Simulated Grant Project: Operation Enduring Freedom

Running Head: Simulated Grant Project

Part I.
A. Statement of Need
Statement of Need
The United States launched Operation Enduring Freedom (OEF) in Afghanistan on October 7, 2001 and Operation Iraqi Freedom (OIF) on March 20, 2003 in Iraq in order to combat terrorism and seek weapons of mass destruction (Hampson, 2010). Since then, “over two million troops have been deployed overseas” in support of these two wars (Tuerk, Yoder, Grubaugh, Myrick, Hamner & Acierno, 2011, p.397). The mental health status of these returning service members should be of utmost importance to everyone in society. Suicide rates in the military community have been rising since the wars began. In 2009, more service members had taken their
own lives than had been killed in either Iraq or Afghanistan (Donnelly, 2009). 334 service members committed suicide while 297 were killed in Afghanistan and 197 were killed in Iraq (Donnelly, 2009). Studies suggest that as many as 20% of service members suffer from post traumatic stress disorder (PTSD) and/or depression (Tuerk, et al., 2011). A study conducted in 2006 at Walter Reed Army Medical Center found that battle injured soldiers have been shown to have higher rates of PTSD/depression in the future versus non injured soldiers who have also had combat experience (Grieger, Cozza, Ursano, Hoge, Martinez, Engel & Wain, 2006). As of March 11, 2011 there have been a total of 42,481 troops that have sustained injuries overseas while fighting in OEF/OIF (“Casualty Status”, 2011).
Current Practices Currently the United States Army utilizes a Psychiatric Consultation Liasion Nursing (PCLN) team which asses incoming wounded service members who have a psychiatric diagnosis upon admission to a military treatment facility (Carroll, 2008). The team in a study conducted at Brooke Army Medical Center in 2008, consisted of three advanced practice nurses, a Senior Active-Duty nurse, two retired military nurses and was led by a psychiatrist. The PCLN team serves as a liaison between the service member, their family and the medical team as well as follows up with patients once they are discharged. The PCLN team works with the patient to address issues such as “pain, depression, altered body image, low self esteem, survivor guilt and anger” as well as working with the family to address “preparing them to see their injured loved one” and dealing with the family’s issues of “anger, guilt, and fear” (Carroll, 2008, p.213). This high level of care ensures that service members do not “fall through the cracks” when going through the rehabilitation process as well as ensuring that their mental health needs are being met from day one.
Target Population The target population for this intervention is all injured service members (Navy, Marines, Army, Air Force, National Guard, etc) who were required to be medically evacuated out of a combat zone in support of OEF/OIF. If a service member had to be medically evacuated out of a combat zone then they likely sustained serious injuries and thus are at higher risk for developing PTSD/depression. In general, the targeted population will likely consist mostly of males between the ages of 18-30 because they are the ones usually at the front lines in the war; however, the ages and gender can vary.
Once a service member is medically evacuated they will be entered into a database so that they can be tracked. Treatment can begin once the patient has arrived to a military treatment facility in the U.S and is medically stable. The program will include all severely injured service members meeting the above qualifications who were injured after the implementation of the program.
B. Proposed Approach
Proposed Intervention The intervention I am proposing is loosely based on the PCLN model that is currently being used by the U.S Army.
I believe that the intensive mental health services and closely monitored follow up care that the PCLN model provides would offer the best possible outcome for the patient. However, my intervention team would be comprised of licensed clinical Social Workers, psychologists and psychiatrists who would begin to deliver prolonged exposure therapy (PE) to the patient as soon as the patient is medically stable. The intervention team would also consist of licensed nurses who would provide case management services to assist the patient in navigating the military’s health benefit systems and ensuring that the patient does not have lapses in care during their rehabilitation process. Prolonged exposure therapy is recognized by the Institute of Medicine as the “only treatment approach with sufficient efficacy data for combat related PTSD” (Tuerk, et al., 2011). The treatment team would also work with the patient’s family in order to take care of their psychosocial needs as well as teaching the family about the patient’s injury, PTSD, depression and suicide warning
signs.
The proposed treatment model would make it mandatory for the treatment team to see a patient once the patient is medically stable. The patient can always opt out of treatment but making the visit by the treatment team mandatory would lessen the stigma surrounding mental health treatment therefore a patient will be more likely to seek treatment. Even though a patient is more likely to focus on the physical aspects of their rehabilitation process in the beginning it is important to teach a patient coping strategies. Teaching a patient coping strategies early in the rehabilitation process will ameliorate their PTSD/depression symptoms later. Patients leave the hospital fairly quickly so treatment would be provided daily for 60 minutes during the patients hospital stay. Follow up mental health care arrangements will be made for the patient by the nurses prior to their discharge from the hospital to ensure that there are not any lapses in care.
Goals and Objectives The purpose of my proposed treatment plan is to provide intensive mental health and case management services to service members who have been severely injured since they are more likely to develop PTSD/depression. The short term goals of the intervention include reducing the stigma surrounding mental health treatment, educating patient’s loved ones on their various diagnoses’, providing the patient with coping strategies and ensuring that there are no lapses in patient care. The long term goal of the intervention is to reduce suicide rates in a high at risk population. The proposed intervention will lower suicide rates in the military population by targeting the most vulnerable service members. Service members who have sustained combat injuries have been shown to have higher rates of PTSD/depression and this could lead to suicide (Carroll, 2008). Providing intensive mental health and case management services soon after a service member is injured reduces a service member’s suicide risk. These services will let a service member know that they have the support of a team of people behind them whenever they need it.

