Clinical Health Psychology in Military and Veteran Settings : Innovations for the Future

Contents About the Editors Chapter 1: Introduction References Part I: Health Economic Challenges Facing the Civilian Healthcare Industry Chapter 2: The US Healthcare System: Components and Functional Areas 1 Introduction 2 The US Healthcare System Includes Public Sector and Private Sector Entities Working in Three Functional Areas: Funding, Administering, and Providing Care 2.1 Funding Healthcare 2.1.1 Percentages of Personal Healthcare Expenditures Insured by Public and Private Sources 2.1.2 Percentages of Individuals Covered by Public Sector and Private Sector Funders 2.2 Delivering Healthcare 2.3 Administering Healthcare 2.4 Strategies for Performing the Tasks in the Three Functional Areas 2.5 Evolution of Public Sector and Private Sector Healthcare Responsibilities: Concurrent and Complementary 2.5.1 1700–1850 2.5.2 1850–1950 2.5.3 1950–Present 2.5.4 Current System 2.5.5 Contrast with European Systems 3 Payment Systems 3.1 Fee-for-Service Payment Structure 3.1.1 Implementing FFS: Tasks and Issues 3.1.2 CMS Method to Set Rates 3.2 Capitated Payment and Managed Care 3.2.1 Implications of Payment System Design 4 Conclusion References Chapter 3: Clinical Practice and Financial Management 1 Introduction to Clinical Financial Management in Public Systems 2 Public Budget Concepts and Characteristics 3 Strategic Planning and the Budget 4 The Basic Components of Financial Strategy in Clinical Applications 5 Budgetary Management in Clinical Programs 6 Cost Classification and Fund Accounting 7 Cost Allocation 8 Monitoring Spending: Principles of Budget Variance Analysis 9 Stakeholder Analysis in Financial Program Planning and Evaluation References Chapter 4: Social Circumstances and Behavioral Patterns: Impacts on Health and Initiatives to Mitigate These Impacts 1 Introduction 2 Factors That Affect Health 2.1 Health as an Adult 2.1.1 Housing Security and Quality 2.1.2 Food Security 2.1.3 Education 2.1.4 Income 2.2 Childhood Health 2.2.1 Family Income 2.2.2 Food Security 2.3 Health at Birth 2.3.1 Family Income 2.3.2 Mother’s Education 2.3.3 Maternal Health During Pregnancy 3 Initiatives to Mitigate the Impacts of Social Circumstances and Behavioral Patterns 3.1 Initiatives in Health Services 3.2 Initiatives to Address Gaps in Education, Food Security, and Housing Security 3.3 Initiatives to Adjust Provider Quality Metrics 4 Conclusion References Chapter 5: Using Computer Technology to Support Clinical Decision-Making 1 Introduction 1.1 Example 1: Predicting and Preventing Suicide 1.2 Example 2: Predicting and Preventing Human Trafficking 1.3 Defining Data and Information 1.4 Integrated Care Requires Integrated Data 2 Collecting Data: The Electronic Health Record (EHR) 2.1 Evolution of EHR Affected the Type of Data Stored 2.1.1 Structured Data Are Used for Practice Management 2.1.2 New Data Added for Medical Records 2.2 Moving from Unstructured to Structured Medical Data 2.2.1 Challenges Moving Clinical Notes to EHR 2.2.2 Incorporating Behavioral Health Data into the EHR 2.2.3 Challenges Incorporating Behavioral Health Data into the EHR 2.2.4 Integrating Data About the Social Determinants of Health in the EHR 2.2.5 Challenges Integrating Data About the Social Determinants of Health into the EHR 2.2.6 Integrating Patient-Generated Health Data into the EHR 3 Exchanging Data to Coordinate Care 3.1 Sharing Data Through a Patient Portal 3.2 Sharing Data Through a Health Information Exchange 3.2.1 Barriers to Sharing Data Through a Health Information Exchange 3.2.2 Addressing the Barriers to Health Information Exchange Through Legislation 4 Using the Data 5 Conclusion References Chapter 6: How Will You Know Whether Your Efforts to Strengthen Patient Health Are Effective and Efficient? How Will You Convince Others? 