Regional Health Command Central

 

Warrior Resiliency Program

The Warrior Resiliency Program (WRP) is a direct reporting unit of Regional Health Command-Central.  The primary focus of the organization is the provision of virtual healthcare or tele-behavioral health patient care services to RHC-C military treatment facilities. In addition to providing clinical services, the WRP oversees and administers the Regional Suicide Reduction Initiative. The primary activities of the SRI include epidemiological tracking and review of Regional suicides and training MTF behavioral health providers in evidence-based assessment and intervention strategies for suicide risk mitigation and prevention. Other activities include the provision of operational support to the RHC-C Behavioral Health Service Line and behavioral health Subject Matter Expertise consultation to Region.

 History

 Services

 Collaborations

 Select Publications and Presentations

History

In the summer of 2007, the Department of Defense Health Affairs “Red Cell” on psychological health and TBI made 397 recommendations to Congress for military Behavioral Health.  While these recommendations spanned multiple lines of action, 84 of them focused on psychological health.  In response to these recommendations, in FY 07 and FY 08 Congress allotted $900M of supplemental funding for psychological health and TBI.  Programs seeking funding were invited to submit a Red Cell proposal to address those gaps.  In December 2007  a proposal was submitted to the Red Cell for the formation of the WRP, which would focus on the prevention and treatment of combat and deployment stressors impacting warriors and families.  The WRP Red Cell proposal was approved in February 2008, and the WRP was formed.

 

The objectives of the WRP have evolved considerably since its inception.  Initially, the organization developed three main objectives. The first objective was to build and restore resiliency among Warriors and their families.  The second objective was to identify and overcome gaps in Military Behavioral Health for building and restoring resiliency.  Lastly, the WRP sought to transform a legacy pathology based mental health system into a resilience oriented behavioral health care system.

 

Although the WRP maintains these objectives in general, the organization has evolved into the RHC-C TBH Hub. In fact, the WRP has quickly evolved into one of the Army leaders in TBH services. In FY15 the organization provided nearly 14,000 clinical encounters which is a 50% increase over FY14 and a 100% increase over FY13.

Services

The WRP provides a wide range of tele-behavioral health services.  In essence, the organization has the capability to provide any clinical and consultative service consistent with capabilities of traditional multi-disciplinary clinics.  Specific clinical services include:

 

  • Psychotherapy
  • Medication management
  • Administrative Separation Mental Status Exams (MSEs)
  • Aeromedical evaluations
  • Forensic support (e.g., RCM 706 Sanity Board Evaluations, expert testimony)
  • Positions of Trust Evaluations (Recruiter, Drill, SARC)
  • Special duty assignments (Sniper, CID)
  • IDES support (e.g., NARSUM, IMR, Appeal, TDRL)
  • Marriage / Family Therapy
  • IOP continuity transition
  • Redeployment surge augment
  • Disaster response

 

Specific to evidence-based treatments and protocols the WRP provides the following:

  • Prolonged Exposure – PTSD
  • Cognitive Processing Therapy – PTSD
  • Problem Solving Therapy
  • Brief Cognitive-Behavioral Therapy for Suicide
  • Collaborative Assessment and Management of Suicidality (CAMS)
  • Cognitive-Behavioral Therapy – Insomnia & Nightmares
  • Cognitive-Behavioral Conjoint Therapy for PTSD

 

 

Collaborations

A unique capability of the WRP is that through collaborative program and training efforts the organization is able to leverage the expertise of civilian, academic, and other federal behavioral health experts in suicide risk, psychological trauma, and psychological resiliency.  Select examples of current and past collaborative efforts include:

 

  • Dr. David Jobes-Catholic University of America (Process Improvement)
  • Ft. Hood/CRDAMC TBH clinic and Addiction Medicine Intensive Outpatient Program (Process Improvement)
  • Dr. Donald Meichenbaum-University of Waterloo (Distinguished Visiting Professor Program)
  • Dr. Craig Bryan-University of Utah (Distinguished Visiting Professor Program)
  • Dr. Richard Tedeschi-University of North Carolina at Chapel Hill (Distinguished Visiting Professor Program)
  • Dr. Alan Peterson-The South Texas Research Organizational Network Guiding Studies on Trauma and Resilience (Distinguished Visiting Professor Program and Consultation)
  • Dr. David Rudd-University of Memphis (Research Support)

