I recently learned about updates to the Naval Center for Combat & Operational Stress Control’s Psychological Health Pathways (PHP) Initiative in a conversation with the center’s director, CAPT Scott L. Johnston. Here is an interview with CAPT Johnston to tell us more about the role of PHP and how it will help our Sailors and Marines access and receive mental health care.
Q: What is the Naval Center for Combat & Operational Stress Control (NCCOSC)?
A: NCCOSC is a Directorate of the U.S. Navy Bureau of Medicine & Surgery’s (BUMED) Wounded, Ill, and Injured Program. The center is based on the campus of Naval Medical Center San Diego (NMCSD). Its mission is to improve the psychological health of Marines and Sailors through programs that educate service members, build resilience, aid research and promote best practices in the treatment of combat and operational stress injuries.
Q: What is the Psychological Health Pathways (PHP) Initiative?
A: PHP is a patient-care initiative that is designed to create a more efficient system for Sailors and Marines with stress-related injuries who need to access and receive high-quality mental health care. It uses three pillars to describe a standardized framework for core clinical and case management processes, and it supports evidence-based care using a comprehensive, interdisciplinary approach to care management. In essence, it is a best-practice psychological health and care management system.
Q: What are the three pillars of PHP?
A: PHP has three interdependent pillars that work together to standardize how these wounded, ill and injured Service Members receive care, regardless of location. These three pillars are the Clinical Pathway, Care Management and Data Management:
1) The Clinical Pathway is a set of standardized clinical practices ranging from the initial collection of demographics and screening measures through the final transition of care. The standardization of intake forms provides consistency in data collection among clinics and military treatment facilities. Patients also benefit by only having to fill out lengthy forms once. Additionally, access to collected data allows clinicians to engage in evidence-informed decision making. PHP is designed to be a flexible process that can be tailored to the resources at a given clinic or treatment facility by providing guidelines and resources for clinicians.
2) Care Management refers to the facilitation of patient advocacy, education, tracking, reporting and timely access to providers and resources. Case managers collaborate with both the mental health provider and the patient to help with coordination and continuity of patient care.
3) Data Management refers to coordinated and centralized data capture. PHP uses a standardized assessment process to collect initial patient demographics and validated self-report outcome measures, 10-week re-evaluation measures and clinical treatment reviews. In tandem with PHP, NCCOSC has implemented a web-based registry and tracking tool designed to support effective care management.
Q: What stage of development is PHP currently in?
A: In the Fall of 2012, PHP moved from the beta-stage of development to a pilot program. There are two major changes to PHP now that it is has become a pilot program. During the previous beta-stage, only a subsample of the mental health patients at NMCSD and Naval Hospital Camp Pendleton (NHCP) were enrolled in the PHP, but as part of the pilot program 100% of identified active duty mental health patients at these two locations (NMSD & NHCP) will be enrolled. Also, during the beta-stage both initial self-reports and 10-week follow-up evaluations were completed with paper-and-pencil. But in the pilot program, electronic data capture and management will now be utilized. Electronic data capture allows patients to complete these assessments either from home via the web, or in clinics using tablets . In addition to making this process easier for patients to complete, providers will now be able to access results instantaneously instead of having a two-week lag while the assessment measures are scored and entered into a database.
Q: What can we learn from the PHP data to date?
A: In addition to providing information to clinical providers regarding evidence-informed decision making, PHP can also be useful for program evaluation. For example, we have been able to utilize beta-stage data to help modify treatment programs. The data showed that for patients in a particular treatment program, there was a significant drop in both depression and PTSD scores over the course of treatment, but that sleep problems did not appear to remit. While this information validated many aspects of treatment protocol, the program is now looking at ways to incorporate additional treatment for sleep problems.
Q: What is the future of PHP?
A: The plan is for the pilot program to continue until the point where fidelity is established, and the end goal is for the program to be distributed Navy-wide.
So in summary, NCCOSC's PHP Initiative, a program to improve the consistency and continuity of patient care, is now in its pilot phase at the mental health clinics at NMCSD and NHCP. This is an exciting new program that has the potential to improve the delivery of mental health care for our Sailors and Marines. Patients will be able to more easily navigate the mental health system and providers will gain a more complete and measurable snapshot of patient progress. I'm looking forward to hearing about future developments as the program progresses.