|
Volume 21, Issue 2 |
Summer 2020 |
|
|
A Publication of VISN 5 MIRECC
MIRECC Matters
Putting Recovery Into Practice
|
|
Newsletter Sneak Peek:
Putting Recovery into Practice During Challenging Times: Hear from the VISN 5 MIRECC Director!
Recovery Resources During Physical Distancing: Read more about how the VISN 5 MIRECC Put Recovery into Practice through resources for Veterans and clinicians!
Social Skills Training for Serious Mental Illness (SST) via Telehealth: Building a VA Community of Practice: Learn how the SST program brought providers together to manage knowledge about SST via telehealth through a Community of Practice.
Collaboration through Telehealth Efforts: Read about two telehealth efforts the MIRECC supported and the positive reactions of the Veterans that participated!
Employee Assistance Program and VISN 5 MIRECC: Work Together to Support Employee Wellness: Learn how MIRECC staff contributed to the "greater good" through the EAP during COVID-19.
VISN 5 MIRECC "Employee of the Week": Finding Positivity During "Ruff" Times: Read about the program devised to highlight the new honorary “employees” who have uplifted the MIRECC staff during remote working!
Comings and Goings: Say 'Hello' to new MIRECC staff and 'Good-bye' to those moving on!
Dr. Richard Goldberg, Director
The co-occurrence of the COVID-19 pandemic and our nation’s long overdue attention to issues of racial injustice has resulted in both significant challenges and newfound opportunities on many personal and professional levels. Within the VISN 5 MIRECC we are making collective efforts to improve delivery of recovery-oriented treatments, services, and resources to help Veterans thrive during the pandemic. We have also started on what I hope will be an ongoing and concerted effort to more actively pursue anti-racist policies and create a just and equitable environment for our staff as well the Veterans we serve. For this current issue, we are including several items relating to our response to the COVID-19 pandemic. Our next issue will highlight efforts relating to our progress toward being more explicitly anti-racist in both how our organization is structured and the range of activities and outputs coming from across our Research, Education and Clinical Cores. We are all in this together and I am confident we will both survive and grow both individually as a MH Center of Excellence committed to improving the recovery and community integration of Veterans living with serious mental illness.
|
|
|
Kinnera Atluri & Joanna Strong Kinnaman, Ph.D.
With the declaration of COVID-19 as a pandemic and the unexpected transition to teleworking, a feeling of unease and uncertainty arose. Questions about what the pandemic meant and how to handle the ever-growing seriousness of the situation put many, including the Veterans we serve as well as staff, into distress. To try and answer these questions and help ease the uncertainty among us all, VISN 5 MIRECC staff decided to pull together resources at both a local and national level.
A team of VISN 5 MIRECC peer support specialists, a research assistant, and an investigator set out to create a repository of resources to support staff and the Veterans they serve on topics such as social distancing, how to stay active and engaged, ways to cope, whole health coping strategies, community resources for those in need of food or assistance, and national hotlines to assist with inquiries or crises. By spreading the word about this project to the rest of the VISN 5 MIRECC, resources found in newsletters, personal research, and from other MIRECCs across the country were sent in abundance.
Staying true to the VISN 5 MIRECC mission of enhancing the recovery and functioning of Veterans with serious mental illness, many resources focused on how to continue with recovery and prevent relapse during quarantine. Specifically, many of the resources focused on assisting interventionists as they continued to provide services to Veterans virtually. These included training resources, guides on how to provide remote services and resources for interventionists’ self-care to ensure their well-being. Making these materials accessible to the interventionists allowed for a smoother transition to working virtually with Veterans.
In addition to gathering a repository of resources for MIRECC staff and Veterans who are participants in our MIRECC studies, we also wanted to provide support to VA clinicians across the country who are continuing to provide recovery-oriented clinical care to Veterans in these stressful times. To this end, MIRECC Investigator and Clinical Core Assistant Director, Dr. Anjana Muralidharan initiated a project to create a recovery handout to be shared at a national level with clinicians so they might pass it on to the Veterans they serve. The collaborative efforts of Dr. Muralidharan, Certified Peer Support Specialists Howard Turner and Tracy Robertson, Research Assistant Kinnera Atluri, and Communications Specialist Joanna Strong Kinnaman, led to the creation of a resource with the primary focus of setting the VISN 5 MIRECC’s vision of Putting Recovery into Practice into action. The resource, found here, utilized each of the ten SAMHSA guiding principles of recovery to help demonstrate ideas for coping during physical distancing. The different principles of recovery include hope, person-driven, many pathways, holistic, peer support, relational, culture, addressing trauma, strength and responsibilities and respect. The team discussed each principle in a collaborative manner in order to reflect all the perspectives of those who assisted and potentially reach a broader audience. Some of the ideas for coping spanned from establishing a routine and finding an information balance that works for each person, to considering physical distancing as an opportunity to give more attention to certain relationships – including pets!