Publications and Presentations

  1. Archuleta, D., Jobes, D. A., Pujol, L., Jennings, K., Crumlish, J., Lento, R. M., Brazaitis, K.,  Moore, B. A., & Crow, B. (2014). Raising the clinical standard of care for suicidal  soldiers: an army process improvement. United States Army Medical Department  Journal, October-December 2014: 55-66.
  2. Cieslak, R., Anderson, V., Bock, J., Moore, B. A., Peterson, A. L., & Benight, C. C. (2013).  Secondary traumatic stress among mental health providers working with the military:  Prevalence and its work- and exposure-related correlates. Journal of Nervous and  Mental  Disease, 201(11), 917-925.
  3. Cozza, S. J., Guimond, J. M., McKibben, J. A., Chun, R. S., Arata-Maiers, T. L., Schneider, B.,  & ... Ursano, R. J. (2010). Combat-injured service members and their families: The  relationship of child distress and spouse-perceived family distress and disruption. Journal  of Traumatic Stress, 23(1), 112-115.
  4. Crow, B. E. & Landry Poole, J. M. (in press). Guideline 7: Testing and assessment. In APA  Telepsychology Guidelines Casebook. Washington, DC: American  Psychological  Association.
  5. DasMahapatra, P., Chiauzzi, E., Pujol, L. M., Los, C., & Trudeau, K. J. (2015.) Mediators and moderators of chronic pain outcomes in an online self-management program.  Clinical Journal of Pain, 31(5):404-13.
  6. Escamilla, M., & Moore, B. A. (2013). A framework for informed evidence-based practice. PsycCritiques, 58(3).
  7. Escamilla, M., LaVoy, M., Moore, B. A., & Krakow, B. (2012). Management of post-traumatic nightmares: a review of pharmacologic and nonpharmacologic treatments since 2010. Current Psychiatry Reports, 14(5), 529-35.
  8. Forbes, D., Creamer, M., Bisson, J. I., Cohen, J. A., Crow, B. E., Foa, E. B., & ... Ursano, R. J. (2010). A guide to guidelines for the treatment of PTSD and related conditions. Journal of Traumatic Stress, 23(5), 537-552.
  9. Krakow, B., Moore, B. A., & Ulibarri, V. A. (in press). Sleep-disordered breathing and posttraumatic stress disorder. In T. Neylan & A. Germain (Eds.), Sleep and  Combat-related PTSD. New York, NY: Springer.
  10. Krakow, B., Ulibarri, V. A., & Moore, B. A., & (2015). Posttraumatic stress disorder and sleep-disordered breathing: a review of comorbidity research. Sleep Medicine Review, December: 37-45.
  11. Landry Poole, J. M. & Crow, B. E. (in press). Guideline 4: Confidentiality of data and  information. In APA Telepsychology Guidelines Casebook. Washington, DC: American  Psychological Association.
  12. Landry Poole, J. M., Pujol, L., & Moore, B. A. (in press). Tele-behavioral health. In J. Beder  (Ed.), Caring for the military: a guide for the helping professions. New York, NY:  Routledge.
  13. Moore, B. A. (2013). PTSD: past, present, and future. CNS Spectrums, 18(2): 71-72.
  14. Moore, B. A., Mason, S. T., & Crow, B. E. (2012). Assessment and management of acute  combat stress on the battlefield. In C. H. Kennedy, E. A. Zillmer, C. H. Kennedy, E. A.  Zillmer (Eds.), Military psychology: Clinical and operational applications (2nd ed.) (pp.  73-92). New York, NY: Guilford Press.
  15. Moore, B. A., Morrissette, D. A., & Stahl, S. M. (in press). Unconventional treatment strategies  for schizophrenia: polypharmacy and heroic dosing. BJPsych Bulletin.
  16. Moore, B. A. & Newbauer, J. F. (2015). Trauma- and stressor-related disorders. In L. Sperry, J.  Carlson, J. D. Sauerheber, J. Sperry, L. Sperry, J. Carlson, ... J. Sperry (Eds.) ,  Psychopathology and psychotherapy: DSM-5 diagnosis, case conceptualization, and  treatment (3rd ed.) (pp. 123-149). New York, NY: Routledge.
  17. Moore, B. A. & Scott, S. (2015). Brevity is the soul of a useful clinical review of PTSD  treatment. PsycCritiques, 60(2).
  18. Pujol, L. A., Sussman, L., Clapp, J., Nilson, R., Gill, H., Boge, J., Keizer, B., Salas, M. M., &  Goff, B. (2015). Functional restoration for chronic pain patients in the military:  Early  results of the San Antonio Military Medical Center Functional Restoration Program. The  United States Army Medical Department Journal, October-December 2015:1-7.
  19. Shearer, D. S., Moore, B. A., & Park, A. Establishing uniform requirements for privileging  psychologists to prescribe in federal service. The Tablet, April 2015: 35-36.
  20. Trudeau, K. J., Pujol, L., DasMahapatra, P., Wall, R., Black, R., & Zacharoff, K. (2015).  A  randomized controlled trial of an online self-management program for people with  arthritis pain.  Journal of Behavioral Medicine, 38(3):483-96.
  21. Villarreal E. & Moore B. A. A close and personal look at posttraumatic stress disorder.  PsycCritiques, 2013;58 (29).

 

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