Life Transitions from Military to Civilians: Modeling Public Policy Implications

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Life Transitions from Military to Civilians
Modeling Public Policy Implications

• Alexander V. Libin, PhD Manon M. Schladen, Ed,
  Julie C. Chapman, PhD, Banks Nathaniel,BS, Miriam
  I. Philmon, BS, Sunil Sen-Gupta, PhD.
• Georgetown University 2. MedStar Health Research
  Institute 3. George Washington University 4. DC
  VAMC, Washington, DC, USA
• Email Alexander.Libin_at_MedStar.net

Improving the Effectiveness of Public
Services APPAM, Moscow, June 28-29, 2011
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LIFE TRANSITIONS
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LIFE TRANSITIONS FOR VULNERABLE POPULATIONSFROM
REHABILIATION TO COOMMUNITY INTEGRATIONInterdisci
plinary Psychosocial Research Program
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Based on the course
Objectives
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In 2007, the Defense Centers of Excellence for
Psychological Health and Traumatic Brain Injury
was founded as a historical partnership between
DoD and the VA.
PSYCHOLOGICAL HEALTH A DEFINITION
Message from the Secretary "As we mark the 85th
year of VA's research program, we celebrate our
innovative researchers who helped turn so many
hopes into realities. VA's forward-looking
contributions to medical research continue to
bring life-improving treatments and
pharmaceuticals to our Veterans and the nation.
We will maintain our steadfast commitment to lead
the way as we transform VA into a 21st century
organization." Eric K. Shinseki, Secretary,
Department of Veterans Affairs
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COMMUNITY INTEGRATION A DEFINITION
Community-integration oriented rehabilitation
focuses not only on reducing typical problems
with behavioral disinhibition or initiation
(executive function), but also on redeveloping
social skills, basic problem-solving, safety
awareness, and the abilities required for a
specific job (RRD, March, 2010).
VA Centers for Excellency objectives
(4) Social Reintegration and Vocational-Work
Rehabilitation. Research in these high priority
areas is encouraged in the following domains for
veterans with all types of disabilities (a)
Development of appropriate outcome measures to
determine the efficacy of interventions with
disabled veterans (b) Development of
empirically validated interventions that optimize
enduring work participation for disabled
veterans and (c) Maximization of social,
economic and personal well-being using
appropriate validated outcome measures.
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LIFE TRANSITIONS FROM MILITARY TO CIVILIAN
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• The main research and training goals of the
  proposed District of Columbia Collaborative
  Network for Community Integration and
  Psychological Health in Homeless Veterans
  (COMPASShome) are
• to establish new practices and enhance services
  related to the timely detection and management of
  Post-traumatic Stress Disorder (PTSD) and
  Traumatic Brain Injury (TBI) in homeless Veterans
• to promote Veterans psychological health
• to foster Veterans reintegration back into the
  community
• The main collaborative mechanism is
• interdisciplinary research and training program
  which is a network comprised of top-ranked
  rehabilitation research (National Rehabilitation
  Hospital, MedStar Health Research Institute,
  National Institutes of Health) and academic
  (Georgetown University, Uniformed Services
  University of the Health Sciences, Catholic
  University of America) facilities.

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Variety of research designsStandardization vs.
Inclusiveness vs. Flexibility
Experiment/RCT
Synthesis and Translation
A Comparative Effectiveness
Research
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Why Do Unmet Needs Exist?
Abnormal conditions
Individual needs

• Physiological - pain, agitation, physical
  discomfort
• Safety - uncomfortable environmental conditions
• Love and belonging - need for social contacts
• Esteem- type of stimulation
• Self-actualization - level of stimulation

• Unable to communicate needs
• Unaware of needs of self
• Unable to use prior coping mechanisms
• Unable to obtain the means for meeting the needs
• Environment does not comprehend the needs
• Environment does not provide the needs

Libin, Alexander Differential Psychology 5ed,
2009 580 pp.
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NON-MEDICAL CARE MODEL Transitional
AspectsCoordinating communication between
providersFrequent follow-ups with families and
discharge plannersMedication remindersTranspor
tationADL assistance
TRANSITION OF CARE FROM HOSPSITAL TO HOME
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Psychosocial and Edutainment Interventions for
Patients with Neurologic Trauma
Health educators and social networks
Individuals with acute subacute neurologic
trauma
Clinicians, advocates, and policymakers
Health care professionals
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MONITORING Computerized Motor Performance
Assessment of Executive Dysfunction (COMPASSED)
The COMPASSED platform will employ a computerized
assessment of executive functioning based on dual
cognitive-motor tasks performance in people with
neurologic impairments such as Traumatic Brain
Injury and Spinal Cord Injury, Stroke, and
Parkinsons disease.
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Case Studies of eHealth2go
Personal Health Record Technology as a Tool for
Spinal Cord Injury Health Self-Management

