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Katherine Smith, MPH Roxana Delgado, PhD Samueli Institute

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.

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Katherine Smith, MPH Roxana Delgado, PhD Samueli Institute

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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, PhD Samueli Institute August 6, 2014

  2. 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.”

  3. Samueli Institute Uncovers the Science of Healing INDIVIDUALS RESEARCH WARFIGHTERS INNOVATION SYSTEMS EDUCATION

  4. 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.

  5. 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

  6. 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 empowerindividuals 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.

  7. 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

  8. 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

  9. What do Guidelines recommend? • Program design and development • Program implementation • Program evaluation • Privacy and confidentiality considerations

  10. 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

  11. “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

  12. Military Mind-Body Program Evaluation

  13. Evaluating a Patient- and Family-Centered Mind-Body Military Program

  14. 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

  15. Using a Mixed-Methods Approach

  16. Quantitative Results:Outcome Measures

  17. PTSD and Depression Symptom Improvement (N=226)

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

  19. Treatment Motivation QuestionnaireInternalized Reasons 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.

  20. Treatment Motivation QuestionnaireHelp Seeking Pre-Intervention 4 Weeks Post-Intervention • 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.

  21. Treatment Motivation QuestionnaireConfidence Pre-Intervention 4 Weeks Post-Intervention • 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.

  22. Qualitative Results: Findings from Experiential Evidence

  23. Qualitative Results: Findings from Experiential Evidence • THEMES: • Quality of Care • Providers • Treatments • Environment • Command Support • Stigma • Treatment Modalities • Reiki • Art • Massage • Yoga/Movement • Individual • Groups • InVivo

  24. Qualitative Results: Findings from Experiential Evidence • 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

  25. Qualitative Results: Findings from Experiential Evidence • 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

  26. Qualitative Results: Findings from Experiential Evidence • 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

  27. Themes from Interviews

  28. LESSONS LEARNED

  29. 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

  30. 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

  31. Patient and Family Involvement

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

  33. “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 “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 ACCESS GUIDELINES: www.SamueliInstitute.org/Guidelines

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