This project began with the hope of finding ways to help individuals cope during these turbulent times and continues still with that hope. Everyone has different ways of handling difficult circumstances. Encouraging individuals focus on positive ways to deal with challenges, remains true to the principles of the VISN 5 MIRECC.
Reference:
|
|
|
Elizabeth Gilbert, Ph.D. and Rebecca Pasillas, Ph.D.
In March 2020, the COVID-19 pandemic hit and caused a nationwide shift for VA mental health treatment to be provided via telehealth modalities. The existing VA Social Skills Training for Serious Mental Illness (VA SST) telehealth protocol, which requires an offsite trained SST provider leading the group via videoconference and an on-site VA provider taking the role of a “roleplay buddy” for face-to-face roleplays with the Veterans in the SST group, has shown promising fidelity, feasibility and group member satisfaction. However, it would not be ideal to implement during the COVID-19 pandemic as it requires Veterans attend groups in-person and risk virus transmission. This presented a dilemma for the provision of treatment to Veterans with serious mental illness diagnoses such as schizophrenia because it is unknown whether group therapy delivered via telehealth for individuals with serious mental illness is adequate or comparable to in-person services (Greenbaum, 2020). Despite these unknowns and by necessity, VA providers began to adapt SST for telehealth independently so that Veterans could virtually attend SST groups from their own homes via phone, Veterans Affairs National Telecommunications System (VANTS) conference calls, VA Video Connect (VVC) videoconference calls, or through a combination of both VVC and VANTS.
The VA SST Training Program communicated with these providers to learn more about how the intervention is being adapted to identify possible clinical recommendations regarding its provision. Based on the information they provided, along with knowledge acquired from the SST literature and from VA telehealth resources, two PowerPoint presentations were developed and delivered in advanced practice SST meetings for previously trained SST providers. The presentation topics focused on providing SST groups via telehealth and providing SST individual sessions via telehealth. Initial recommendations shared in the presentations included information about group composition, telehealth methods of delivery, and practical considerations. A sample of preliminary recommendations included the following:
- SST groups of smaller size (e.g., 4-6) rather than the more typical 6-8 group member size might work better in a telehealth platform.
- Access to group member phone numbers and addresses where the Veterans are located while participating in telehealth is vital to have in case of an emergency.
- Having an SST co-facilitator for the group to follow-up with Veterans who are having technical issues during the group is helpful.
The presentations also covered topics related to modifying steps of the structured SST session sequence to accommodate a telehealth format and/or the current pandemic, modifying the discussion of the skills according to the method of telehealth delivery (e.g., an SST facilitator would discuss importance of eye contact if it is used in-person but acknowledge that eye contact is not something that can be well practiced via videoconference or via phone), and developing individualized practice assignments for outside group that are feasible and safe (e.g., involve calling someone on the phone vs. visiting someone in person). The teaching of specific social skills in the Bellack et al. (2004) manual that are relevant to the COVID-19 pandemic were also discussed. The following SST skills (among others) can be adapted for pandemic-related social situations:
- Reminding Someone Not to Spread Germs
- Making a Doctor’s Appointment on the Phone (e.g., for a telehealth appointment)
- Leaving Stressful Situations (e.g., if you find yourself in an area where you can’t maintain 6’ physical distance)
- Asking for Information (e.g., to learn how to order groceries for delivery; to ask about COVID-19 information or about how to access telehealth services)
Knowledge about SST via telehealth is in its infancy. For this reason, bringing providers together to generate and manage knowledge about this new delivery method of SST through a virtual Community of Practice (CoP) seems wise. The purpose of this CoP organized by the VA SST Training Program is to share information, improve skills, and advance the general knowledge about SST via telehealth. A distribution mailgroup for the CoP was created, and the inaugural SST via telehealth CoP meeting was held on June 22nd, 2020, with 51 VA staff attending. The CoP meetings are scheduled monthly and a means of managing information gained from these meetings and conducting more formal program evaluation on the developing intervention is planned. Providers trained in SST are welcome to attend the meetings, and the SST website will be updated with information about SST via telehealth as this information evolves. PDFs of the two presentations on SST via telehealth are available on the SST website http://www.mirecc.va.gov/visn5/training/social_skills.asp and additional materials will be added as this knowledge base develops. Hopefully, this is one example in which clinical practice will shape and inform future research.
