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AbstractThe 1985 medical standards and guidelines for the adjudication of mentally impaired claimants for SSI and SSDI disability benefits were evaluated and basically found to reflect the statutory definition of disability according to the current perspective of psychiatry.

CHAPTER ONE: Introduction -- CHAPTER TWO: Methods -- CHAPTER THREE: Measuring the Readiness of Soldiers and Families -- CHAPTER FOUR: Evaluation of Existing Data Sources and Potential Instruments to Support a Readiness Metric -- CHAPTER FIVE: Improving Readiness Assessment -- CHAPTER SIX: Summary and Recommendations -- APPENDIX A: Readiness Policies -- APPENDIX B: Interview Protocols -- APPENDIX C: Existing Data Sources -- APPENDIX D: Terms Used for Instrument Search -- APPENDIX E: Instruments Identified in the Instrument Search -- APPENDIX F: Instruments from Supplemental Search

This study is a comprehensive assessment of the quality of PTSD and depression care delivered by the Military Health System (MHS), including performance on 30 quality measures evaluating receipt of recommended assessments and treatments.

The U.S. Department of Defense (DoD) strives to maintain a physically and psychologically healthy, mission-ready force, and the care provided by the Military Health System (MHS) is critical to meeting this goal. Given the rates of posttraumatic stress disorder (PTSD) and depression among U.S. service members, attention has been directed to ensuring the quality and availability of programs and services targeting these and other psychological health (PH) conditions. Understanding the current quality of care for PTSD and depression is an important step toward improving care across the MHS. To help determine whether service members with PTSD or depression are receiving evidence-based care and whether there are disparities in care quality by branch of service, geographic region, and service member characteristics (e.g., gender, age, pay grade, race/ethnicity, deployment history), DoD's Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) asked the RAND Corporation to conduct a review of the administrative data of service members diagnosed with PTSD or depression and to recommend areas on which the MHS could focus its efforts to continuously improve the quality of care provided to all service members. This study characterizes care for service members seen by MHS for diagnoses of PTSD and/or depression and finds that while the MHS performs well in ensuring outpatient follow-up following psychiatric hospitalization, providing sufficient psychotherapy and medication management needs to be improved. Further, quality of care for PTSD and depression varied by service branch, TRICARE region, and service member characteristics, suggesting the need to ensure that all service members receive high-quality care.

This article describes the psychological health workforce at military treatment facilities, examines the extent to which care is consistent with clinical practice guidelines, and identifies facilitators and barriers to providing this care.

Introduction -- Methods -- Remote Versus Non-Remote Differences in Demographics and Behavioral Health Care Utilization -- Access to Direct Care for the Behavioral Health Cohort -- Quality of Behavioral Health Care: Initial Care -- Quality of Behavioral Health Care: Medication Management -- Quality of Behavioral Health Care: Transitions of Care -- Summary and Recommendations -- Appendix A: Sensitivity Analyses of Remoteness Definition -- Appendix B: Technical Specifications for Access and Behavioral Health Quality of Care Measures -- Appendix C: PTSD, Depression, and SUD Cohort Demographic and Service Characteristics -- Appendix D: Cohort Descriptive Data by Diagnostic Cohort -- Appendix E: Summary of Remote Versus Non-Remote Differences in Behavioral HealthQuality Measures.

In recent years, the number of U.S. service members treated for psychological health conditions has increased substantially. In particular, at least two psychological health conditions—posttraumatic stress disorder (PTSD) and major depressive disorder (MDD)—have become more common, with prevalence estimates up to 20 percent for PTSD and 37 percent for MDD. Delivering quality care to service members with these conditions is a high-priority goal for the military health system (MHS). Meeting this goal requires understanding the extent to which the care the MHS provides is consistent with evidence-based clinical practice guidelines and its own standards for quality. To better understand these issues, RAND Corporation researchers developed a framework to identify and classify a set of measures for monitoring the quality of care provided by the MHS for PTSD and MDD. The goal of this project was to identify, develop, and describe a set of candidate quality measures to assess care for PTSD and MDD. To accomplish this goal, the authors performed two tasks: (1) developed a conceptual framework for assessing the quality of care for psychological health conditions and (2) identified a candidate set of measures for monitoring, assessing, and improving the quality of care for PTSD and MDD. This article describes their research approach and the candidate measure sets for PTSD and MDD that they identified. The current task did not include implementation planning but provides the foundation for future RAND work to pilot a subset of these measures.

Background: Socioeconomically disadvantaged adults experience greater healthcare disparities and increased risk of depression compared to higher-income groups. Aim: To create a depression care model for disadvantaged adults utilizing service agencies, through a community–academic partnership. Methods: Using participatory research methods, an organizational needs assessment was performed to ascertain depression care needs, identify barriers to clients receiving treatment, and marshal resources. Interviews and surveys were conducted with community organizational leaders. Focus groups were conducted with clients who used the service agencies. Results: Interviews and surveys identified barriers including discontinuity of care and unmet basic needs for food, housing, health insurance and transportation. Focus groups enriched the understanding of barriers including lack of motivation to seek depression care, lack of social support and needed resources for the uninsured, underinsured and homeless. The findings were used to develop a depression care model combining depression management with motivational interviewing to evaluate and meet needs, and peer education to motivate and provide support. Conclusions: This partnership facilitated the development of a community-driven intervention that academic researchers acting alone could not realize. To provide depression care to socioeconomically disadvantaged individuals, the intervention must include mitigating solutions to barriers.

Concerns about access to behavioral health care for military service members and their dependents living in geographically remote locations prompted research into how many in this population are remote and the effects of this distance on their use of behavioral health care. The authors conducted geospatial and longitudinal analyses to answer these questions and reviewed current policies and programs to determine barriers and possible solutions

With many service members now returning to the United States from the recent conflicts in Iraq and Afghanistan, concern over adequate access to behavioral health care (treatment for mental, behavioral, or addictive disorders) has risen. Yet data remain very sparse regarding how many service members (and their dependents) reside in locations remote from behavioral health providers, as well as the resulting effect on their access to and utilization of care. Little is also known about the effectiveness of existing policies and other efforts to improve access to services among this population. To help fill these gaps, a team of RAND researchers conducted a geospatial analysis using TRICARE and other data, finding that roughly 300,000 military service members and 1 million dependents are geographically distant from behavioral health care, and an analysis of claims data indicated that remoteness is associated with lower use of specialty behavioral health care. A review of existing policies and programs discovered guidelines for access to care, but no systematic monitoring of adherence to those guidelines, limiting their value. RAND researchers recommend implementing a geospatial data portal and monitoring system to track access to care in the military population and mark progress toward improvements in access to care. In addition, the RAND team highlighted two promising pathways for improving access to care among remote military populations: telehealth and collaborative care that integrates primary care with specialty behavioral care.