ADF Health 2010 - Volume 11 Number 1MilHOP StudyThe Military Health Outcome Program (MilHOP)In order to identify, plan and implement a progressive Defence healthcare system and services that meet the need of a modern Defence Force the ADF is undertaking its largest and most comprehensive study of current and former personnel. The Military Health Outcomes Program – or MilHOP as it has come to be known – is an AU$12 million research program that commenced in April and will conclude with a final report presented to Defence leadership in June 2012. Drawing on the expertise of the Centre for Military and Veterans’ Health (CMVH – see related article) and helping the ADF meet the recommendations of the Dunt Review into Defence Mental Health (see related article), MilHOP has at its core the intention of better understanding the health and wellbeing of ADF members, which reflects the belief of Defence Senior Leaders that people are the ADF’s greatest asset. That core value is more than just a glib throwaway to appease public cries for a more humane management of men and women in uniform. It is actually being demonstrated and given substance by the considerable investment into new and improved Defence health initiatives in areas such as mental health, rehabilitation and eHealth projects (see related articles on all these topics). At the forefront of these initiatives are an additional AU$83 million dollars in mental health and AU$155 million to enhance ADF Rehabilitation services. These figures assume greater weight when considering the relative sixe of the ADF – 56,000 permanent members and 21,000 reservists. HISTORICAL STUDIESSince 2000 the Federal Government has conducted formal health studies on major overseas deployments to the Australian Near North Area of Influence. The Deployment Health Studies Program was established to provide a systematic and ongoing means of assessing and understanding the health effects of deployment on ADF personnel. Studies have recently been completed on deployments to the Solomon Islands (2008), East Timor and Bougainville (2009). While the research from these studies has informed the MilHOP Study, relatively low participation rates limited the conclusions that could be drawn. Without a high participation rate, the impact of deployment on the health status of personnel cannot be clearly defined. MilHOP will inform the development of a robust, evidence-base approach to the specific health needs of ADF personnel resulting from the deployment experience. Information provided from MilHOP will support the development of targeted health programs designed to meet the health needs of deploying ADF personnel now and into the future. The data will also inform the development of Department of Veterans Affairs (DVA) Statements of Principle (SOP), which rely on published scientific data to identify any causal links between deployment exposures and subsequent ill health. The MilHOP study consists of four surveys, across two studies:
The MEAO Health Study and surveysThe MEAO Health Study is designed to ascertain the health status of ADF personnel who have deployed to the MEAO. It will investigate specific chemical, physical, biological and psychological exposures and other risk factors where changes in health outcomes are found. MEAO Health Study 1 - The Prospective StudyThis survey involves recruiting currently serving ADF personnel approximately four months prior to deployment to the MEAO, and following them up four months after their return from deployment. It is estimated that 3,000 personnel will be eligible to participate in this study, and it will focus on those deploying to Afghanistan between July 2010 and late 2011. At each time point, all participants will be asked to complete a self-administered questionnaire on their health, exposure to potential hazardous substances, and in general an insight into their deployment experiences. A subset of deploying personnel (approximately 750 participants sourced mainly from specialist units such as the Special Forces and Combat Engineering Regiment) will also be asked to take part in a series of physical tests. Additionally, sub sample of these participants (approximately 100 Special Forces personnel will also participate in neuro-cognitive testing). This study commenced on 23 April 2010. MEAO Health Study 2 - The Census StudyThe Census Study collects retrospective data from all 27,000 ADF personnel who have deployed to the Middle East between 1 October 2001 and 31 December 2009. The study collects data from serving personnel through a self-administered questionnaire addressing Brief Deployment History, health and deployment experiences, and commenced in May 2010. Data will be sought from ex-serving members until late 2011. It is being conducted by the CMVH University of Queensland node and aims to ascertain the physical, emotional and environmental effects of deployment in order to better manage the health care needs of current service personnel and veterans. MEAO Health Study 3 - The MEAO Mortality and Cancer Incidence StudyCMVH will collect data on deaths and cancers from the Australian Institute of Health and Welfare. Serving and ex-serving members will not be required to actively participate in this study. Communication with Defence and the ex-serving community will not be required for this component. The Health and Wellbeing SurveyThe goal of this study is to establish the prevalence of mental health conditions in the ADF. This study is being jointly conducted by the Directorate of Mental Health, and the University of Adelaide (UA) node of CMVH. The study will use a self-report questionnaire and a clinician-administered interview for selected cases. The Health and Wellbeing Study will collect information from personnel who are in the ADF but who have not deployed to the Middle East. Over 30,000 currently serving personnel will be invited to participate. This information will be combined with information from the MEAO Census Studies to determine the prevalence of mental health conditions in the ADF. This study is a key initiative of the Mental Health Reform Process resulting from the Dunt review. The study was released on the internet on 23 April 2010. Using data from these studies, the ADF and Federal Government will have an opportunity to plan for a holistic approach to Defence and veterans’ health needs for the first time. In his Review of ADF Mental Health, Professor David Dunt recognised the need for accurate baseline mental health data to provide effective services for all Defence Force members. Such baseline information will allow the ADF to identify what services are required and what programs are most needed. The Health and Wellbeing Study will identify risk factors for currently-serving ADF members, as well as identify cultural and organisational factors which may increase stigma and barriers to mental health care. The ADF’s current post-deployment screening programs will also be evaluated for their usefulness. The Health and Wellbeing Study’s first component is an online survey of all personnel not previously deployed to the Middle East. Data from the MEAO Census and this online Survey will be combined to provide baseline estimates of mental health issues and psychological distress in the ADF. In the second component, a subset of 1,400 personnel will be invited to participate in a one-hour clinical telephone interview. These interviews will provide validation of psychological screening measures currently administered to all ADF members following operational deployment. These telephone interviews will also test the accuracy of self-report information collected during the online Health and Wellbeing Survey. Like any survey, the number of participants increases the validity of the collected data. The ADF has embarked upon a promotional campaign to raise awareness of MilHOP and encourage commanders to make the survey available to every serving member. The core messages of the campaign are that MilHOP is about gathering health data in order to develop more effective and ongoing support services, and that if contacted by CMVH, members and veterans should consider participating for the benefit of themselves, their family, other veterans and especially their mates. Engagement with the broader Defence community is essential to achieve the desired participation rates. Ex-Service Organisations are especially important in encouraging ex-serving veterans to participate. .Families and friends of serving and former Defence members are also acknowledged as often being the greatest ‘influencers’ on personnel and veterans. It is hoped that family and friends can help someone wavering about undertaking the survey to go ahead and complete it. Without a detailed understanding of the effects of operational deployments, Defence cannot develop policies and provide the services that members may require. Broad ADF participation in MILHOP provides an opportunity to shape the future.
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