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Better Coordination of Psychological Health, TBI Programs For Military Needed

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I see a lot of traumatic brain injuries (“TBI”) in my practice. Most are caused by workplace accidents and vehicle crashes. As one might expect, those brave men and women who serve in our armed forces are also at risk of TBI and psychological injury.

While researching TBI treatment recently I came across a press release about a study by the Rand Corporation addressing the need for better treatment programs for the military. It seems an appropriate topic for Veterans Day:

More than 200 programs are available to help U.S. military members and their families with psychological health and traumatic brain injury issues, but better coordination of those efforts is needed, according to a new RAND Corporation study.

The RAND project compiled the first comprehensive catalog of programs sponsored or funded by the Department of Defense to aid military members and their families with psychological health or traumatic brain injury issues. The work was sponsored by the assistant secretary of defense for health affairs and the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.

“The good news is, there are a lot of programs to assist military service members who are dealing with such psychological health issues as post-traumatic stress disorder or major depression, or the short- and long-term psychological and cognitive consequences of a traumatic brain injury,” said Robin M. Weinick, the study’s lead author and a senior social scientist at RAND, a nonprofit research organization.

“But our work suggests that there is significant duplication of effort, both within and across branches of service,” Weinick said. “To better care for military service members, the Department of Defense needs a centralized evidence base to better track which approaches work, which ones are less effective and which programs need more resources.”

Between 2001 and the end of 2010, more than 2.2 million military members were deployed in Iraq and Afghanistan. Despite the recent drawdown in Iraq, the high operational tempo of the past decade, longer deployments and more-frequent redeployments have resulted in significant mental health problems among some service members.

The RAND study is the first to fully catalog all support programs for psychological health and traumatic brain injuries, as well as assess how such efforts compliment traditional service providers and routine care. The study identified 211 programs, but found no single source within the Department of Defense or service branches that maintains a list of these programs or tracks new program development.

RAND researchers said the Department of Defense should conduct a comprehensive needs assessment to identify how many service members and family members require services, what their characteristics are, what types of assistance they need and where they are located. The department should then identify how well programs are meeting those needs, what opportunities exist to improve current programs and where the need exists to develop new programs.

The RAND study also recommends the Department of Defense identify a central authority responsible for coordinating programs between service branches and within the Office of the Secretary of Defense. That central authority also would handle efforts toward evaluating program effectiveness and the continued tracking of these programs.

“The effectiveness of these programs is not being consistently evaluated,” said Carrie Farmer, a study co-author and a RAND associate policy researcher. “Fewer than one-third of the programs in any branch of service reported having an evaluation to assess their effectiveness in the past 12 months.”

Other recommendations from the study include:

  • Establish clear and strategic relationships between programs and existing clinical care systems.
  • Examine existing gaps in routine service delivery that could be filled by programs.
  • Evaluate and track new and existing programs and use evidence-based interventions to support program efforts.

The study, “Programs Addressing Psychological Health and Traumatic Brain Injury Among U.S. Military Servicemembers and Their Families" can be found at www.rand.org. Other authors of the study include Ellen Burke Beckjord, Laurie T. Martin, Emily M. Gillen, Joie D. Acosta, Michael P. Fisher, Jeffrey Garnett, Gabriella Gonzalez. Todd C. Helmus, Lisa H. Jaycox, Kerry A. Reynolds, Nicholas Salcedo and Deborah M. Scharf.

Research for the study was conducted jointly by the Center for Military Health Policy Research, a RAND Health program, and the Forces and Resources Policy Center, a RAND National Defense Research Institute program.