Category Archives: network literacy

Seamless Transition Committee: A Model for Providing Coordinated Care

Jay Morse & Heidi Radunovich, PhD

Creative Commons [Flickr, Veteran, October 4, 2008]
Creative Commons [Flickr, Veteran, October 4, 2008]
Veterans returning from combat deployment who are seeking health care can be faced with complicated treatment plans. One Veteran’s Affairs health care center has implemented a “Seamless Transition Committee (STC)” which allows for complex cases to be presented to a multi-disciplinary team for feedback and coordination of care. The STC is composed of leaders from a wide range of disciplines and includes: the chief psychologist; program managers; the suicide prevention coordinator; and the medical director of the Post-Deployment Primary Care Clinic. In a typical case, the STC team members would discuss the case background, establish treatment priorities, and agree to treatment recommendations. Review meetings are scheduled for one hour each week at the same time and location.

Results of the program evaluation conducted by Mallen, Schumacher, Leskela, Thuras, and Frenzel [1] suggest that this is a promising model. Over the 3 year study, 149 veteran’s cases were reviewed by the Seamless Transition Committee. Over 50% of the veterans in the STC program had at least 3 mental health diagnoses. The most common diagnoses included: (1) Depressive disorders (77.2%); (2) PTSD (62.4%); (3) Substance abuse (56.4%); (4) Anxiety disorder (44.3%); and (5) Personality disorder (20.1%). Over 40% of the veterans in the program were psychiatric inpatients at some time and over 60% participated in the facility’s Psychiatry Partial Hospitalization program (PPH).

A pre/post study analysis was conducted. Significant changes in service utilization were noted, including a significant decline in psychiatric hospitalization rates. Overall:

  • Visits to mental health clinics increased.
  • PPH utilization remained approximately the same.
  • Inpatient psychiatric hospitalization rates declined from 24.7% to 8.2%.
  • There were no significant changes in emergency room or primary care utilization rates.

The researchers noted that as veterans’ cases were presented at the STC, the veterans utilized outpatient services more often and used inpatient services less. The results of a staff survey indicated that the staff believed that veterans’ care was improved. These changes were attributed to expedited care received through the STC. The STC might provide a good model for other systems of care that wish to enhance collaboration among specialists, and provide more efficient care to patients.

Reference:

[1] Mallen, M., Schumacher, M., Leskela, J., Thuras, P., & Frenzel, M. (2014). Providing coordinated care to veterans of Iraq and Afghanistan wars with complex psychological and social issues in a department of veterans affairs medical center: Formation of seamless transition committee. Professional Psychology-Research and Practice, 45(6), 410-415. doi:10.1037/a0037755

This post was written by Jay Morse & Heidi Radunovich, PhD, members of the MFLN Family Development (FD) team which aims to support the development of professionals working with military families. Find out more about the Military Families Learning Network FD concentration on our website, on Facebook, on Twitter, YouTube, and on LinkedIn.

Trauma Therapists and Compassion Satisfaction

Jay Morse & Heidi Radunovich, PhD

Creative Commons [Flickr, Compassion International, March 16, 2008]
Creative Commons [Flickr, Compassion International, March 16, 2008]
Mental health professionals working with traumatized clients can experience excessive amounts of stress that may lead to compassion fatigue and burnout (link “Military Psychologists in a Combat Zone”).  In a recent publication, researchers Craig and Sprang [1] have included an often overlooked idea of compassion satisfaction as a possible outcome in their study of trauma therapists and compassion fatigue and burnout.

What is compassion satisfaction?

Compassion satisfaction is the feeling of gratification that can be derived from helping others or from care giving.  Compassion satisfaction is about helping others and deriving pleasure from knowing that you made a positive contribution to an individual’s well being.

