• Chapter One Introduction.
• Providing effective care for PTSD and MDD for service members.
• Research objectives.
• Organization of this report.
• Chapter Two Methods.
• Provider data.
• Survey of MTF psychological health providers.
• Key informant discussions.
• Chapter Three Characteristics of the psychological health workforce across the MHS.
• Service branch differences in the size and composition of the psychological health workforce.
• Individual and practice characteristics of surveyed MTF PH providers.
• Summary.
• Chapter Four Delivery of guideline-concordant case for PTSD and MDD.
• Approaches to monitoring provider performance and use of guideline-concordant care.
• Delivery of guideline-concordant psychotherapy.
• Medication management within MTFs.
• Use of measureent-based care.
• Summary.
• Chapter Five Facilitators and barriers to provision of guideline-concordant care for PTSD and MDD.
• Training and supervision in guideline-concordant psychotherapies.
• Perceived barriers to delivering guideline-concordant treatment.
• Summary.
• Chapter Six Summary and recommendations.
• Overview.
• Strengths and limitations.
• Delivering guideline-concordant care for PTSD and MDD in MTFs: key findings.
• Recommendations to guide improvements in PH care across the MHS.
• Directions for future research.
• Appendix.
• References.

Providing accessible, high-quality care for psychological health (PH) conditions, such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), is important to maintaining a healthy, mission-ready force. It is unclear whether the current system of care meets the needs of service members with PTSD or MDD, and little is known about the barriers to delivering guideline-concordant care. RAND used existing provider workforce data, a provider survey, and key informant interviews to (1) provide an overview of the PH workforce at military treatment facilities (MTFs), (2) examine the extent to which care for PTSD and MDD in military treatment facilities is consistent with Department of Veterans Affairs/Department of Defense clinical practice guidelines, and (3) identify facilitators and barriers to providing this care. This report provides a comprehensive assessment of providers' perspectives on their capacity to deliver PH care within MTFs and presents detailed results by provider type and service branch. Findings suggest that most providers report using guideline-concordant psychotherapies, but use varied by provider type. The majority of providers reported receiving at least minimal training and supervision in at least one recommended psychotherapy for PTSD and for MDD. Still, more than one-quarter of providers reported that limits on travel and lack of protected time in their schedule affected their ability to access additional professional training. Finally, most providers reported routinely screening patients for PTSD and MDD with a validated screening instrument, but fewer providers reported using a validated screening instrument to monitor treatment progress.

• Preface
• Figures
• Tables
• Summary
• Acknowledgments
• Abbreviations
• Chapter One: Introduction: PTSD and Depression Among Service Members
• Care Provided to Service Members with PTSD and Depression
• Measuring Quality of Health Care
• PTSD and Depression Quality Measures
• Organization of This Report
• Chapter Two: Methods: Overview
• Processing Inpatient and Outpatient Encounter Data
• Identification of Service Members in PTSD and Depression Cohorts
• Technical Specifications for Quality Measures
• Analyses
• Chapter Three: Characteristics of Service Members in PTSD and Depression Cohorts, and Their Care Settings and Treatments: Demographic Characteristics of the PTSD and Depression Cohorts
• Military Service Characteristics of the PTSD and Depression Cohorts
• Utilization of Mental Health Services
• Treatment Setting, Encounter Characteristics, and Types of Providers Seen by PTSD and Depression Patients
• Assessments and Behavioral Interventions Delivered to Service Members in the PTSD and Depression Cohorts
• Prescriptions for Psychotropic Medications Filled by Service Members in the PTSD and Depression Cohorts
• Summary
• Chapter Four: Quality of Care for PTSD and Depression: Quality Measure Results for PTSD
• Overview of Measures for Service Members in PTSD Cohort
• Quality Measure Results for Depression
• Summary of Measures for Service Members in the Depression Cohort
• Chapter Five: Variations in Care for PTSD and Depression Based on Patient Characteristics: Performance of PTSD Measures by Age of Service Member
• Performance of PTSD Measures by Race/Ethnicity of Service Member
• Performance of PTSD Measures by Gender of Service Member
• Performance of PTSD Measures by Pay Grade of Service Member
• Performance of PTSD Measures by Deployment History of Service Member
• Performance of Depression Measures by Age of Service Member
• Performance of Depression Measures by Race/Ethnicity of Service Member
• Performance of Depression Measures by Gender of Service Member
• Performance of Depression Measures by Pay Grade of Service Member
• Performance of Depression Measures by Deployment History of Service Member
• Summary of Variations by Service Member Characteristics
• Chapter Six: Summary and Recommendations: Main Findings
• Policy Implications
• Final Thoughts
• Appendix: A. Technical Specifications for Administrative Data Quality Measures for PTSD
• B. Technical Specifications for Administrative Data Quality Measures for Depression
• C. Rules for Processing Administrative Data for Inpatient Stays and Outpatient Visits
• References.

