RESPECT-Mil Implementation Page

Background

Created by international experts in primary care management of depression and posttraumatic stress disorder (PTSD), RESPECT-Mil (Re-Engineering Systems for the Primary Care Treatment of Depression and PTSD in the Military) is an innovative program to provide systematic evidenced-based care to Soldiers with symptoms of depression and PTSD in the primary care setting. It is a systems approach designed to improve treatment outcomes while helping clinics to more fully implement the VA/DoD Clinical Practice Guidelines for Major Depressive Disorder and PTSD. The RESPECT-Mil treatment model involves primary care providers, assisted by RESPECT-Mil Care Facilitators (RCFs) trained to screen their patients for depression and PTSD and to communicate with them about behavioral health issues. Advantages of this care model include identifying and treating problems early, delivering effective, easy-to-access care in the primary care setting with reduced stigma, and promoting collaboration between primary care and behavioral health in military treatment facilities. This model also provides improved continuity of care for problems that require long-term, sustained interventions and as a result, Soldiers in the RESPECT-Mil program are less likely to "fall through the cracks" of an often complex health services delivery system.

This Web page was developed to provide policies and directives, fact sheets, clinical tools, training material, and related links to assist healthcare providers implement the RESPECT-Mil Program. Information on the care for depression and PTSD in the primary care setting and the roles of the primary care clinician, behavioral health specialist and care facilitator can be found on the RESPECT-Mil Web Page.

Policies and Directives

• MEDCOM Circular 40-20, Re-Engineering Systems of the Primary Care Treatment (of Depression and Post-Traumatic Stress Disorder) in the Military Documentation Forms, 4 Oct 10
• MEDCOM OPORD 10-25, Expansion of the Re-engineering Systems of the Primary Care Treatment of Depression and PTSD in the Military – (RESPECT-Mil) Program, 5 Feb 10
• MEDCOM OPORD 09-05, Implementation of Behavioral Health Training into Primary Care, 6 Nov 08
• Fragmentary Order 2 to OPORD 07-34, 091230Q Jan 08
• MEDCOM OPORD 07-34 (Re-engineering Systems of the Primary Care Treatment of Depression and PTSD in the Military - RESPECT MIL) 03144R Jan 07

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Clinical Guidance

• PC Brief Treatment Guide (Depression Management Using the PHQ-9 and PTSD Management Using the PCL
• RESPECT-Mil Depression Training Tools
• RESPECT-Mil PTSD Tools
• P4 Screener for Suicide Risk, 2010
• VA / DoD Clinical Practice Guideline for Management of Major Depressive Disorder (MDD), May 09
• VA/DoD Clinical Practice Guideline for Management of Post-Traumatic Stress, Oct 10
• VA/DoD Clinical Practice Guideline for Management of Substance Use Disorders (SUD), Aug 09

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Other Related Information

• PsychCentral Article, Army Care for Mental Disorders Improves with Primary Care Involvement, 7 Jun 12
• Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE), RESPECT-Mil Information Sheet, Winter 2010
• US Medicine, Program Aims to Reach Patients with Behavioral Health Needs in Primary Care Setting, Sep 10
• Military.com Article, R-E-S-P-E-C-T Spells Reduced Stigma, 21 Jul 08
• Army Hopes Program Makes Soldiers More Apt to Get MH Care, Psychiatric News Vol 43, No 3, 1 Feb 08
• US Army News Release - Army Announces New Health Program: RESPECT-MIL, 22 Jan 07

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Manuals and Guidelines

• Primary Care Clinician (PCC) Manual, Version Mil-2.0, Aug 08
• Behavioral Health (BH) Manual, Version Mil-2.0, Aug 08
• Care Facilitator (RCF) Manual, Version Mil-2.0, Aug 08

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Forms and Measures

• MEDCOM Form 774, RESPECT-Mil Primary Care Screening, Oct 10
• PHQ-9 (Patient Health Questionnaire with ID), Jul 10
• PCL (Post Traumatic Stress Disorder (PTSD) Checklist with ID), Sep 07
• MEDCOM Circular 40-20, Re-Engineering Systems of the Primary Care Treatment (of Depression and Post-Traumatic Stress Disorder) in the Military Documentation Forms, 4 Oct 10 New!
• PC Brief Treatment Guide (Depression Management Using the PHQ-9 and PTSD Management Using the PCL
• P4 Suicidality Screener Form, RESPECT-Mil 2012
• Mood Disorder Questionnaire
• Development and Validation of a Screening Instrument for Bipolar Spectrum Disorder: The Mood Disorder Questionnaire, Am J Psychiatry 157:11, November 2000
• RESPECT-Mil Patient Satisfaction Questionnaire

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RESPECT-Mil Care Facilitator (RCF) Tools

