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: Alexander.Libin@MedStar.netEmail: Alexander.Libin@MedStar.net

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….