• Introduction
• Methods
• Characteristics of service members in PTSD and depression cohorts, and their care settings and treatments
• Quality of care for PTSD and depression
• Variations in care for PTSD and depression based on patient characteristics
• Summary and recommendations
• Appendix A. Technical specifications for administrative data quality measures for PTSD
• Appendix B. Technical specifications for administrative data quality measures for depression
• Appendix C. Rules for processing administrative data for inpatient stays and outpatient visits.

"The U.S. Department of Defense (DoD) strives to maintain a physically and psychologically healthy, mission-ready force, and the care provided by the Military Health System (MHS) is critical to meeting this goal. Given the rates of posttraumatic stress disorder (PTSD) and depression among U.S. service members, attention has been directed to ensuring the quality and availability of programs and services targeting these and other psychological health (PH) conditions. Understanding the current quality of care for PTSD and depression is an important step toward improving care across the MHS. To help determine whether service members with PTSD or depression are receiving evidence-based care and whether there are disparities in care quality by branch of service, geographic region, and service member characteristics (e.g., gender, age, pay grade, race/ethnicity, deployment history), DoD's Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) asked the RAND Corporation to conduct a review of the administrative data of service members diagnosed with PTSD or depression and to recommend areas on which the MHS could focus its efforts to continuously improve the quality of care provided to all service members. This report characterizes care for service members seen by MHS for diagnoses of PTSD and/or depression and finds that while the MHS performs well in ensuring outpatient follow-up following psychiatric hospitalization, providing sufficient psychotherapy and medication management needs to be improved. Further, quality of care for PTSD and depression varied by service branch, TRICARE region, and service member characteristics, suggesting the need to ensure that all service members receive high-quality care"--Publisher's description.

• 1 Front Matter-- 2 Summary-- 3 1 Introduction-- 4 2 History, Diagnostic Criteria, and Epidemiology-- 5 3 Neurobiology-- 6 4 Programs and Services for PTSD in the Department of Defense and the Department of Veterans Affairs-- 7 5 Prevention-- 8 6 Screening and Diagnosis-- 9 7 Treatment-- 10 8 Co-Occurring Psychiatric and Medical Conditions and Psychosocial Complexities-- 11 9 Access to Care-- 12 10 Findings and Recommendations-- 13 Appendix A: Committee Member Biographies-- 14 Appendix B: Congressional Legislation-- 15 Appendix C: Posttraumatic Stress Disorder Programs in the Department of Defense.
• (source: Nielsen Book Data)

Prior to the military conflicts in Iraq and Afghanistan, wars and conflicts have been characterized by such injuries as infectious diseases and catastrophic gunshot wounds. However, the signature injuries sustained by United States military personnel in these most recent conflicts are blast wounds and the psychiatric consequences to combat, particularly posttraumatic stress disorder (PTSD), which affects an estimated 13 to 20 percent of U.S. service members who have fought in Iraq or Afghanistan since 2001. PTSD is triggered by a specific traumatic event - including combat - which leads to symptoms such as persistent re-experiencing of the event; emotional numbing or avoidance of thoughts, feelings, conversations, or places associated with the trauma; and hyperarousal, such as exaggerated startle responses or difficulty concentrating. As the U.S. reduces its military involvement in the Middle East, the Departments of Defense (DoD) and Veterans Affairs (VA) anticipate that increasing numbers of returning veterans will need PTSD services. As a result, Congress asked the DoD, in consultation with the VA, to sponsor an IOM study to assess both departments' PTSD treatment programs and services. Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment is the first of two mandated reports examines some of the available programs to prevent, diagnose, treat, and rehabilitate those who have PTSD and encourages further research that can help to improve PTSD care.
(source: Nielsen Book Data)