Enhanced Post Deployment Screening
While the primary purpose of the screening is to promptly identify and offer treatment to those who have deployment-related health problems, the screening serves other purposes as well:
- Providing feedback, guidance, education, and advice on the reintegration process (or other life problems/issues that come up during the interview). This includes providing information on potential signs of trouble that may emerge after the screening along with CAF and community resources to address these.
- Screening for mental or physical health problems that may be totally unrelated to deployment.
- Demystifying and de-stigmatizing mental illness and mental health care.
This is a screening process, not a diagnostic or therapeutic process. The goal is to identify those in need of further evaluation and/or care, while improving the quality of care for the population of returnees as a whole through a systematic process. For those who clearly need further evaluation, the focus should be on engaging the member in the process. For those who do not need further evaluation, it is appropriate to give them positive feedback on both their participation in the process as well as their personal coping abilities.
The process consists, in brief, of the following steps:
- The member is briefed at the time they are given the survey booklet to help orient them to the purpose of the process, the identity of the interviewer, confidentiality policy, and follow-up aspects of the process.
- The member completes a 20-minute paper survey containing standardized mental and physical health assessment instruments.
- The survey results are entered into an Excel spreadsheet, which scores and summarizes the results.
- The interviewer reviews the survey report.
- The interviewer administers a semi-structured interview to the service member; the member may elect to bring along a significant other to the interview. The interviews themselves take between 20 and 45 minutes.
- The interviewer makes recommendations, if indicated, for follow-up evaluation or treatment of any problems identified.
- About 6 to 8 weeks after the interview, the appointment register is reviewed to assure that those for whom follow-up was recommended actually received it. Those members with major issues who do not follow-up will be contacted to determine if further care is still needed.
In general, every CAF member (Regular and Reserve Force) who is deployed should receive a follow-up interview 3-4 months after return from theatre. Members who deployed on short assignments (59 days or less) do not need an interview. Also, members who deployed to locations in Europe and the United States do not require an interview. Members who are already receiving mental health care should also complete this process, though it may be completed at the time of a regularly scheduled visit with their mental health care provider. The rationale for screening those already in care is several-fold:
- At times, physical or psychosocial comorbidities are detected. Attention to physical health issues is particularly critical given that routine post-deployment medical exams are no longer being done.
- At times, a surprising residual symptom burden is uncovered.
- Exclusion of those in care would systematically bias the surveillance data collected.
The survey report contains a large amount of information in summary form. This approach is meant to provide a systematic way of digesting the information and interpreting its clinical significance. It is recommended that the social worker review the demographic information of the survey report to obtain a quick snapshot of the individual. The summaries for each psychometric instrument should then be reviewed to determine areas for further exploration in the interview. The interview guide will map some of the responses to the areas covered by the interview. The report applies standard algorithms to the validated survey responses; these have very good correlation with clinical diagnoses in validation studies. Nevertheless, both false positive and false negative results will occur. Interviewers should look at the totality of evaluation (questionnaire results plus the interview) in making decisions about the need for further care.
During the semi-structured interview, the interviewer will discuss with the military member any concerns identified in the computer-generated report from the detailed questionnaire, and together evaluate the potential impact on the member’s employment. The interviewer would then recommend whether or not the CAF member would require further medical services by filling out the referral sheet that is included with the Enhanced Screening. The member will be informed of any follow-up recommendations that are made, and the purpose of such follow-up. The member should also be informed that they may be contacted (confidentially) if they do not follow through as recommended, to ensure that those who need help the most will receive it.
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