Showing posts with label pain management. Show all posts
Showing posts with label pain management. Show all posts

Tuesday, August 7, 2012

What are Some of DoD's Specialized Care Programs for Chronic Illnesses and PTSD?

Specialized Care Program (SCP) Track I


What Is It?

The SCP Track I is an intensive treatment program designed to address persistent disabling symptoms attributed by service members to deployment or other military exposure. It features three-weeks of multidisciplinary treatment of patients in small groups of three to eight individuals.

The program is based upon internationally recognized centers for management of chronic illness. It provides state-of-the-art care for those suffering from multiple symptoms such as:
Fatigue
Headache
Digestive Problems
Weight Gain
Joint Pain
Skin Rash
Memory Problems
Weight Loss



The Program's Goals
  • Improve conditioning and decrease symptoms via a gradual, paced physical reactivation program.

  • Provide opportunities to improve work performance and other activities of daily living.

  • Promote overall well-being, symptom reduction, improved coping and decreased healthcare utilization through the practice of positive health behaviors and skills.

  • Actively involve each participant in creating an individualized symptom management plan.

What Type of Care Is Provided?

The Specialized Care Program is designed to meet each participant's needs at a variety of levels. In addition to treatment of physical symptoms, there are interventions to assist in dealing with the stressors which accompany chronic pain and chronic illness such as loss of former abilities, strain on relationships, and transition from the military.
This program provides carefully coordinated delivery of care that takes into account many medical perspectives.

SCP Track I patients work closely with an internist and a health psychologist. Other members of the health care team include a, physical therapist, nurse, clinical social worker, and a nutritionist. A range of other medical specialists are also available depending on a patient's medical needs. 

The Program includes:
  • A thorough review of medical history and past diagnostic testing with an internist
  • Education regarding symptoms and personal health care management
  • Support and education for family members
  • Group and one-on-one meetings to discuss the impacts of physical symptoms, life stressors, and military experiences
  • Information regarding benefits for veteran
Who Can Participate?

The SCP Track I is available to members of all armed services and components, as well as to family members affected by persistent symptoms. The Specialized Care Program emphasizes treatment over evaluation.

Prior to admission to the Specialized Care Program, each person's medical record is extensively reviewed by a multidisciplinary team of healthcare professionals. The purpose of this review is to determine whether or not the Specialized Care Program would be an appropriate treatment


What Is the Specialized Care Program SCP Track II?

  • Intensive, three-week, multi-disciplinary treatment program for patients with deployment-related stress, Post Traumatic Stress Disorder (PTSD) and/or difficulties adjusting to re-deployment

  • Comprehensive program designed to accommodate a need for treatment of operational stress and PTSD associated with recent combat deployments

  • Focus on supportive treatment for service members from OEF/OIF with difficulties readjusting upon return who attribute concerns to operational stress or other operational issues and:
    • Assistance through other treatment venues has been unsuccessful or

    • Treatment resources at local and specialty care settings under existing standards of care have been exhausted or

    • Treatment resources at local and specialty care settings are not available to meet the specific treatment needs of the patient and

    • Patient continues to experiences difficulties in functional status and quality of life.

  • Designed to prevent chronic PTSD which creates higher usage of medical/behavioral health resources

  • Designed to reduce co-morbid health concerns such as depression, substance abuse, and domestic violence which contribute to high utilization of healthcare services
What Type of Care Is Provided by the SCP Track II?
  • Each SCP-Track II treatment plan is designed to meet individual patient needs

  • An internist evaluates/provides needed medical treatment for physical symptoms

  • Program teaches patients strategies to deal with the physiological, behavioral, emotional, and cognitive effects of stress/trauma and their resultant consequences on social, occupational, emotional, and interpersonal functioning and quality of life

  • Treatment program is group oriented, with three to eight individuals going through 3 week program as a group in order to facilitate trust and mutual support
What Are the Key Elements of Care for SCP Track II?
  • Behavioral health and self-care strategies and treatment modalities including:
    • Cognitive-behavioral therapy

    • Group exposure therapy

    • Physical reactivation

    • Stress management (relaxation training, massage therapy, yoga and acupuncture)

    • Educationally-based self-care focus with relapse prevention follow up

    • Multiple phone call follow up contacts for 10 months with clinician to secure improvements

    • Functional status emphasis and return to duty

  • Multi-disciplinary staff (physician, psychologist, social worker, nurse, physical therapist)

  • Structured, day-hospital milieu, 0730 - 1600 for three weeks, Mon.- Fri.

  • Ease of access to other referral sources within the Walter Reed National Military Medical Center (WRNMMC) system

How Are People Referred to the Program?
  • Military health system clinicians can refer patients meeting admission criteria to the program
    • Patients must be ambulatory and capable of some exercise

    • Patients musts be stable enough for independent functioning

  • Referral must include evaluation by a mental health professional to rule out significant co-morbid mental illness, e.g., psychosis, suicidality, active substance abuse

  • For healthcare facilities lacking evaluation assets, referrals for evaluation may be made to DHCC Ambulatory Care Program

  • The individual's command must approve program attendance

  • For additional referral information click here.




