Clinical Military Psychologists
Jan 18 Ch 5,6
Disclaimer
Information and opinions expressed by Maj
Dhillon and other military/government
employees providing lectures are not
intended/should not be taken as representing
the policies and views of the Department of
Defense, its component services, or the US
Government.
Overview
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Clinical Psychologists
Pediatric Psychologists
Forensic Psychologists
Prescribing Psychologists
Behavioral Health Consultants
Clinical Health Psychologists
Neuropsychologists
Military Mental Health Technicians
Clinical Psychologists
• Doctoral Level
• American Psychological Association (APA) accredited
program
• Pathway:
– APA internship
– Direct accession
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Retention bonus
Board Certification Bonus
Licensed in any state
Must be able to do any job, anywhere, with anyone
Pediatric Psychologists
• Same as clinical but completed post doctoral
fellowship in child psychology
• Specifier on job code designating specialty
• Highly sought for overseas assignments and
stateside big military medical facilities
Forensic Psychologists
• Same as clinical but completed post doctoral
fellowship in forensic psychology
• Fellowship can include working with criminal
investigation arm of their service
• Testify as expert witness in UCMJ cases
– Mental status during criminal act, capacity to
understand and participate in proceedings, opinion on
insanity defense, etc.
• Conduct evaluations for UCMJ cases
• Job code specifier after training
Prescribing Psychologists
• Same as clinical but obtained M.S. in
psychopharmacology and supervised
prescribing hours before certification
• Specifier on job code
• Born from operational necessity due to critical
shortage of psychiatrists and psychiatric nurse
practitioners
Behavioral Health Consultants
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Any Mental Health provider except psychiatry
4 weeks of training
Located within primary care clinic
Consult with primary care managers (PCMs) on patient
cases involving behavioral component such as:
– Weight management, Smoking cessation, Prescription
adherence, Chronic Pain Management, sleep problems…
• 50% of formal mental health care conducted in primary
care
• 15-30 min appointments, behavior and functioning
focused, patient belongs to PCM, BHC gives feedback
on consultation to PCM
Clinical Health Psychologists
• “applies scientific knowledge of the
interrelationships among behavioral,
emotional, cognitive, social and biological
components in health and disease to the
promotion and maintenance of health; the
prevention, treatment, and rehabilitation of
illness and disability, and the improvement of
the health care system.
Clinical Health Psychologists
• Specifically focus on physical health conditions
where behavioral factors play a primary or
secondary role
• Population Health Management
– Survey health of population, provide preventative care
and interventions, disease management and outcome
measurement
– Primary prevention: prevent onset of a condition
– Secondary prevention: identify those at risk
– Tertiary prevention: treat symptomatic patients
Clinical Health Psychologists
Post doctoral fellowship training
1-2 years
– assessment/management of
chronic disease and illness
– Health maintenance via
prevention
– Evaluate intervention
effectiveness
– Interdisciplinary collaboration
– Disease management team
development
– Develop a population health
approach
– Conduct applied clinical
research
• Job code identifier
• Primarily assigned to big
military medical facilities
• AF is a major post doc
fellowship training site
• Biofeedback certification
• Provide:
– Tobacco cessation, weight
management, chronic pain
management, insomnia
management,
Neuropsychologists
• 2 year post doc fellowship
• Focused on brain-behavior relationships
• Evaluate members of their service based on
the regulations for that service
– Army and AF have different regulations when it
comes to aviators and medication
• Job code specifier
• Most frequently placed in larger military
medical facilities
Neuropsychologists
• Differs from civilian neuropsychology
– Readily available baseline assessment data for
most mil members
• ASVAB
• AFOQT
• Service member records
– Neuropsych measures developed for specific
military populations (i.e., Armstrong Laboratory
Aviator Personality Survey)
Neuropsychologists
• Fitness for Duty Evaluations
– Assess type, level, an prognosis of neurological
impairment
– Traumatic Brain Injury
• Mil mbrs at high risk due to training, environment, and
combat
• Cognitive, emotional, behavioral, physical deficits
• Significantly impact knowledge, skills, and abilities required