References:
Bellack, A. S., Mueser, K. T., Gingerich, S., & Agresta, J. (2004). Social skills training for schizophrenia: A step-by-step guide (2nd ed.). The Guilford Press.
Greenbaum, Z. (2020, July/August). How well is telepsychology working? Monitor on Psychology, 51(5), 46.
|
|
|
Joanna Strong Kinnaman, Ph.D. & Lillian Hammer
The VISN 5 MIRECC has supported several important telehealth efforts since the initiation of telework due to the COVID-19 pandemic. In two recent examples, the MIRECC initiated novel tele-consent and tele-research procedures and has helped support a local clinical program in examining more closely the responses of Veterans to telehealth services.
The Development of a Patient Centered Mental Health Intervention for Recent Veterans (RR&D RX002159) research study staff have worked hard to make the study easily accessible to Veterans remotely. Consent forms are either mailed in hard-copy or encrypted and emailed to Veterans ahead of their consent appointment. For assessments, word documents containing the response options are emailed to Veterans to allow them to follow along with the assessor during telephone appointments. All the intervention sessions are conducted through Virtual Care Manager, an encrypted VA video chat program. Overall, the switch to remote appointments has been met with praise from Veteran participants. Those who began the study prior to work-from-home have reported appreciating greater flexibility in scheduling since they no longer must drive to a VA center. They have also appreciated the ability to continue to participate in the study without putting their health at risk. New Veteran participants who have only met with us remotely have mentioned that they likely would not have been able to participate, or would not have been interested in participating, had the study been conducted in-person.
Collaboration also seems to be a driving force in a recent VISN 5 MIRECC partnered effort related to telehealth. The MIRECC is partnering with the VA Maryland Healthcare System (VAMHCS) Psychosocial Rehabilitation and Recovery Center (PRRC) located at the Baltimore Medical Center. Dr. Neil Weissman, Coordinator of the PRRC, recently reached out to Dr. Richard Goldberg, Director of the VISN 5 MIRECC, with an interest in obtaining feedback from participating Veterans about their current experiences with the telehealth services provided by the PRRC. The MIRECC helped the PRRC develop procedures and an assessment instrument focused on Veteran opinions and experiences with the telehealth program.
In this effort, the MIRECC offered initial direction for the PRRC through consultation on the best way to obtain the information from Veterans. The MIRECC also helped construct the survey with scaled items as well as open-ended questions and provided ongoing feedback and guidance on the survey. The survey includes questions such as satisfaction with group and individual telehealth sessions, progress toward recovery goals, and how much the program has helped Veterans manage their mental health symptoms (anxiety, depression, etc.).
In the current procedures, Veterans are sent mail or email copies of the survey and a MIRECC staff member reaches out to each Veteran for a telephone interview. Tracy Robertson, a MIRECC Certified Peer Support Specialist and a group facilitator at the PRRC, was chosen as the individual that would give the phone survey. As Dr. Weissman put it, “we wanted to have someone that Veterans knew and [with whom] they could be comfortable that it [the information they provided] would be anonymous.” The Veterans are informed about the forthcoming telephone surveys during telehealth groups. The telephone interview takes about fifteen minutes. According to Ms. Robertson, “Everyone who completed the survey has been willing to do it and appreciated that the PRRC was doing it. Everyone thanked me at the end.” Ms. Robertson’s general impression is that it seemed that most of the Veterans have felt fee to talk to her about their experiences and liked having an individual connection with her on the phone. The PRRC hopes to have all the information soon, and when they do, they MIRECC has also offered to help analyze the data so that the program can look at the Veteran responses in aggregate.