• FIRST-STEP System

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Education and Training

• Provider
  • Military Health System Clinical Quality Management (MHS-CQM) On-Line Education (CME/CNE) Presentation, Improving Mental Health Screening, Evaluation, Treatment, and Referral through the RESPECT-Mil Program, 23 Nov 10
  • Savannah RESPECT-Mil Champion Conference 14-16 Jun 10
  • Introduction
  • Goals and Agenda 15 Jun 10
  • Screening Process
  • FIRST-STEPS
  • RESPECT-Mil Business Model
  • Program Examples
  • Hunter Army Airfield
  • Fort Riley
  • Schofield Barracks
  • Implementation Planning
  • Goals and Agenda 16 Jun 10
  • Metrics
  • Maintain Momentum
  • RESPECT-Mil Re-Engineering Systems of Primary Care Treatment in the Military, Power Point slides, 19 Oct 09
  • RESPECT-Mil Depression and PTSD Web-Based Training (The Army has mandated that all primary care providers take a 2 hour web-based training course on the management of depression and PTSD. This training is available to providers in all the services.)
  • Military Health System Clinical Quality Management (MHS-CQM) On-Line Education (CEU) Presentation, Evaluation of the U.S Army's RESPECT-Mil Program, 12 Sep 08  (Review of the findings of the 2007 NQMP study of the Army's RESPECT-Mil Program.)
• Patient
  • Depression Education Pamphlet, Jan 09
  • PTSD Education Pamphlet, Jan 09
  • RESPECT-Mil  Program Information Brochure, Jan 09
  • Self Management Worksheet

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RESPECT-Mil Newsletter

DHCC RESPECT-Mil program now provides a semi-annual newsletter highlighting RESPECT-Mil activities at DHCC and various sites. We intend for this newsletter to be a source of information, a communication instrument and a place to celebrate our providers. To subscribe to the newsletter, please submit a request at this link PDHealth.RESPECT-Mil@amedd.army.mil and indicate whether you prefer a link to the newsletter or a hardcopy mailed to your address. When requesting a hardcopy, please provide you full mailing address with a contact phone number.

• RESPECT-Mil Newsletter Summer 2012
• RESPECT-Mil Newsletter Fall 2011
• RESPECT-Mil Newsletter Spring 2011
• RESPECT-Mil Newsletter March 2010

Research

• Research Papers/Journal Articles
  • RESPECT-Mil: Feasibility of a Systems-Level Collaborative Care Approach to Depression and Post-Traumatic Stress Disorder in Military Primary Care, Military Medicine, 173, 10:935, October 2008
  • Systematic Review of Multifaceted Interventions to Improve Depression Care, General Hospital Psychiatry 29 (2007) 91–116
  • RESPECT-Mil: Feasibility of a Systems-Level Collaborative Care Approach to Depression and Post-Traumatic Stress Disorder in Military Primary Care, Military Medicine, Vol 173, Oct 08
  • MHS-CQM Evaluation of the Army's RESPECT-Mil Program Special Study Fact Sheet, 2007
  • Systematic Review of Multifaceted Interventions to Improve Depression Care. (Abstract) General Hospital Psychiatry 29 (2007) 91-116
  • Collaborative Care for Depression - A Cumulative Meta-analysis and Review of Longer-term Outcome. (Abstract) Arch Intern Med/Vol 166, Nov 27, 2006
  • A Three-Component Model for Reengineering Systems for the Treatment of Depression in Primary Care. Psychosomatics 2002; 43:441-450)
  • Re-engineering Systems for the Treatment of Depression in Primary Care: Cluster Randomised Controlled Trial. BMJ, doi:10.1136/bmj.38219.481250.55
• Research Web Sites
  • USUHS Center for the Study of Traumatic Stress
  • The International Society for Traumatic Stress Studies

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Related Links

• Behavioral Health
• afterdeployment Web Site (The Military Health System's mental wellness resource Web portal for service members, veterans, and military families suffering post-deployment mental health problems.)
• Army Behavioral Health Web Site
• Defense Centers of Excellence For Psychological Health & Traumatic Brain Injury Web Site
• Depression
  • DHCC Major Depressive Disorder Page
  • The MacArthur Foundation's Initiative on Depression and Primary Care
  • VA, Collaborative Care for Depression in the Primary Care Setting: A Primer on VA’s Translating Initiatives for Depression into Effective Solutions (TIDES) Project
  • Rand Partners in Care: An Integrated Approach to Improving Care for Depression in Primary Care
  • National Institute of Mental Health Depression Page
  • American Psychological Association Depression Page
  • MedlinePlus: Depression Page
  • Deployment Health Clinical Training Series Module on Managing Depression in Primary Care Using the VA/DoD Major Depressive Disorder Clinical Practice Guideline 7 May 07
  • DHCC Suicide Prevention Page
• Post Traumatic Stress Disorder
  • DHCC Post Traumatic Stress Disorder Page
  • DHCC Combat/Operational Stress Page
  • VA, National Center for PTSD
  • National Institute of Mental Health Post-Traumatic Stress Disorder (PTSD) Page
  • American Psychological Association Posttraumatic Stress Disorder Page
  • MedlinePlus: Post Traumatic Stress Disorder Page
  • VA, Veterans Health Initiative, Independent Study Course, PTSD: Implications for Primary Care, Mar 02
• Integrated Treatment in Primary Care
• Pittsburgh Regional Health Initiative (PRHI) Integrating Treatment in Primary Care Web Page
• Center for Health Care Strategies, Inc., Integrating Physical and Behavioral Health Care in Medicaid: An Online Toolkit
• RESPECT-Mil Page

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