These challenges may contribute to a longer time to reassess treatment response, adjust therapy, and achieve remission. Given the relative success in face of the challenges presented, and the need to address the increased mental health burdens of the ongoing U. These sites are funded to participate in training to prepare them to train others and to hire one or two nurse care facilitators and an administrative assistant for local quality assurance.
Tools and educational pieces are available online to all Army primary care and behavioral health providers who may not work at one of the clinics designated to implement the program or equipped with a dedicated care facilitator. Google Scholar. Am J Epidemiol ; 3 : — Google Preview. Mental disorders among U. Am J Psychiatry ; 9 : — JAMA ; 9 : — Am J Psychiatry ; 1 : — 3. Preventive Services Task Force Screening for depression: recommendations and rationale. Ann Intern Med ; 10 : — 4.
JAMA ; 10 : — National Quality Management Program. GAO, 1— Engel CC Improving primary care for military personnel and veterans with posttraumatic stress disorder—the road ahead. Gen Hosp Psychiatry ; 3 : — Am J Psychiatry ; 11 : — JAMA ; Arch Intern Med ; 21 : — Gen Hosp Psychiatry ; 2 : 91 — Arch Gen Psychiatry ; 5 : — A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder.
Arch Gen Psychiatry ; 3 : — 8. JAMA ; 12 : — Primary care clinicians treat patients with medically unexplained symptoms: a randomized controlled trial. J Gen Intern Med ; 7 : — 7. A randomized trial of buprenorphine maintenance for heroin dependence in a primary care clinic for substance users versus a methadone clinic.
Psychosomatics ; 6 : — BMJ ; : A fidelity measure for integrated management of depression in primary care. Med Care ; 11 : — 7. J Gen Intern Med ; 9 : — J Gen Intern Med ; 7 : — Prim Care Psychiatry ; 1 : 9 — J Am Board Fam Pract ; 2 : — Psychiatr Q: ; 1 : 45 — Med Care ; 12 : J Affect Disord ; 1 : 61 — 6. Cost-effectiveness of a collaborative care program for primary care patients with persistent depression.
Am J Psychiatry ; 10 : — Cost-effectiveness of improving primary care treatment of late-life depression. Arch Gen Psychiatry ; 12 : — Incremental cost-effectiveness of a collaborative care intervention for panic disorder. Psychol Med ; 3 : — Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Search Menu.
Article Navigation. Close mobile search navigation Article Navigation. Volume Oxford Academic. Thomas Oxman, MD. Sheila Barry, BA. Box , Newbury, NH Patrice Stewart, PhD. John W.
Allen J. Dietrich, MD. Cite Cite Charles C. Select Format Select format. She used her Facebook promotional posts to let customers know Unangst Tree Farm was a drop-off point for items that would go into the stockings and be shipped to troops overseas.
Last year, the donations dropped off at the Unangst farm doubled - two truck loads of items were donated. A wish list is published each year by the KMF group to help structure the donations. Included are snack items such as power bars, crackers, cookies, seed and nut packets and other comfort items.
The holiday packages go to all branches of the military and to locations in Afghanistan, Kuwait, Iraq, ships at sea and any other troop locations that request support from home. This year, KMF is also requesting monetary donations due to the COVID pandemic, seeing that as a way to offset diminished activities associated with former drop-off points that are more restrictive this year.
Organizers intend to use the funds to buy needed items in bulk and make it easier to sanitize large boxes containing the Christmas stockings full of personal items for the troops.
In addition, localized monitoring may facilitate more real-time and personalized feedback, which is more challenging to conduct when the monitoring of all Army sites is centralized. Ongoing evaluations of the relative merit and impact of different monitoring strategies e. The real-world implementation of RESPECT-Mil in Army primary care settings is comparable to other collaborative care efforts that are often conducted under more tightly controlled research conditions.
Challenges included establishing initial contact with service members on referral to the program, procuring service member engagement in the full course of recommended treatment, obtaining provider buy-in, provider time constraints and competing demands, and the provision of oversight and accountability to program fidelity. Factors that facilitated the implementation of RESPECT-Mil included valuing routine screening for depression and PTSD as an effective way to reach service members who may otherwise fall through the cracks; behavioral health champions' support and consultations with primary care providers; and solid linkages between primary care providers and care facilitators.
Our findings highlight key junctures where opportunities for engaging service members in needed treatment for depression or PTSD may be improved. Potential avenues for improving program fidelity include increasing the comfort of primary care providers and incentives to address depression and PTSD within primary care settings, ensuring warm handoffs between the initial primary care referral and the care facilitator in order to protect against dropouts, equipping providers with additional skills and strategies to improve treatment engagement, and providing individualized provider performance feedback.
Even if perfect program fidelity were achieved, barriers such as stigma and lack of leadership support for recommended treatment plans are unlikely to be completely overcome without corresponding increases in organizational and policy support.
Recommendations issued in this report are targeted at the provider, clinic administration, and military organizational levels on how to improve the implementation of primary care collaborative care programs aimed at enhancing mental health care.
Archer, J. Bower, S. Gilbody, K. Lovell, D. Richards, L. Gask, C. Dickens, and P. Chaney, E. Rubenstein, C. Liu, E. Yano, C. Bolkan, M. Lee, B. Simon, A. Lanto, B.
Felker, and J. Craske, Michelle G. Rose, Ariel J. Dietrich, Allen J. Oxman, John W. Williams Jr. Schulberg, Martha L. Bruce, Pamela W. Lee, Sheila Barry, Patrick J.
Raue, Jean J. Engel, Charles C. Williams, and Allen J. Felker, Bradford L. Rubenstein, Laura M. Bonner, Elizabeth M. Yano, Louise E.
Parker, Linda L. Worley, Scott E. Fortney, John C. Pyne, Mark J. Edlund, David K. Williams, Dean E. Robinson, Dinesh Mittal, and Kathy L.
Frayne, Susan M. Chiu, Samina Iqbal, Eric A. Berg, Kaajal J. Glasgow, Russell E. Vogt, and Shawn M. Hedrick, Susan C. Schell, Terry L. Tanielian and Lisa H. Jaycox, eds.
Schnurr, Paula P. Friedman, Thomas E. Oxman, Allen J. Dietrich, Mark W. Thota, Anilkrishna B. Byard, Carlos S. Zometa, Robert A. Hahn, Lela R. McKnight-Eily, Daniel P. Chapman, Ana F. Abraido-Lanza, Jane L. Pearson, Clinton W. Anderson, Alan J. Gelenberg, Kevin D. Hennessy, Farifteh F. Duffy, Mary E. Vernon-Smiley, Donald E. Nease Jr. Weinick, Robin M. Farmer, Laurie T. Martin, Emily M. Gillen, Joie Acosta, Michael P. Fisher, Jeffrey Garnett, Gabriella C. Gonzalez, Todd C.
Helmus, Lisa H. Wells, Kenneth B. Carney, and Lisa V. However, this was not possible given that the program had already been implemented throughout most of the Army installations before the start of the evaluation. This evaluation naturalistically investigated changes in clinical symptoms and functioning to examine the impact of the program on participants. The final disposition of visits in which a probable diagnosis is identified is not tracked and thus is not provided in this article.
Eunice C. Jaycox , et al. Of the primary care visits made from August to March , 93 percent , included screens for PTSD and depression.
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