In this study, a national sample of 532 clinical social workers and clinical psychologists who identified themselves as “trauma specialists” completed surveys measuring compassion fatigue, burnout, and compassion satisfaction.  Additionally, the participants responded to a measure of the use of evidence-based therapy practices.  Other variables considered in this study included age, gender, licensure, clinical experience, type of work organization, trauma training, and percentage of PTSD clients.  Gender and age distributions of the sample were comparable to national averages for clinical social workers and psychologists.  The mean age for the sample was 53 years with 23 years of experience.  Only 62% of the social workers and psychologists reported that they had specialized training in treatment of traumatized individuals.  Key findings of the study included:

  • Consistent with previous research, caseloads with a high percentage of traumatized clients may increase the risk for compassion fatigue and burnout.
  • Clinical experience was not a predictor of compassion fatigue (when considering all factors listed above) but was a predictor of compassion satisfaction. Age was not a significant predictor of compassion fatigue or compassion satisfaction.
  • Using evidence-based practices decreases the risk for compassion fatigue. Compassion satisfaction increased with use of evidence-based practices.
  • A lack of training in trauma-specific therapies was associated with burnout in clinicians working with traumatized individuals.

Overall, therapists who work with traumatized clients seem to be less vulnerable to burnout when they have received appropriate training in trauma treatment practices and are able to use them, and when they have a more balanced caseload related to trauma. Compassion satisfaction also seems to be a possible positive outcome among therapists who work with traumatized clients, and is also more likely for those who use evidence-based treatments, and for those who are more experienced practitioners.

References

[1]Craig, C. D., & Sprang, G. (2010). Compassion satisfaction, compassion fatigue, and burnout in a national sample of trauma treatment therapists. Anxiety, Stress, and Coping, 23(3), 319-339. doi:http://dx.doi.org/10.1080/10615800903085818

This post was written by Jay Morse & Heidi Radunovich, PhD, members of the MFLN Family Development (FD) team which aims to support the development of professionals working with military families. Find out more about the Military Families Learning Network FD concentration on our website, on Facebook, on Twitter, You Tube, and on LinkedIn.

Welcome to the Early Intervention Team

The Early Intervention Team is excited and honored to be joining the Military Families Learning Network (MFLN)’s Family Development Concentration Area. The goal of the Family Development Early Intervention (EI) team is to enhance the capacity of professionals working with military families who have young children (birth to 5 years old) with or who are at-risk for disabilities and developmental delays.

The inclusion of children with disabilities and their families into child care centers, schools, and communities expresses that each and every child and family is important and a valuable member to society. Successful inclusion of children with disabilities embodies many things including:

  • Providing access to programs, services, and activities for all children and families.
  • Encouraging participation and providing appropriate adaptations for individual children and families, as needed.
  • Providing support to programs and professionals to increase their skills to make inclusion successful and advocate for inclusion in their communities.
  • Using person-first language. Describing “a child with a disability” instead of “a disabled child” recognizes that children with disabilities are children first and more similar to other children than different. Learn more about person-first language here.

Learn more about inclusion from the Division of Early Childhood (DEC) of the Council for Exceptional Children here.

Support for children and families, as well as the professionals and communities that serve them, is necessary for successful inclusion. The EI team will provide information, training, and resources for military family providers such as early intervention providers, teachers, child care providers, new parent support members, and case managers.

Our EI team calls the University of Illinois in Urbana-Champaign home. Amy Santos and Micki Ostrosky are faculty members in the Department of Special Education in the College of Education at Illinois. They serve as the project leaders for the EI team. Kimberly Hile and Jenna Weglarz-Ward are doctoral students in special education with extensive experiences and expertise in programs and services for young children with disabilities and their families.