References
Carroll, D.
W. (2008). Perspectives in Psychiatric Consultation Liaison Nursing. Perspectives in Psychiatric Care, 44(3), 211-215.
Casualty Status. (2011, March 11). Defense.gov. Retrieved March 11, 2011, from http://www.defense.gov/news/casualty.pdf
Donnelly, J. (2009). Rising Military Suicides. Congress.org. Retrieved February 25, 2011, from http://www.congress.org/news/2009/11/25/rising_military_suicides
Grieger, T. A., Cozza, S. J., Ursano, R. J., Hoge, C., Martinez, P. E., Engel, C. C., et al. (2006). Posttraumatic Stress Disorder and Depression in Battle-Injured Soldiers. American Journal of Psychiatry, 163(10), 1777-1783.
Hampson, R. (2010). Afghanistan: America’s Longest War. Usatoday.com. Retrieved February 25, 2011, from http://www.usatoday.com/news/military/2010-05-27-longest-war-afghanistan_N.htm
Tuerk, P. W., Yoder, M., Grubaugh, A., Myrick, H., Hammer, M., & Acierno, R. (2011). Prolonged exposure therapy for combat-related posttraumatic stress disorder: An examination of treatment effectiveness for veterans of the wars in Afghanistan and Iraq. Journal of Anxiety Disorders, 25, 397-403.

Logic Model
Antecedent
Inputs/intervention
Short term Goals
Long term Goal
-Stigma surrounding mental health
treatment
Mandatory visits to ALL combat injured service members by the treatment team
Lessen the stigma surrounding mental health care therefore making it more likely for patients to seek treatment

Reduce suicide rates in the military population
-Patients have lapses in care and are “lost in the system”
Nurse case managers who will oversee a patients rehabilitation process and ensure that all physical/mental health needs are being met
Ensure that patients have no lapses in treatment

-Lack of knowledge in regards to PTSD, suicide, or depression
Intervention team provides psychoeducational classes for the loved ones of the injured service member
Loved ones will be able to understand why the service member is acting a certain way and instead of taking things personal they will support the service member

-PTSD/depression in combat injured service members
Providing intensive mental health services (prolonged exposure therapy) soon after the service member arrives to the hospital
Address symptoms as soon as possible and provides service member with coping strategies to assist them in the future