1 Introduction to Health Program Evaluation 2 Tasks Required to Conduct a CER or CEA Study 2.1 Task # 1: Specify the Study Questions and the Date for Reporting Results to the Study Stakeholders 2.2 Task # 2: Specify the Study Sample 2.3 Task # 3: Specify Data Sources and Variables 2.4 Task # 4: Specify the Analytical Strategy 2.5 Task # 5: Specify the Types of Reports to Inform the Stakeholders About the Study Results 3 Additional Tasks Required for CEA Studies 3.1 Additional Steps Required to Specify the Study Goal in Task 1 4 Additional Steps Required to Specify the Reporting Format in Task 5 4.1 What Types of Agencies Compare the Cost-Effectiveness Ratio to a Threshold? 5 Conclusion References Chapter 7: Business Strategies and Disruption in Vision Care 1 Introduction 2 Disruptive Innovation 2.1 Examples of Disruptive Innovation 2.2 Impacts of Disruption on Skilled Individuals Working in the Incumbent Firms 2.3 Regulatory Issues Raised by Disruptive Innovations 3 Case Study: EyeQue 3.1 The EyeQue Innovation 3.2 Steps to Analyze Potential Impacts of a Disruptive Innovation (Illustrated for the EyeQue Case) 3.2.1 Components of the Vision Care Industry and Relationships Among Those Components Vision Care Eyeglass Manufacturers and Distributors Payment Structures: Vision Care Plan and Health Savings Accounts 3.2.2 Regulatory Environment for Consumer Protection 3.2.3 Strategic Responses by the Incumbent Providers 3.2.4 EyeQue Market Experience 4 Other Examples of Disruptive Innovation in Health Care 5 Conclusions References Chapter 8: Advancements in Health Care Communication 1 Introduction 2 Types of Technology 2.1 Self-Diagnostic Tools 2.2 Mobile Health 2.3 Telehealth and Virtual Health Care 3 Communication Channels 3.1 Scenario 1: Traditional Health Care Model 3.2 Scenario 2: Health Care Providers Utilizing EHR Systems 3.2.1 Channel 2: Providers and the Database 3.2.2 Channel 3: Patients and the Provider Database 3.3 Scenario 3: Health Care Providers Utilize EHR Systems and Patients Communicate with Providers via Telehealth 3.4 Scenario 4: Health Care Providers Utilize EHR Systems and Patients Utilize Mobile Apps, Self-Diagnostic Tools, and Monitoring Devices: Provider Organization Does Not Integrate the New Types of Information into the EHR System 3.4.1 How Channel 1 Is Affected by Technology 3.4.2 Channel 4: Patients and Their Devices 3.5 Criteria for Evaluating Mobile Health Applications 3.6 Scenario 5: Health Care Providers Utilize EHR Systems and Patients Utilize Mobile Apps, Self-Diagnostic Tools and Monitoring Devices: Provider Organization Integrates the New Types of Information into the EHR System 3.6.1 Channel 5: Patient Device and the Provider Database 3.6.2 Channel 2: Using the App Data to Generate Useful Information for Clinicians 4 Conclusion References Part II: Innovative Clinical Applications in the Military & Veteran Health Clinics Chapter 9: Assessment and Treatment of Chronic Pain in the Military: Current Practices and Future Directions for Clinical Health Psychologists 1 Introduction 1.1 Chronic Pain Problem in the US Military 1.2 Paradigm Shift in Pain Treatment in the Military 2 Pain Assessment and Treatment Approaches 2.1 Biopsychosocial Assessment 2.1.1 Clinical Interview 2.1.2 Self-Report Instruments 2.2 Behavioral Treatment Approaches 2.2.1 Motivational Interviewing 2.2.2 Cognitive-Behavioral Therapy for Chronic Pain 2.2.3 Contextual Cognitive Behavioral Therapy Approaches 3 Future Directions 3.1 Assessment 3.2 Treatment Programs 4 Case Study 4.1 Biopsychosocial Assessment 4.1.1 Treatment 4.1.2 Discussion 5 Discussion References Chapter 10: Post-traumatic Stress Disorder and Chronic Pain Among Military Members and Veterans 1 Definitions of PTSD and Chronic Pain 2 Prevalence of PTSD and Chronic Pain 3 Comorbidity Between PTSD and Chronic Pain 4 Risk Factors for PTSD and Chronic Pain 5 Treatment for PTSD 6 Treatment for Chronic Pain 7 Treatment of Comorbid PTSD and Chronic Pain 8 Case Study 1 9 Case Study 2 10 Conclusion and Future Directions References Chapter 11: Clinical Health Psychologists’ Role in the COVID-19 Response in Veteran and Military Hospitals 1 Impact of COVID-19 on Military and Veterans 