MFLN Family Development Early Intervention (EI) Team [J. Weglarz-Ward, January 27, 2015]
MFLN Family Development Early Intervention (EI) Team [J. Weglarz-Ward, January 27, 2015]
Collectively, we have accumulated close to 90 years of experience working with children with disabilities and their families. As a team, we have a long history of working together not only on undergraduate and graduate programs in special education and early childhood education but also on various state and national projects. We are all committed to supporting military family providers who can make a positive impact on the lives of young children with disabilities and their families. Collectively, our team brings a broad range of expertise in early childhood education, special education, and early intervention. Our team members have been teachers, administrators, evaluators, trainers and technical assistance providers, and consultants for early childhood programs. We have published peer-reviewed journal articles, book chapters, and in other publications including training modules, monographs, policy briefs, position papers, and guides. We serve on numerous boards, expert panels, commissions, and advisory groups at the local, regional, and national levels. We also present our research at various national, regional, and state conferences, meetings, and symposia. Additionally, we are all parents, with nine children among us ranging in age from 1 to 18 years old. Each of us has experienced the first-hand joys and struggles of parenting, child development, and special education.

In the coming months, military family providers will have access to resources, engage in conversations, and participate in trainings on topics such as:

  • Supporting social and emotional development of young children
  • Early warning signs and interventions for young children with Autism Spectrum Disorder and their families
  • Addressing challenging behaviors
  • Addressing daily and life transitions of young children in military families
  • Recommended practices in early childhood special education and early intervention

We are looking forward to being part of the MLFN community!

This post was written by Jenna Weglarz-Ward & Michaelene Ostrosky, PhD, members of the MFLN FD Early Intervention team, which aims to support the development of professionals working with military families. Find out more about the Military Families Learning Network FD concentration on our website, on Facebook, on Twitter, YouTube, and on LinkedIn.

Trauma Exposure, High Risk Behaviors and Functional Impairment

Jay Morse & Heidi Radunovich, PhD

Creative Commons Licensing [Flickr, Fluorescent Adolescent, November 20, 2010]
Creative Commons Licensing [Flickr, Fluorescent Adolescent, November 20, 2010]
According to recent research, 47% of children and adolescents exposed to trauma and traumatic loss reported attachment problems or functional impairments during adolescence in addition to other high risk behaviors including suicidality (24%), and substance abuse (20%)[1]. Using data collected by the National Child Traumatic Stress Network (NCTSN), Layne and colleagues studied the effects of cumulative exposure of up to 20 different types of trauma on a large group of adolescents [1]. Findings from the study indicated that the probability of 9 types of adolescent high risk behaviors and functional impairment increased incrementally with each type of trauma exposure in childhood and adolescence.

Layne, et al. (2014)

Adapted from Layne, et al. (2014)

A total of 3,785 of 14,088 participants contained in the Core Data Set (CDS) were selected for study. Criteria for selection for the study included: (1) reported at least one confirmed or suspected type of trauma, (2) completed indicators of high-risk behavior and demographic questionnaires, and (3) were between the ages of 13 to 18 years old at baseline. All participants had sought health services through providers associated with NCTSN.

Examining the links between trauma event types and problem behaviors was the primary goal of the study. With each type of trauma or loss exposure, the probability of adolescent high-risk behavior and functional impairment increased. Of particular note, participants in the study had an average of more than 4 types of trauma exposure during childhood and adolescence.

Adolescence is a critical time for development of healthy cognitive and emotional functioning. Identifying childhood trauma, and treating individuals can reduce problems in later life.

Reference

[1] Layne, C., Greeson, J., Ostrowski, S., Kim, S., Reading, S., Vivrette, R., . . . Pynoos, R. (2014). Cumulative trauma exposure and high risk behavior in adolescence: Findings from the national child traumatic stress network core data set. Psychological Trauma-Theory Research Practice and Policy, 6(Suppl 1), S40-S49. doi:10.1037/a0037799

This post was written by Jay Morse & Heidi Radunovich, PhD, members of the MFLN Family Development (FD) team which aims to support the development of professionals working with military families. Find out more about the Military Families Learning Network FD concentration on our website, on Facebook, on Twitter, YouTube, and on LinkedIn.

