Vanderbilt experts are using standardized patients at the Center for Experiential Learning and Assessment to help train military health care providers to identify mental health concerns among returning U.S. service personnel. (Photo by Joe Howell)
According to research conducted by the Rand Corporation, approximately 18.5 percent of U.S. service members who have returned from Afghanistan and Iraq currently have post-traumatic stress disorder or depression; and 19.5 percent report experiencing a traumatic brain injury during deployment.
Funded by the U.S. Army Medical Research and Acquisition Activity, faculty and staff from Vanderbilt University are conducting workshops for military health care providers with a goal of enhancing provider communication with service members to promote early identification of mental health concerns and subsequent referrals to address those needs.
In a cooperative agreement with Force Health Protection and Readiness, the DoD office responsible for all activities related to deployment medicine, Peabody’s Susan Douglas Kelley, Ph.D., and Leonard Bickman, Ph.D., received a three-year grant to develop a training program for military and civilian providers who screen returning service members for deployment-related health problems. They targeted a specific point in time after the service members’ return — the Post-Deployment Health Reassessment, or PDHRA, conducted 90-180 days after redeployment to the U.S. — for the study.
Kelley collaborated with Vanderbilt University School of Medicine’s Lynn Webb, Ph.D., assistant dean for Faculty Development, who helps Vanderbilt physicians improve their communication with patients and staff, to teach military providers patient-centered communication skills – techniques used to build trust and compliance.
Kelley and Webb conducted training exercises with providers at three U.S. military treatment facilities. They say that incorporating these techniques into the PDHRA interview could enhance the relationship between the provider and service member, thus potentially increasing the likelihood a service member will disclose information that could lead to a referral for follow-up consultation if needed.
Webb recognized significant differences between a traditional physician-patient encounter and the PDHRA interview, which is typically 15 minutes or less in length.
“With the average interview so short, relationship-building with the patient becomes even more important because you have to do very specific things in a brief interview to enhance the chance that the soldier will feel comfortable divulging something that he or she probably doesn’t want to divulge in the first place,” Webb said. “Soldiers generally don’t want to disclose symptoms out of fear it will make them appear they are not ready for combat.”
Rather than a typical lecture-based seminar, the workshop emphasizes active discussion and hands-on practice to enhance participant engagement and skill-building. The providers practice the patient-centered communication techniques with standardized patients, who are actors trained to simulate real patients, or in this case, returning soldiers. This simulation was conducted via live video streaming from Vanderbilt’s Center for Experiential Learning and Assessment.
“We want to show that training in patient-centered communication is feasible and can be effective in increasing identification of soldiers with mental health concerns and their subsequent compliance with provider recommendations,” said Kelley, senior research associate, deputy director of Peabody’s Center for Evaluation and Program Improvement and the study’s co-primary investigator.
“Maintaining the psychological health of service members is a top priority of DoD,” said Cmdr. Nicole Frazer, the Force Health Protection and Readiness liaison for the study. “We’ve greatly enhanced the mental health components of these assessments.”
Kelley and Bickman are leading the evaluation team conducting research on the feasibility and efficacy of the workshop in enhancing soldier disclosure and compliance with referrals. Results will be reported to U.S. Army Medical Research and Acquisition Activity in the fall.
This study builds on a previous DoD-funded comprehensive evaluation of the PDHRA process completed by Kelley and Bickman, Ph.D., Betts Chair and Professor of Psychology, in 2009.
News and Public Affairs