Preventing Psychological Disorders in Service Members and Their Families An Assessment of Programs (2014) / Chapter Skim
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2 CONCEPTUAL FRAMEWORKS FOR REVIEWING EVIDENCE-BASED PREVENTION IN PSYCHOLOGICAL HEALTH
2 CONCEPTUAL FRAMEWORKS FOR REVIEWING EVIDENCE-BASED PREVENTION IN PSYCHOLOGICAL HEALTH
Pages 15-34
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Behavioral health problems include substance use disorders; alcohol and drug addiction; and serious psychological distress, suicide, and mental disorders. This includes a range of problems from unhealthy stress or subclinical conditions to diagnosable and treatable diseases like serious 15
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The committee notes that the effort to destigmatize mental health issues is one of the biggest factors driving the evolving use of terminology in the military health system and the health care field in general. GOOD PSYCHOLOGICAL HEALTH Prevention strategies designed to reduce the onset and severity of posttraumatic stress disorder (PTSD)
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Universal prevention strategies are offered to the entire population, with the goal of the intervention being to reduce the probability of the undesired outcome. Selective prevention strategies are targeted to
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This committee is in agreement with the conclusions made by prior committees that for individuals with full-blown disorders, treatment should include prevention elements to lower the likelihood of relapse as well as associated negative outcomes; for example, treatment for individuals diagnosed with depression should include suicide prevention strategies. It should be noted, however, that individuals' psychological health conditions will affect the psychological health of their families; thus, treatments that include an ecological framework may include preventive approaches for those at risk due to the illness of a family member (e.g., there are preventive opportunities for family members of service members with PTSD or traumatic brain injury; see Tanielian et al., 2013)
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SOURCE: SAMHSA, 2009. There are other generally accepted standards of evidence for effective prevention programs.
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. In addition, effective prevention programs use varied methods of imparting knowledge and achieving behavior change.
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recognizes multiple levels of influence, including the individual, interpersonal, institutional, community, and society, and therefore promotes targeting multiple levels to prevent negative outcomes. This model is particularly appropriate when considering military prevention programs because of the highly structured work and social life of military personnel and their families.
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Nash and colleagues (2010) adopted a framework for defining the scope of stress outcomes and for promoting military mental health prevention based on the IOM model for classifying the spectrum of interventions for psychological disorders, which is summarized in the IOM "protractor" (IOM, 1994)
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. The IOM model suggests that the military can promote more effective prevention interventions by defining the early subclinical states that confer the greatest risk for either failure of role performance or future psychological health disorders and by identifying the moderators 2 Acute stress reaction and acute stress disorder are subthreshold or preclinical posttraumatic states that are targets for early intervention to prevent the onset of PTSD.
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for whom indicated prevention interventions might most usefully be offered. To define "cases" of preclinical operational stress based on sound conceptual reasoning and empirical support.
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The committee's model incorporates three frameworks relevant to effective measurement of prevention programs in the area of psychological health: the Donabedian paradigm for assessing quality of care, the National Behavioral Health Quality Framework, and the National Quality Forum criteria. The committee also considered the utility of the Porter model, as directed by the statement of task.
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Healthy living -- Assist communities to use best practices to enable healthy living 4 By behavioral health, SAMHSA refers to a state of mental/emotional well-being and/or actions that affect wellness. Behavioral health problems include substance use disorders; alcohol and drug addiction; and serious psychological distress, suicide, and mental disorders.
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Affordable/accessible -- Foster affordable high-quality behavioral health care for individuals, families, employers, and governments by developing and advancing new and recovery-oriented delivery models In the NBHQF, prevention and wellness are often captured as population-level measures. The NBHQF is aligned with the three aims of the National Quality Strategy5 developed by the Department of Health and Human Services (HHS)
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The Porter Model In addition to identifying the best metrics for resilience and prevention programs, the committee was asked to consider the potential utility of the Porter model and the psychological outpatient clinical pathway for PTSD among service members. The Porter model (Kaplan and Porter, 2011)
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Instead, the model serves as a general guide for thinking about the complex process of identifying the best metrics for assessing DOD prevention programs. In Chapter 5 the committee refers to this model when it considers what DOD should measure in assessing its resilience and prevention programs.
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On the basis of its review of various models for assessing the effectiveness and performance of prevention programs, the committee found that Porter's value model is applicable to the treatment pathways; however, it is not an appropriate model for assessing the value of prevention interventions. The committee concluded that an organizing framework would help provide a structure for decision making about what is important to measure in a systematic assessment of resilience and prevention programs.
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Falls Church, VA: Defense Health Board Task Force on Mental Health.
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Principles of effective prevention programs. American Psychologist 58(6–7)
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2013a. National Behavioral Health Quality Framework (Draft)
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