Military Psychologists in a Combat Zone – Competency and Care

By Jay Morse & Heidi Radunovich, PhD

Creative Commons Licensing [Flickr, Vietnam War-US Troops 1965, November 3, 2010]
Creative Commons Licensing [Flickr, Vietnam War-US Troops 1965, November 3, 2010]
The American Psychological Association’s code of ethics holds psychologists responsible for ensuring their competency to practice. In their call to “take care and do no harm” and to be aware of their own health and the influence that may have on their practice [1], military psychologists are often faced with assessing their own psychological and emotional health under the pressure of combat. In a review of literature relevant to professional competency and secondary trauma, Johnson, Bertschinger, Snell, and Wilson [2] have addressed the need for professional competence in a combat zone and provided recommendations for self-care and possible solutions for self-assessment for military clinical psychologists.

In combat situations, military psychologists can be susceptible to compassion fatigue, burnout, and secondary traumatic stress. Compassion fatigue is evident when a practitioner begins to treat a client on a purely cognitive level and to lose the ability to emotionally process a client’s story. Burnout evolves over time and can result in feelings of hostility toward clients. Risk factors associated with compassion fatigue may include:

  • Experiences of helplessness or lack of power to assist clients
  • Lack of support
  • A personal history of trauma
  • Working with trauma survivors for an extended period of time

Observing and interacting with military members who have witnessed death, serious injury, or have experienced threats to their own well-being can place military psychologists at risk for secondary traumatic stress (STS). Risk factors that may be associated with STS include:

  • Inexperience
  • A caseload filled with traumatized clients
  • Personal experience of combat-related or childhood trauma

In addition to the risk of compassion fatigue and STS, military clinical psychologists (MCPs) have dual identities – that of a practicing medical professional and as a commissioned military officer. These competing demands can cause a wide variety of moral dilemmas when making treatment decisions. The difficulty of making complex moral decisions places additional stress on combat clinicians. The stress of combat, addressing the ethical dilemmas of being a military officer and a psychologist, and the risk of combat fatigue or STS can place a burden on a military psychologist. To minimize the risks associated with the challenges of this position, the authors have made the following recommendations:

Actively pursue self-care – Pay close attention to the basics: physical activity, sleep, and nutrition. Maintain a balance between your personal and professional life as much as possible, and deliberately self-assess using reminders such as a checklist.

Engage with colleagues – Regular conversations with peers can provide support and most importantly provide a critical assessment of your mental and health. Be open to expressing your own grief and suffering.

 

References

[1] American Psychological Association. (2010). Ethical principles of psychologists and code of conduct. Retrieved from http://www.apa.org/ethics/code/index.aspx

[2] Johnson, W., Bertschinger, M., Snell, A., & Wilson, A. (2014). Secondary trauma and ethical obligations for military psychologists: Preserving compassion and competence in the crucible of combat. Psychological Services, 11(1), 68-74. doi:10.1037/a0033913

 

This post was written by Jay Morse & Heidi Radunovich, PhD, members of the MFLN Family Development (FD) team which aims to support the development of professionals working with military families. Find out more about the Military Families Learning Network FD concentration on our website, on Facebook, on Twitter, YouTube, and on LinkedIn.

FD Webinar: Wellness Strategies, Burnout Prevention, & Mindfulness

Two Part Series on Wellness Strategies, Burnout Prevention, & Mindfulness

Part One

Date: April 2, 2015

Time: 11am-1pm Eastern

Location: https://learn.extension.org/events/1878#.VKwzNitShXt

cover_Kacy_Mixon__June_3__2006

Eric Thompson, PhD and Isabel Thompson, PhD,  will explore current research findings linked to burnout and wellness for mental health clinicians. The presentation will also include burnout prevention and wellness strategies utilized to promote a more mindful work-life balance.

