1. Interdisciplinary Pain Team Training Program Michael E. Clark, PhD Candon Norton, PsyD Chronic Pain Rehabilitation Program Tampa Veterans’ Hospital www.vachronicpain.org

2. History & Development 2008 VA National Pain Initiative 2008 VA National Pain Initiative –Proposal for enhanced pain services nationwide Increase the number of pain specialists Increase the number of pain specialists Enhance primary care providers’ pain management knowledge and skills Enhance primary care providers’ pain management knowledge and skills Stimulate the development of interdisciplinary pain services nationwide Stimulate the development of interdisciplinary pain services nationwide –Specific training objectives and timeframes were contained in the National Pain Initiative proposal Each facility is expected to send at least one primary care provider for training in the “stepped care” model of pain treatment within two years of initiative approval Each facility is expected to send at least one primary care provider for training in the “stepped care” model of pain treatment within two years of initiative approval Each VISN is to implement at least one CARF-accredited interdisciplinary pain management program within 5 years of initiative approval. Each VISN is to implement at least one CARF-accredited interdisciplinary pain management program within 5 years of initiative approval.

3. History & Development The VA National Pain Initiative proposed that the Tampa VA Chronic Pain Rehabilitation Program (CPRP), serve as the model center/training site. The Interdisciplinary Pain Team Training Program provides program development and consultation services to treatment teams nationwide.

4. Mission Provide VA clinical care staff with the information and tools necessary to effectively treat veterans and active duty service members with chronic pain conditions utilizing the biopsychosocial model within an interdisciplinary framework Provide VA clinical care staff with the information and tools necessary to effectively treat veterans and active duty service members with chronic pain conditions utilizing the biopsychosocial model within an interdisciplinary framework

5. Current Training Staff 1 FTE Pain Psychologist 1 FTE Pain Psychologist –Serves as coordinator of training program 1 FTE Pain RN 1 FTE Pain RN –Serves as Nurse Educator and Support Pain specialists in each discipline of the CPRP volunteer time to help educate training participants. Pain specialists in each discipline of the CPRP volunteer time to help educate training participants.

6. Team-Oriented Our goal is for each facility to send as many core members of the treatment team as is feasible. Our goal is for each facility to send as many core members of the treatment team as is feasible. Taking part in our program as a unit helps educate the treatment team to each other’s specialty areas while fostering the communication and teamwork necessary for interdisciplinary pain management to function at its best. Taking part in our program as a unit helps educate the treatment team to each other’s specialty areas while fostering the communication and teamwork necessary for interdisciplinary pain management to function at its best.

7. Chronic Pain Psychology Medicine Occupational Therapy Physical Therapy PsychiatryPharmacy Recreation Therapy Nursing Social Work Dietetics Pool Therapy Vocational Rehabilitation

8. Training Format An individualized itinerary corresponding to each visiting team’s unique training needs and goals is developed An individualized itinerary corresponding to each visiting team’s unique training needs and goals is developed Training experiences incorporate didactic sessions, interaction with and observation of interdisciplinary treatment modalities. Training experiences incorporate didactic sessions, interaction with and observation of interdisciplinary treatment modalities. Training takes place at the James A. Haley Veterans’ Hospital in Tampa, FL and typically lasts 2-4 days. Training takes place at the James A. Haley Veterans’ Hospital in Tampa, FL and typically lasts 2-4 days.

9. Training Format Typically, training includes an assortment of the following topics Typically, training includes an assortment of the following topics –Interdisciplinary pain treatment program development –Information on CARF accreditation standards –Integration of pain outcomes measures –Cognitive-behavioral pain treatment –Polytrauma pain treatment –OEF/OIF pain screening and treatment –Blast-related headache treatment –Medical management –Interventional treatment

10. Outcomes 7 Training Sessions 7 Training Sessions 18 Participants from VAMCs, CBOCs, & military medical facilities 18 Participants from VAMCs, CBOCs, & military medical facilities –Training groups ranged in number from 1-9 –Various disciplines represented in training groups 6 Psychologists 6 Psychologists 4 PM&R Physicians 4 PM&R Physicians 2 Nurses 2 Nurses 2 Anesthesiologists 2 Anesthesiologists 1 Pharmacist 1 Pharmacist 1 Chief of staff 1 Chief of staff 1 Primary care physician 1 Primary care physician 1 PM&R Program Administrator 1 PM&R Program Administrator

11. Outcomes Implemented pre-, post-, and follow-up assessment measures beginning with the most recent 10 participants Implemented pre-, post-, and follow-up assessment measures beginning with the most recent 10 participants –Pre-training data collected upon arrival to training program prior to any content presentation –Post-training data collected on last day of training after completion of content presentation –Follow-up questionnaires will be sent to graduates 6 months after completion of the training program Feedback is attained using a 5-point Likert Scale Feedback is attained using a 5-point Likert Scale –1 = Not At All or Never –5 = To A Very Great Extent

12. Pre-Training MeansPost-Training Means Skills needed for interdisciplinary pain care? 3.675 Knowledge needed to participate in interdisciplinary pain care? 3.334.75 Resources needed to implement interdisciplinary pain program? 2.442.75 Satisfaction with training staff?-5 Satisfaction with training facilities?-4.63 Satisfaction with training content?-4.88 Overall satisfaction with training Program? -5 Recommend to other providers?-5 Outcomes

13. Future Directions Marketing & Recruitment for team participation in the Interdisciplinary Pain Team Training Program Marketing & Recruitment for team participation in the Interdisciplinary Pain Team Training Program Formalization, Standardization, & Dissemination of Provider Education Resources Formalization, Standardization, & Dissemination of Provider Education Resources Formalization, Standardization, & Dissemination of Patient Education Resources Formalization, Standardization, & Dissemination of Patient Education Resources

14. How to Get Started Contact the coordinator Contact the coordinator –Provide information about the current status of pain management programs at your VA facility. –Indicate which members of your treatment team will be visiting. –Specify group goals for training, as well as individual goals for treatment team members. Secure travel support from your local facility or VISN. Secure travel support from your local facility or VISN.

15. Contact Information Coordinator: Candon Norton, PsyD Website: www.vachronicpain.org www.vachronicpain.org Phone Number: 813-972-2000, ext. 5569