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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. - PowerPoint PPT Presentation
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Life Transitions from Military to Civilians: Life Transitions from Military to Civilians: Modeling Public Policy ImplicationsModeling Public Policy Implications
Alexander V. Libin, PhDAlexander V. Libin, PhD; Manon M. Schladen, Ed, Julie C. Chapman, PhD, ; Manon M. Schladen, Ed, Julie C. Chapman, PhD, Banks Nathaniel,BS, Miriam I. Philmon, BS, Sunil Sen-Gupta, PhD.Banks Nathaniel,BS, Miriam I. Philmon, BS, Sunil Sen-Gupta, PhD.
1.1. Georgetown University; 2. MedStar Health Research Institute; 3. George Georgetown University; 2. MedStar Health Research Institute; 3. George Washington University; 4. DC VAMC, Washington, DC, USAWashington University; 4. DC VAMC, Washington, DC, USA
Email: [email protected]: [email protected]
Improving the Effectiveness of Public Services
APPAM, Moscow, June 28-29, 2011
LIFE TRANSITIONS
LIFE TRANSITIONS FOR VULNERABLE POPULATIONS:LIFE TRANSITIONS FOR VULNERABLE POPULATIONS:FROM REHABILIATION TO COOMMUNITY INTEGRATIONFROM REHABILIATION TO COOMMUNITY INTEGRATION
Interdisciplinary Psychosocial Research ProgramInterdisciplinary Psychosocial Research Program
Based on the course:Objectives
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
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 (RR&D, March, 2010).
(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.
VA Centers for Excellency objectives:
LIFE TRANSITIONS: FROM MILITARY TO CIVILIANLIFE TRANSITIONS: FROM MILITARY TO CIVILIAN
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.
Variety of research designs:Standardization vs. Inclusiveness vs. Flexibility
Standardization
-Sampling
-Data collection
-Data analysis
Diversity of
-Impairments
-Environments
-Accommodation needs/Interventions
Experiment/RCTSurvey/Correlational Designs Qualitative/Ethnography
Mixed Method Designs
Synthesis and Translation: A Comparative Effectiveness
Research
Longitudinal/ Repeated Measures
Why Do Unmet Needs Exist?
– 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
Individual needs Abnormal conditions
Libin, AlexanderDifferential Psychology5ed, 2009 – 580 pp.
NON-MEDICAL CARE MODEL: NON-MEDICAL CARE MODEL:
Transitional AspectsTransitional Aspects
Coordinating communication Coordinating communication between providersbetween providers
Frequent follow-ups with families Frequent follow-ups with families and discharge plannersand discharge planners
Medication remindersMedication reminders
TransportationTransportation
ADL assistanceADL assistance
TRANSITION OF CARE: FROM HOSPSITAL TO HOMETRANSITION OF CARE: FROM HOSPSITAL TO HOME
Psychosocial and Edutainment Interventions for Psychosocial and Edutainment Interventions for Patients with Neurologic TraumaPatients with Neurologic Trauma
RRTCResearchers
Consumers with Neurologic Disorders
T1: P
reve
ntion
of s
econ
dary
com
plica
tions
T2: Education on barriers to health care,
secondary conditions, exercise,
and comm
unicationT3:
Sta
te o
f the
Scie
nce
Confe
renc
e
Preve
nting
seco
ndar
y con
dition
s to
achie
ve
healt
hy liv
ing w
ith S
CI - R
esea
rch
findin
gs
and
innov
ative
train
ing co
ncep
ts
T4: Virtual resource network on
exercise and prevention of
secondary conditionsIndividuals with acute &
subacute neurologic trauma
Health care professionals
Health educators and social networks
Clinicians, advocates, and policymakers
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 Parkinson’s disease.
MONITORING: Computerized Motor Performance Assessment of Executive
Dysfunction (COMPASSED)
Case Studies of eHealth2go
• 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
Personal Health Record Technology as a Tool for Spinal Cord Injury Health Self-Management
HEALTHCARE NAVIGATOR FRAMEWORKHEALTHCARE NAVIGATOR FRAMEWORK
Sensitive adjustmentBased on individual profile(preferences, needs, and abilities)
Personal improvement throughtraining of learning processes
Entertainment-at-hands asa form of communication
NAVIGATOR Educational module
Communication module
Testing module
This project is funded by NIDRR grant H133N060028, The National Capital Spinal Cord Injury Model System
HEALTHCARE HEALTHCARE NAVIGATOR NAVIGATOR FRAMEWORKFRAMEWORK
NAVIGATOR Self-monitoring
Community Integration
ADL activities
This project is funded by NIDRR grant H133N060028, The National Capital Spinal Cord Injury Model System
NIDRR grant #H133B031114, the Rehabilitation Research and Training Center on Secondary Conditions
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
• 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
“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)
Campbell et al., BMJ 2007, 455-459
CER future developments: CER future developments: The VA Rehabilitation ResearchThe 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
CER future developments: CER future developments: The VA Rehabilitation ResearchThe 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
CER future developments: CER future developments: The VA Rehabilitation ResearchThe VA Rehabilitation Research
ACKNOWLEDGEMENTSACKNOWLEDGEMENTSSupported 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 Collaborators and Sponsorsand Sponsors
THANK YOU!THANK YOU!
TO BE CONTINUED….TO BE CONTINUED….