We offer 2.0 National Association of Social Worker CE credits and CE credits for licensed Marriage and Family Therapists in the state of Georgia for each of our webinars, click here to learn more. For more information on future presentations in the 2014 Family Development webinar series, please visit our professional development website or connect with us via social media for announcements: (Facebook Twitter)

Don’t forget to join us for part two of this Series

Date: April 23, 2015

Time: 11am-1pm Eastern

Location:  https://learn.extension.org/events/1879#.VKw3JSvF9uJ

 

Latino Stressors and Adjustment

By Jay Morse & Heidi Radunovich, PhD

Creative Commons Licensing [Flickr, Insignificance, February 24, 2008]
Creative Commons Licensing [Flickr, Insignificance, February 24, 2008]
When cultural values (such as the importance of family) conflict with other demands, the resulting stress can lead to a mental health issue. Alamilla, Kim, and Lam examined ethnic identity, cultural change, and mental health in a group of 130 Latino/a students at a predominately European American university to determine what influence cultural change would have on symptoms of anxiety, hostility, and somatization (complaints about physical symptoms not caused by physical disease) [1].

The 130 students of Latino background (74 women and 56 men), 31% were first generation, 59% were second generation, 5% were third generation, and 5% were fourth, fifth, or did not report generation status. The students were assessed to determine:

  • Adherence to traditional Latino/a values such as an emphasis on family, respect, dignity, and cultural pride
  • Orientation towards a traditional Latino value system compared with a traditional Anglo culture
  • Ethnic/minority student stresses (e.g., social climate, interracial relationships, discrimination)
  • Perceived racism
  • Psychological symptoms

The results of the study indicated that the higher the perceived racism, the higher the levels of anxiety, hostility, and somatic symptoms, regardless of level of acculturation. Minority student stresses were also found to predict psychological symptoms. Interestingly, level of acculturation or type of values did not seem to predict adjustment. This means that, while level of acculturation and type of values might be important in some regards, sense of racism, or stressors relating to being a minority can have a much greater impact. As a therapist, it will be important to be aware of the role that these sorts of stressors can play for Latino clients.

 Reference

[1] Alamilla, S. G., Kim, B. S. K., & Lam, N. A. (2010). Acculturation, enculturation, perceived racism, minority status stressors, and psychological symptomatology among Latino/as. Hispanic Journal of Behavioral Sciences, 32(1), 55-76. doi:10.1177/0739986309352770

This post was written by Jay Morse & Heidi Radunovich, PhD, members of the MFLN Family evelopment (FD) team which aims to support the development of professionals working with military families. Find out more about the Military Families Learning Network FD concentration on our website, on Facebook, on Twitter, You Tube, and on LinkedIn.

Ethnic Minorities in the Military

By Jay Morse & Heidi Radunovich, PhD

Cover photo image: Creative Commons Licensing [Flickr, Third Army celebrates start of Hispanic American Heritage Month, September 15, 2011]
Cover photo image: Creative Commons Licensing [Flickr, Third Army celebrates start of Hispanic American Heritage Month, September 15, 2011]
By 2050, the U.S. Census Bureau estimates that more than 50% of the U.S. population will be made up of ethnic minorities. Are their social and psychological needs different than those of the predominately European American majority, particularly during family separations such as deployment?

In a 2010 article, Behnke, MacDermid Anderson, and Weiss published the results of a study comparing ethnic groups and their views of the resources available to them during times of stress (such as deployment or other separation from family) and their resulting intention to leave the military[1].

Of the 14,791 participants in the study (married with children), ethnic participant groupings were as follows: 10,829 European/American; 1,987 African-American; 1,111 Hispanic/Latino; 864 Asian American/Pacific Islanders. Resources considered included:

  • Material resources – pay grade and family income.
  • Family resources – personal time, family health benefits, support for children, child care, and military family support programs.
  • Work-related resources – satisfaction with workload, assignments, quality of leadership.
  • Social resources – military member support from the military community.

The researchers found that minority groups faced with family separation were almost twice as likely to consider leaving the military when compared with European Americans. The researchers also found important similarities and differences among minority groups related to separations (such as deployment) and available resources:

  • There were no differences among ethnic groups when considering the relationship between family separation and family or work resources.
  • For Latinos and Asian Americans the influence of material resources, pay grade or family income, was more significant than for other groups.
  • The relationship between family separation and social resources was almost twice as strong for Asian Americans than for other groups.