1.1 Caregiver and Provider Stress 2 Veteran Health Administration’s Response to Service Provision During COVID-19 2.1 VHA’s Expansion of Virtual Care 2.2 Telemental Health 2.3 Adjustment to Teletherapy During COVID-19 3 Post-pandemic Challenges and Future Directions for Health Psychologists in Military and Veteran Hospitals 3.1 Maintaining Frontline Providers’ Well-being 3.2 Implementing and Improving Teletherapy Technology References Chapter 12: Telehealth Applications in Military and Veteran Healthcare Settings 1 Some Telehealth Applications 1.1 Before-COVID CMS Telehealth Policies 1.2 Interstate Medical Licensure Compact Relevant to Telehealth 1.3 After-COVID CMS Telehealth Policies 2 Discussion References Chapter 13: The Health Psychologist Role in Providing Services to Transgender Veterans 1 General Overview of Population 1.1 Early Experiences of Transgender Veterans in the Military 1.2 Repeal of Transgender Ban 1.3 Reinstatement of Transgender Ban 1.4 Transgender Care Within the Veterans Health Administration 2 Transgender Health 2.1 2015 US Transgender Survey 2.2 Housing 2.3 Employment 2.4 Health Care Utilization 2.5 Suicide Risk 2.6 Mental Health 2.7 Sexual Assault and Associated Health Concerns 2.8 Support 3 Male to Female (MTF) and Female to Male (FTM) Transgender Veterans 3.1 Veteran MTFs and FTMs 4 Treatment Considerations 4.1 Minority Stress Model 4.2 Responding to Transgender Clients 5 Intake and Clinical Interview 6 Considerations for Clinical Interviews with Transgender Patients 7 Holistic Treatment of Transgender Veterans 8 Psychological Assessment Considerations with Transgender Patients 8.1 Psychological Testing 8.1.1 Norms and Test Selection 8.1.2 Interpretation and Report Writing 8.1.3 Providing Feedback to Transgender Patients 8.2 Readiness Evaluations 8.2.1 Guidelines for Referrals to Feminizing/Masculinizing Hormone Therapy 8.2.2 Guidelines for Referrals to Surgery 8.2.3 Additional Considerations 9 Conclusion References Chapter 14: The Health Psychologist Role in Providing Services to the Military Families and Parenting 1 Military Parenting 1.1 Military Families 1.2 Parenting Cycle of Deployment 1.2.1 Pre-deployment Phase 1.2.2 Deployment Phase 1.2.3 Post-deployment Phase 2 Risk Factors 2.1 Children 2.1.1 Effects of Deployment 2.1.2 Younger Children 2.1.3 Older Children and Teenagers 2.1.4 Relocation 2.1.5 Separation from Parent 2.1.6 Mental Health 2.1.7 Parents 2.1.8 Parental Traumatic Stress 2.1.9 Protective Factors 3 Clinical Recommendations for Deployment Cycle 3.1 Pre-deployment 3.1.1 Recommendations 3.2 Deployment Recommendations 3.2.1 Recommendations 3.3 Sustainment of Military Parent and Family Members 3.3.1 Recommendations 3.4 Notification of Return from Deployment 3.4.1 Recommendations 3.5 Post-deployment 4 General Clinical Recommendations and Tips During the Deployment Cycle (Gewirtz et al., 2011) 5 Recommendations, Interventions, and Resources 5.1 FOCUS 5.2 PMTO 5.3 ADAPT 5.4 Strong Military Families Intervention 5.5 Sesame Street for Military Families 5.6 Child–Parent Psychotherapy 5.7 Family Advocacy Program 6 Mobile Apps 6.1 Babies on the Homefront 6.2 The Big Moving Adventure 6.3 Sandboxx References Index This book will fill an important gap in literature covering the clinical health psychology applications affecting the military and veteran health care systems. The authors draw on a wealth of experience related to treatment of service members and veterans, implementation of innovative research programs within military settings, and analysis of health economics issues. Section I examines key economic challenges facing civilian, military and Veteran healthcare providers. Section II discusses innovative clinical health psychology applications in military hospitals and clinics from around the country, including comprehensive literature reviews and presenting novel clinical applications in military hospitals. This book is relevant for clinicians, policymakers and administrators working with military and veteran patients.