• Goals
• To explore the general utility and usability of a
  personal health record (PHR) in meeting the
  health-related information needs of persons with
  spinal cord injury (SCI)
• To explore information formats and PHR
  applications that may be of specific use to
  persons with SCI in
• Obtaining cardiometabolic risk screening
• Self-managing diet for the prevention of obesity
  and cardiometabolic syndrome
• Self-managing skin health and prevention of
  pressure ulcers
• Methods
• Design Case Study Series
• Location National Rehabilitation Hospital and
  participants homes in the Baltimore/Washington
  DC metropolitan area.
• Participants 12 ethnically and racially diverse
  individuals of both genders with SCI representing
  various levels of education and health literacy
• Process
• Health Information Needs Assessment
• Custom PHR Development
• Uses MedStar eHealth2go and Microsoft HealthVault
• PHR Use
• PHR Evaluation

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HEALTHCARE NAVIGATOR FRAMEWORK
Sensitive adjustment Based on individual
profile (preferences, needs, and abilities)
Testing module
NAVIGATOR
Educational module
Personal improvement through training of learning
processes
Communication module
Entertainment-at-hands as a form of communication
This project is funded by NIDRR grant
H133N060028, The National Capital Spinal Cord
Injury Model System
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HEALTHCARE NAVIGATOR FRAMEWORK
ADL activities
NAVIGATOR
Self-monitoring
Community Integration
This project is funded by NIDRR grant
H133N060028, The National Capital Spinal Cord
Injury Model System
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Role-playing Simulation as an Educational Tool
for Health CarePersonnel Developing an Embedded
Assessment Framework
Mixed methodology pre-post intervention
research design
Libin A, Lauderdale M, Millo Y, Shamloo C,
Spencer R, Green B, Donnellan J, Wellesley C,
Groah S. Role-Playing Simulation as an
Educational Tool for Health Care Personnel
Developing an Embedded Assessment Framework.
Cyberpsychol Behav. and Social Network, 3, 2010
NIDRR grant H133B031114, the Rehabilitation
Research and Training Center on Secondary
Conditions
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CER future developments The VA Rehabilitation
Research
Nor is there one way of
knowing, science there are many such
ways...Science itself has conflicting parts with
different strategies, results, metaphysical
embroideries...(p.143) Paul Feyerabend, Killing
Time (1995)

• Building the evidence base is an iterative
  process involving exploratory and confirmatory
  steps
• Research is context-bound experimental research
  conducted in the laboratory produces different
  types of evidence than field experiments or
  experiential research
• Rehabilitation Research is population-bound

Campbell et al., BMJ 2007, 455-459
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CER future developments The VA Rehabilitation
Research

• Research Design
• Participatory strategies (think about who is
  representative reflect what participatory
  means)
• Mixed method strategies and designs
• Sampling
• Going outside known channels use wider community
  outlets
• Think social exclusion in broader terms

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CER future developments The VA Rehabilitation
Research

• Critical appraisal of what constitutes evidence
• Facilitating communication between basic,
  clinical and applied research
• Greater public involvement in the research
  process
• Replacing traditional linear models of knowledge
  translation with iterative and interactive models
  of knowledge diffusion
• Moving from evidence-based to
  evidence-influenced understanding of knowledge
  production
• Examination of the contextual, situational and
  personal factors that determine clinical decision
  making

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ACKNOWLEDGEMENTS
Supported in part by the Medstar Health Research
Institute, a component of the Georgetown-Howard
Universities Center for Clinical and
Translational Science (GHUCCTS) and supported by
Grant U54 RR026076-01 from the NCRR, a component
of the National Institutes of Health (NIH). Its
contents are solely the responsibility of the
authors and do not necessarily represent the
official views of NCRR or NIH. Supported in
part by the NIDRR grant H133B031114,
Rehabilitation Research and Training Center on
SCI Promoting Health and Preventing
Complications through Exercise, and by NIDRR
grant H133N060028, The National Capital Spinal
Cord Injury Model System
Collaborators and Sponsors
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THANK YOU!
TO BE CONTINUED.
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