On December 8th, 2015, Dictionary.com announced that the Word of the Year was Identity, partly because of the expanding conversations about gender identity. The news stood out to me because 2015 was a year I learned a lot from working with transgender patients.
I was trained in the Primary Care Behavioral Health Consultation model (PCBH; Robinson & Reiter, 2016) while I was a pre-doctoral clinical psychology resident (intern) in early 2007. As a young U.S. Air Force (USAF) officer and clinician, I found the primary care rotation to be exciting and exhausting. However, as a colleague of mine says, the primary care bug bit hard and I was hooked! I enjoyed the fast-paced generalist environment and the need to be prepared for anything. After graduation, I was fortunate to continue doing part-time PCBH work until I separated from the USAF in 2015. The USAF calls their PCBH program the Behavioral Health Optimization Program, a.k.a. BHOP (USAF, 2014). I BHOPped along for a few years until I was certified as an official “mentor” by Patti Robinson in 2011. For three years thereafter, I trained residents in BHOP. I truly had no idea that the skills I learned during my residency rotation would prove so valuable not just in primary care clinics, but also in a variety of other military settings, including the deployed environment.
As educators in the field of suicidology, we have often trained and supervised providers in the conduct of suicide risk assessments. In general, we have noted that while providers are becoming more knowledgeable about how to perform a suicide risk assessment, they continue to experience challenges in how to best communicate about suicide risk. Based on our experiences, we would like to provide you with some practical recommendations when completing clinical documentation and when consulting with colleagues.
Air Force Guide for Suicide Risk Assessment, Management, and Treatment
Appendices for Air Force Guide for Suicide Risk Assessment, Management, and Treatment
I have been training providers in Prolonged Exposure therapy (PE) and collecting outcome data for the past seven years. Since I arrived at the Philadelphia VA Medical Center, I have been involved in the training of approximately 45 clinicians in PE and collected outcomes for over 300 cases. And while what follows is certainly not an exhaustive list of factors to consider in providing PE to a Veteran population, it does represent a convergence of my clinical observations and our empirical findings. With that stated, my findings and observations in providing PE to veterans are: 1) therapist experience matters; 2) service-connection is an important issue; and 3) not enough attention is paid to safety behaviors.
Although the pace of deployment has decreased in recent years, military members continue to deploy to combat zones and other areas around the globe. Behavioral health providers who serve a military population are well aware of the ebbs and flows of stresses on military members and their families around deployment cycles. Modern evidence-based care includes use of appropriate psychotherapies and medications to treat major depressive disorder, PTSD, and other deployment-related conditions. In addition to providing good care, it is important to consider the compatibility of treatments with future deployments. The following article will discuss the concepts of deployment-limiting conditions and the impact of psychotropic medications on deploy ability.