Dr. Weissman described the PRCC as a recovery-oriented program that values collaboration with their Veteran participants. When asked about the reason the PRRC initiated the survey, he responded, “We really wanted to know if it [the program] was meeting their needs and to what degree it was meeting their needs…we hope they [the Veteran participants] would see the obvious - that their opinion counts a lot.” He stated that the PRRC will use the feedback to adjust the program to meet their needs better. For example, he stated that “if Veterans report being unsatisfied or doing groups seems difficult on the phone, then we might try and do more video groups.” The survey procedures were also put into place to get a general sense of the impact of social distancing on individuals’ symptoms and their recovery goals. Finally, a big question that Dr. Weissman hopes will be answered through this effort is: what might be the takeaway post-COVID? More specifically, many Veterans that attend the PRRC seem to struggle with isolation as a norm (i.e., before the pandemic). Dr. Weissman is hoping that learning more about the experiences of the PRRC Veterans could inform if telehealth services should be provided to people who are isolating as a bridge for connection or does telehealth reinforce isolation? These are important questions to answer as the program works to support the Veterans during this unprecedented time. Using this survey to get direct feedback from Veterans, look at the data in aggregate and modify the program services as needed, is an excellent way to facilitate collaboration and to involve Veterans in their own care.
These telehealth efforts have supported continued participation for Veterans in research and clinical programming that otherwise would not have been possible during the COVID-19 pandemic. And the positive responses of Veterans to these services? Is an invaluable added bonus!
|
Frederick Martin, Psy.D.
At the beginning of the COVID-19 pandemic, Dr. Richard Goldberg, Director of the VISN 5 Mental Illness Research, Education and Clinical Center (MIRECC), asked the MIRECC staff how we could contribute to the greater good during an all-staff meeting. In addition to the MIRECC staff who volunteered to help with COVID-19 screening patients and employees prior to hospital entry and distributing protective gear, many of the licensed clinicians provided support to the VA Maryland Health Care System (VAMHCS) staff through the Employee Assistance Program (EAP).
MIRECC staff have provided mental health care services to individual employees participating in EAP. MIRECC staff, drawing on knowledge and techniques from evidence-based interventions, have also conducted online presentations and supportive group sessions to enhance VAMHCS employee coping and wellness during the COVID-19 pandemic as part of EAP.
The presentations and sessions for groups of employees offered by MIRECC staff through EAP have featured a variety of self-care and wellness techniques. For example, Clare Gibson, Ph.D., a National Trainer and Consultant for the VA Social Skills Training for Serious Mental Illness (VA SST) Training Program, offered a presentation on “Staying Well During Stressful Times: Lessons From Positive Psychology.” Rick Martin, Psy.D., a National Trainer and Consultant for the VA SST Training Program, provided a presentation on “Breathing, Stretching and Relaxation” (BSR) which is a version of seated yoga that was developed at the Greater Los Angeles VA. The Assistant Director of the MIRECC Clinical Core, Anjana Muralidharan, Ph.D. conducted two presentations on “Practicing Self-Compassion and Loving-Kindness in Difficult Times”. Richard Goldberg, Ph.D. provided both afternoon and evening mindful meditation sessions as part of the EAP effort to offer employees wellness support during the COVID pandemic. These are some examples, although not a complete list, of the services and support MIRECC staff members have provided through EAP during the COVID pandemic. We are honored that we have been able to be a part of supporting the VA staff that serve our Veterans. Please keep an eye out for future presentations that will be announced through the VAMHCS EAP.
|
|
Lillian Hammer
For most of us, the continuing global pandemic has meant a dramatic shift in the daily routine that we once had. One day we had desk neighbors, a quiet place to work, and the occasional break to chat. Now, many of us find ourselves working alongside family members, roommates, friends, and pets. They talk (or bark or even howl) during conference calls, might bring the occasional cup of pick-me-up coffee or a tennis ball to throw, and sometimes even encourage a work break and walk around the block. In essence, they have become our new coworkers.
As part of their COVID-19 Moral Boosting Initiative, the VISN 5 MIRECC began a few projects to keep staff connected and encourage smiles. One project is entitled the “Employee of the Week” program. The program was devised to highlight the new honorary “employees” who have supported and uplifted the MIRECC staff during this, for most of us, unprecedented time. The program allows MIRECC employees to be creative; each “Employee of the Week” is submitted to the Social Committee with a couple of photos of the employee, a job title (my personal favorite has been “Food Acquisition Specialist” for a big brown lab), and a description of what their job duties have included during the pandemic. To be fair, it is also a great excuse to see the people and pets who are so important in each other’s lives. Plus, every single employee so far has been adorable.