For all groups, the importance of family resources was as important as work-related resources when considering remaining in the military.

As clinicians working with ethnic minority groups in the military, it is important not only to consider that a client is part of an ethnic minority, but that their individual mental health needs may vary according to their particular ethnicity. For all ethnic minorities, working with the family is particularly important – insuring that there is adequate and stable support from home. Family support may have a large part to play in a military member staying in the military and providing a stable livelihood for the family.

 

Resource

[1]Behnke, A. O., MacDermid, S. M., Anderson, J. C., & Weiss, H. M. (2010). Ethnic variations in the connection between work-induced family separation and turnover intent. Journal of Family Issues, 31(5), 626-655. doi:10.1177/0192513X09349034

This post was written by Jay Morse & Heidi Radunovich, PhD, members of the MFLN Family Development (FD) team which aims to support the development of professionals working with military families. Find out more about the Military Families Learning Network FD concentration on our website, on Facebook, on Twitter, You Tube, and on LinkedIn.

Suicidality Among Veterans after Surgery

Jay Morse & Heidi Radunovich, PhD

Suicidal ideation and behavior is a critical topic for the U.S. military.  According to a recent Huffington Post article, 185 active-duty Army soldiers committed suicide? in 2013 – more than the number of Army soldiers killed in combat in Afghanistan in that year [1].    However, much still needs to be learned about what increases risk of suicide, and the role that ethnic status could play in suicide risk.

Cover photo image: Creative Commons Licensing [Flickr, White Wreath Association, May 29, 2009]
Cover photo image: Creative Commons Licensing [Flickr, White Wreath Association, May 29, 2009]
Copeland and colleagues researched suicidality in Hispanic and African American veterans [2] to determine if there was a relationship between suicidal behavior and ideation (SBI) in post-surgical patients who had a history of severe mental illness. This analysis included 89,995 veterans who had undergone surgeries such as bone or joint surgery, vascular surgery, or amputations.

Of the 89,995 VA patients (with an average age of 64) in this sample, 2,836 were found to have suicidal behavior and ideation in the 3 years following surgery.  Consistent with previous research (Prior suicide attempts, Oct 2014), the researchers concluded that veterans with a previous history of severe mental illness (schizophrenia, bipolar disorder, PTSD, or depression) experienced a significantly increased likelihood of SBI.

However, the results of the study were not as clear when examining different ethnicities – African Americans showed an increased likelihood of SBI while Hispanics did not, and it was not clear why this was the case. It was noted that both African-American and Hispanic surgical patients reported higher rates of severe pain after surgery, but received lower doses of medication than White, non-Hispanic pain patients.  More study will be required to determine the influence of ethnicity on   the risk of SBI following surgery.

While this study had a number of limitations, (the study used archival data and was limited to veterans, there were few women in the study) the importance of mental health care following surgery was clear.  Pre-operative and post-operative mental health monitoring is important to achieve a positive outcome for the patient.

When working with minority groups in the military, consideration should be given to the individual client’s environment – family, work, and community – and the influence of culture in these groups.

In an upcoming webinar Dr. Andrew Behnke will focus on current issues and implications for clinical and advocacy work with Latino military families.

References

[1] Wood, D. (2013, September 25).  Tragedy of military suicides will ‘go on for many years,’ army chief warns. The Huffington Post. Retrieved from: http://www.huffingtonpost.com/news/military-suicide-rate/

[2] Copeland, L. A., McIntyre, R. T., Stock, E. M., Zeber, J. E., MacCarthy, D. J., & Pugh, M. J. (2014). Prevalence of suicidality among hispanic and african american veterans following surgery. American Journal of Public Health, 104, S603-8.

 This post was written by Jay Morse & Heidi Radunovich, PhD, members of the MFLN Family Development (FD) team which aims to support the development of professionals working with military families. Find out more about the Military Families Learning Network FD concentration on our website, on Facebook, on Twitter, You Tube, and on LinkedIn.