms for pilots, (look at drop in performance as opposed to impairment defined by regular norms on measures like IQ) – FS IQ=120.8, SD=8.2, – Impaired performance is 2 SDs below mean Avg IQ is actually an impairment for pilots

20. Neuropsychologists MicroCog-Generalizes well to common neuropsych conditions – Reaction Time and Information Processing Speeds are especially important in assessing high performance aircraft pilots Armstrong Laboratory Aviator Personality Survey – Produced and standardized by AF gives profile of flyers in Personality, Psychopathology, and Crew Interaction domains

21. Neuropsychologists NEO PI-R Personality measure on 5 factors – Neuroticism (low), Extraversion (high), Openness (middle), Agreeableness (low), and Conscientiousness (high) Critical components of aviator neuropsych assessment: speed/accuracy; attention/ concentration; vigilance; memory; working memory; auditory, spatial, and kinesthetic processing; new learning; multi-tasking; cognitive flexibility, problem solving

22. Neuropsychologists Aviator profiles – The Right Stuff—fighter pilot: aggressive, dominant, exhibitionistic, impulsive, playful – The Company Man—transport pilot: high achievement, endurance, affiliation, and orderliness – The Wrong Stuff—low exhibition, understanding, affiliation, and orderliness – High somatization due to high defensiveness and denial of psychological problems – Most pilots are RTD due to high resiliency and achievement orientation

23. AF Mental Health Techs Per AFMAN 36-2108, 4Cs are supposed to be able to: Support MH svcs in psychiatry, psychology, social work, FAP, ADAPT, & MHC. Assist pro-staff w DEVELOPING & IMPLEMENTING tx plans. PERFORMS specified MH tx. REPORTS & DOCUMENTS pt care.

24. Military Mental Health Techs Conduct/assist in individual & group tx. Perform initial, basic, & standard psych assessment, clinical interviewing, MSEs Assist in: dx, tx, pt education, & disposition planning. Observe, monitor, record, & report pt progress. Assist in or arrange pt referral to public, private or mil community agencies.

25. Military Mental Health Techs Training – Tech School--MH Apprentice: – 3 mos training DSM-IV-TR diagnostic criteria – How to do an intake interview – Operations of MH elements EXPERIENCE to obtain--MH Journeyman: – Administering, scoring & reporting psych testing; – Interviewing pts for biopsychosocial hx& personal info; – ASSISTING pro staff to carry out prescribed tx plan EXPERIENCE to obtain--MH Craftsman: – Conducting briefings. – Performing or supervising Psych assessment. – Interviewing pts and assisting in tx or substance abuse prevention & counseling