On our weekly all-staff calls, the suspense builds as the announcement of the new employee of the week gets closer and closer. People wonder if this week it will be their little employee who wins. When the photos get delivered by email and the description is read aloud, there are always a few giggles and “aw”s. The staff praise each other’s home coworkers and the creativity of the job descriptions. The winner’s parent always gets excited to tell them (even if the winner themselves seems characteristically unenthused). The “Employee of the Week” announcement is always something to always look forward to. Not only does it allow for greater connection between coworkers, but it also allows those who submit and read the descriptions to see that during this time of uncertainty and upheaval, at least the kids and pets are happy we’re home!
|
|
Joanna Strong Kinnaman, Ph.D. & Melanie Bennett, Ph.D.
Joanna Strong Kinnaman recently began her position as the VISN 5 MIRECC Communications Specialist. Her goals for the work are to expand the MIRECC’s dissemination efforts and help strengthen the MIRECC as a national VA resource for mental health recovery for Veterans with serious mental illness. She has also taken over the role as Editor-in-Chief for the MIRECC Matters newsletter, which has been in circulation for twenty years. She is a Licensed Clinical Psychologist and has worked with the VISN 5 MIRECC in several previous positions including VA Social Skills Training for Serious Mental Illness Program Manager and Program Evaluator. Dr. Strong Kinnaman also worked for the VA-SST program developing a Computer Based Training program that now serves as the primary didactic tool for the EBP’s decentralized training model. Dr. Strong Kinnaman has also spent some of her career working in the private sector, contributing to marketing and design strategies for a technology company that serves the DOD. Since returning to work with the VISN 5 MIRECC she states that she is “thrilled that she can again work in a capacity to serve Veterans.” Welcome Joanna!
Dr. Arthur Ryan completed the Advanced Fellowship in Mental Illness Treatment and Research and took a position as a Research Investigator with the VISN 19 Rocky Mountain MIRECC for Veteran Suicide Prevention. He is based at the Washington DC VA and will continue his research on understanding, treating, and preventing Veteran suicide. We are thrilled that Dr. Ryan has stayed within the VA and within the mental health centers of excellence, and that we will still be able to see him since his "move" has kept him nearby! Congratulations to Dr. Ryan!
Katie Despeaux Ieft the MIRECC in July 2020 to begin an MA program in French and Francophone Studies at the University of New Mexico in Albuquerque. Katie’s primary role at the MIRECC has been as Lead Researcher for several MIRECC studies including PRIME Care, Reproductive Life Planning for Women Veterans with Mental Illness Pilot Trial, Veteran Identity Measure Pilot, Multifamily Group to Reduce Marital Conflict and Disability in Veterans with mild Traumatic Brain Injury, and others. Thank you, Katie, for all your wonderful contributions and best of luck on your new endeavor!
|
|
DEPARTMENT OF VETERANS AFFAIRS
VISN 5 MIRECC
Baltimore VAMC Annex Building 209 W. Fayette Street, 7th Floor, Baltimore, MD 21201 Phone: 410-637-1850
Putting Recovery Into Practice
|
|
MIRECC DIRECTOR
Richard Goldberg, Ph.D.
MIRECC ADMINISTRATIVE OFFICER
David Czajkowski
RESEARCH CORE
Associate Director: Julie Kreyenbuhl, Pharm.D., Ph.D.
Assistant Director: Robert Buchanan, MD
EDUCATION CORE
Co-Associate Director: Melanie Bennett, Ph.D. Co-Associate Director: Samantha Hack, Ph.D. Coordinator: Ralf Schneider, MA, CPRP
CLINICAL CORE
Associate Director: Amy Drapalski, Ph.D. Assistant Director: Anjana Muralidharan, Ph.D.
|
MIRECC MATTERS EDITOR
Joanna Strong Kinnaman, Ph.D. MIRECC MATTERS ASSOCIATE EDITOR Ralf Schneider, MA, CPRP
PHOTO CREDITS
Dr. Goldberg's photo: Medical Media, VA Maryland Health Care System University of Maryland School of Medicine
MIRECC MATTERS
An electronic publication of the VA Capitol Health Care Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC)
www.mirecc.va.gov/visn5
|
|
|
|
|