Thursday, August 2, 2012

CDC: Military Veterans Report Poorer Health

Disparities More Pronounced Beginning at Age 45
Aug. 2, 2012 -- People who served in the military carry a heavier health burden than non-veterans. According to a CDC report released today, veterans are significantly more likely to have two or more chronic diseases, such as diabetes, heart disease, and high blood pressure, as well as other health problems.
Nearly 1 in 5 vets between the ages of 45 and 54 reported at least two chronic conditions compared to less than 15% of non-veterans. Close to 1 in 3 former service members who are 55 to 64 said they had more than one chronic disease compared to one-quarter of men who never served.
"The effects of military service on physical and psychological health, especially after extended overseas deployments, are complex," write the researchers. "There may also be long-term consequences of military service for the health and health care utilization of veterans as they age."
The report was produced by the National Center for Health Statistics, a division of the CDC. It draws on data from the 2007-2010 National Health Interview Survey, and it covers veterans aged 25 to 64, directly comparing their health with that of non-veterans.
"Overall," the researchers write, "veterans aged 25-64 appear to be in poorer health than non-veterans, although not all differences in health are significant for all age groups."

Age Differences and Health

While younger veterans -- those aged 25 to 34 -- showed few differences with their non-veteran counterparts, some significant disparities appear as they get older.
"The health differences that appear at older ages suggest that the effects of military service on health may appear later in life," the researchers write.
Starting at age 35, veterans report having more work problems related to physical, mental, or emotional issues. As a group, 18% of veterans report that such problems limit the type or amount of work they can do, compared to 10% of non-veterans. This was especially pronounced among vets between the ages of 45 and 54.
Veterans in that latter age group were also more likely to report other serious health problems. While veterans in general described their health as fair or poor more often than men who never served (16% compared to 10%), those between 45 and 54 were the most likely to do so.

Psychological Distress

Serious psychological distress also struck 45- to 54-year-old veterans with greater frequency than other age groups. They were the only age group to report significantly higher amounts of such distress -- defined by the researchers' as "unspecified but potentially diagnosable mental illness" -- compared to non-veterans.
The researchers note that this report only considers "people with the most severe psychological distress. Other measures of mental health that capture a wider range of mental disorders might show more differences between veterans and non-veterans."
Nearly 9 out of 10 surveyed men who served in the military carry health insurance. That's significantly higher than non-veterans, and, the authors write, it "may influence their access to health care and the likelihood of being diagnosed with various conditions."

Wednesday, July 18, 2012

Veterans' Health: Beyond PTSD and Traumatic Brain Injury

By: Margaret Stone
The Huffington Post


Over the past decade, the Department of Veterans Affairs and Department of Defense have expanded their efforts to meet the mental health needs of our service men and women. In particular, a better understanding of post-traumatic stress and traumatic brain injury (TBI) has led to major changes in how the healthcare community addresses veterans' needs.
But the intense focus on PTSD and brain injuries can mask deeper, more complex problems. Beyond the physical and psychological trauma lies an inextricably linked group of behavioral and physical health issues -- drug and alcohol addiction, chronic pain and depressive disorders. They're all serious medical conditions, and too often they're overlooked or untreated.
Alcohol abuse is the most prevalent problem among U.S. military personnel and one that poses a significant health risk, according to the National Institute on Drug Abuse (NIDA). Twenty-seven percent of Army soldiers screened three to four months after returning from deployment in Iraq met criteria for alcohol abuse, according to an April 2011 study. Alcohol abuse puts these vets at increased risk for other harmful behaviors such as drunk driving, drug use and suicide.
Veterans often self-medicate with alcohol or drugs to push down the painful memories, fight insomnia and dull the physical pain. Those serving in Iraq and Afghanistan also face multiple deployments and less "dwell" time at home to recuperate and reconnect with their communities and families.
Today, chronic pain is a leading cause of disability among military personnel. While TBI and concussive brain injuries capture today's headlines, other combat wounds and "wear-and-tear" injuries from heavy equipment and grueling patrols still account for a majority of disability cases. That in turn has sparked a wave of prescription-medication addiction among vets -- the unintended consequence of modern medicine's reliance on powerful narcotics to manage both acute and chronic pain.
The military has slowly begun to recognize the value of alternative, non-narcotic therapies for pain management. A May 2010 report by the Pain Management Task Force makes numerous recommendations for alternative therapies in conjunction with pain physicians such as acupuncture, chiropractic care, massage and occupational therapy. Realistically, though, all of these therapies require long-term commitment and support -- hence the beckoning "quick fix" of the prescription pad.
Undiagnosed and untreated PTSD and TBI are in many cases accompanied by depressive disorders, which can be as crippling as the physical wounds a veteran may bear. Depression, moodiness, lethargy and sleeplessness all play a part in these conditions. Without treatment, many veterans self-medicate to seek the mental peace and quiet they find so elusive.
The government and VA have begun to address these complex issues. Under General Peter W. Chiarelli, the Army has made significant strides in preventive measures, programs and support for our troops and how best to address brain injuries. A recent study, "Army 2020: Generating Health and Discipline in the Force Ahead of the Strategic Reset Report 2012," lays out a comprehensive analysis of the behavioral and physical health needs of our troops.