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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. Disclaimer. - PowerPoint PPT Presentation
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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
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Investigators and Research Staff
Brenda S. Hanson, PhD Military Principal Investigator
Roxana E. Delgado, PhD Samueli Institute Principal Investigator
Katherine Smith, MPH Samueli Institute Associate Investigator
Vickie Thomas, PhD Military Associate Investigator
Claudia Martin, LISW Military Associate Investigator
Sandra Gordon, BS Samueli Institute Associate Investigator
Michal Boyars Research Coordinator
Ames Davis Research Coordinator
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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.”
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Samueli Institute Uncovers the Science of Healing
THROUGH FOR TO• Improve
Performance
• Reduce Chronic Symptoms
• Enhance Wellness
RESEARCH
INNOVATION
EDUCATION
INDIVIDUALS
WARFIGHTERS
SYSTEMS
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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.
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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
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What are Mind-Body Family Empowerment Programs?
Two important elements:1) Family- and patient-centered principles of care delivery2) 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.
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What is the Evidence Based?
Strong evidence based for:1) Family- and patient-centered care2) Use of mind-body practices
• Effective in clinical and non-clinical populations• Benefits for patients, families, providers, hospitals, and payers
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Evolution of Guidelines
• 3 expert panels and papers at IPFCC 5th 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
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What do Guidelines recommend?
• Program design and development
• Program implementation
• Program evaluation
• Privacy and confidentiality considerations
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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 MilleganHead, 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 BrumageDeputy Commander for Clinical Services
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“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
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Military Mind-Body Program Evaluation
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Evaluating a Patient- and Family-Centered Mind-Body Military Program
Collaboration
Information Sharing
Respect and Dignity
Participation
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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
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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)
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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
• After 4 weeks, quality of life was significantly (p<.05) better for all domains (except Environment).
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
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PTSD and Depression Symptom Improvement (N=226)
0 10 20 30 40 50 60 70 80 90 1000
10
20
30
40
50
60
Perception of PTSD Symptoms Im-provement
Percent Improvement
Freq
uenc
y
0 10 20 30 40 50 60 70 80 90 10005
10152025303540
Symptom Improvement Attributed to Intervention Alone
Percent Improvement
Freq
uenc
y
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Knowledge of PTSD
Minimal 1 2 3 4 5 6 Extensive05
10152025303540
Understanding of PTSD before the Program (N=226)
Perc
ent
Minim
al 1 2 3 4 5 6
Extensiv
e0
10
20
30
40
Understanding of PTSD after the Program (N=226)
Perc
ent
Before the program, how would you rate your understanding of PTSD?
Having completed the program, how would you rate your understanding of PTSD?
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Treatment Motivation QuestionnaireInternalized Reasons
Not at all True
Somewhat True
Very True0
102030405060708090
100
9.9
35.5
54.7
Perc
ent
Not at all True Somewhat True
Very True0
102030405060708090
100
8.2
28.7
63.1
Pre-Intervention 4 Weeks Post-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.
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Treatment Motivation QuestionnaireHelp 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.
Not at all True
Somewhat True
Very True0
102030405060708090
100
7.9
60.6
31.5
Perc
ent
Not at all True
Somewhat True
Very True0
102030405060708090
100
2.1
51.8 46.2
Pre-Intervention 4 Weeks Post-Intervention
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Treatment Motivation QuestionnaireConfidence
• 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.
Not at all True
Somewhat True
Very True0
102030405060708090
100
2.5
63.5
34.0
Perc
ent
Not at all True Somewhat True
Very True0
102030405060708090
100
9.2
52.338.5
Pre-Intervention 4 Weeks Post-Intervention
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Qualitative Results: Findings from Experiential Evidence
Process Structure
OutcomesMaintain Gains in Health
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Qualitative Results: Findings from Experiential Evidence
Process Structure
OutcomesMaintain Gains in Health
THEMES:• Quality of Care
• Providers• Treatments• Environment
• Command Support• Stigma
• Treatment Modalities• Reiki• Art• Massage• Yoga/Movement• Individual• Groups• InVivo
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Qualitative Results: Findings from Experiential Evidence
Process Structure
OutcomesMaintain 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
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Qualitative Results: Findings from Experiential Evidence
Process Structure
OutcomesMaintain 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
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Qualitative Results: Findings from Experiential Evidence
Process Structure
OutcomesMaintain 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
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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
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LESSONS LEARNED
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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
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Patient and Family Involvement
• Project focus on empowerment of patients and families
• Role in panel presentations at IPFCC 5th International Conference
• Involvement in writing Guidelines
• Participation in reviewing Guidelines
• Role on WRC program evaluation team
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Patient and Family Involvement
Conference (Fish Bowl Panelists)
Study Participation
Guidelines Development and Review
Military MB Program
Evaluation Design and Execution
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Questions?
www.SamueliInstitute.org/Guidelines
ACCESS GUIDELINES:
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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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