of technical jobs in military
• In combat concussive blasts more common than penetrating
ones and cause cerebral damage but are more difficult to
identify
Neuropsychologists
– Medevac process from theater to Continental US
(CONUS):
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Injury on battlefield
Self Aid and Buddy Care on battlefield
Rapid medical response by medical technicians
Battlefield hospital care stabilizes member
Aerovac to Landstuhl Regional Medical Center in
Germany for further care
• Transfer to CONUS military/VA medical center
• Defense Veterans Brain Injury Center (DVBIC) for
specific treatment and rehabilitation for TBI
Neuropsychologists
– Attention Deficit Hyperactivity Disorder &
Learning Disorders
• No entry to military service w/history of ADHD,
unsatisfactory academic performance and /or current
NEED for medication
• If diagnosis made after member is in military, retention
in service possible only if symptoms do not interfere
with ability to do job
• Accommodations are not possible in military
environment
• Inability to perform results in an administrative
discharge as opposed to a medical discharge
Neuropsychology
• Military Aerospace Neuropsychology
– Branch of clinical neuropsych managing
assessment, selection, and disposition of military
and NASA members on flying status
– Integrates clinical-, aviation-, and neuro-psych
– 90% of air mishaps are due to human factors
– Must assess and integrate interplay of cognitive,
information processing, sleep/fatigue, stress,
ergonomics, toxicity, personality factors on flying
Neuropsychology
– AF School of Aerospace Medicine inaugurated by
President Kennedy the day before his
assassination at Brooks AFB in San Antonio now
moved to Wright Patterson AFB, OH
– Also address issues like airsickness, gravity loss of
consciousness, hypoxia, mishap investigation,
human factors research, stress reactions to flying,
motivation to fly, air traffic control, reverse
malingerers
Neuropsychology
• Multidimensional Aptitude Battery (MAB-II)
– Different norms for pilots, (look at drop in
performance as opposed to impairment defined
by regular norms on measures like IQ)
– FS IQ=120.8, SD=8.2,
– Impaired performance is 2 SDs below mean
• Avg IQ is actually an impairment for pilots
Neuropsychologists
• MicroCog-Generalizes well to common
neuropsych conditions
– Reaction Time and Information Processing Speeds
are especially important in assessing high
performance aircraft pilots
• Armstrong Laboratory Aviator Personality
Survey
– Produced and standardized by AF gives profile of
flyers in Personality, Psychopathology, and Crew
Interaction domains
Neuropsychologists
• NEO PI-R Personality measure on 5 factors
– Neuroticism (low), Extraversion (high), Openness
(middle), Agreeableness (low), and Conscientiousness
(high)
• Critical components of aviator neuropsych
assessment: speed/accuracy; attention/
concentration; vigilance; memory; working
memory; auditory, spatial, and kinesthetic
processing; new learning; multi-tasking; cognitive
flexibility, problem solving
Neuropsychologists
• Aviator profiles
– The Right Stuff—fighter pilot: aggressive, dominant,
exhibitionistic, impulsive, playful
– The Company Man—transport pilot: high
achievement, endurance, affiliation, and orderliness
– The Wrong Stuff—low exhibition, understanding,
affiliation, and orderliness
– High somatization due to high defensiveness and
denial of psychological problems
– Most pilots are RTD due to high resiliency and
achievement orientation
AF Mental Health Techs
• Per AFMAN 36-2108, 4Cs are supposed to be
able to: Support MH svcs in psychiatry,
psychology, social work, FAP, ADAPT, & MHC.
• Assist pro-staff w DEVELOPING &
IMPLEMENTING tx plans.
• PERFORMS specified MH tx.
• REPORTS & DOCUMENTS pt care.
Military Mental Health Techs
• Conduct/assist in individual & group tx.
• Perform initial, basic, & standard psych
assessment, clinical interviewing, MSEs
• Assist in: dx, tx, pt education, & disposition
planning.
• Observe, monitor, record, & report pt
progress.
• Assist in or arrange pt referral to public,
private or mil community agencies.
Military Mental Health Techs
• Training
– Tech School--MH Apprentice:
– 3 mos training DSM-IV-TR diagnostic criteria
– How to do an intake interview
– Operations of MH elements
• EXPERIENCE to obtain--MH Journeyman:
– Administering, scoring & reporting psych testing;
– Interviewing pts for biopsychosocial hx& personal info;
– ASSISTING pro staff to carry out prescribed tx plan
• EXPERIENCE to obtain--MH Craftsman:
– Conducting briefings.
– Performing or supervising Psych assessment.
– Interviewing pts and assisting in tx or substance abuse prevention &
counseling