MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. -- The Defense Health Agency is moving forward in assuming responsibility of all military medicine programs. As it does, the focus is on best practices and standardization. One program that has been chosen to set the standard is the women's trauma intensive outpatient program.

As Maj. (Dr.) Wendy Hampton, the outgoing chief of Psychological Health Intensive Outpatient Programs for Madigan, doffs her uniform to return to her civilian life as a social worker at Fort Riley, Kan., the reservist hands the reins and this new role to her inbound successor, Capt. (Dr.) Shellie Jervis.

"The National Defense Authorization Act of 2019 authorized the establishment of intensive outpatient programs to treat military sexual trauma. So, in meeting that authorization DHA (Defense Health Agency) selected our women's trauma program to be one of the pilot programs," said Hampton.

"Initially there were 30 programs, two military and the rest were civilian programs that were being considered for the pilot program," Hampton said. This is the case simply because there are so few military programs in existence.

The program addresses all forms of sexual trauma female service members have experienced as well as some domestic violence issues. "But, the largest percentage of our patients have experienced military sexual trauma," noted Hampton.

As a step up program from outpatient therapy and a step down program from inpatient, the women's trauma track serves as a space to work rigorously on improving the coping mechanisms the participants employ to respond to their trauma.

"Our goal is to teach them skills to either prevent an initial hospitalization or to prevent a re-hospitalization," Hampton said.

The program functions as the service member's place of duty for four hours of each day for its six-week duration.

"They are able to spend part of their work day just getting treatment," explained Hampton.

Robbi Robertson, a licensed clinical social worker, and Paulette Haas, a licensed mental health counselor, lead the program that incorporates yoga (with trauma-informed yoga therapist and LMHC Noriko De Guzman), occupational therapy (with certified OT Patrick Hogg), biofeedback, art therapy (with art therapist Brenda Maltz), dialectical and cognitive behavior therapies in evidence-based practice, and four weeks of aftercare.

"So, all the pieces that they were looking for, we already had," said Hampton.

In addition, the providers work in conjunction with Joann Hollandsworth, a registered nurse who is the hospital's sexual assault response coordinator, the base's special judge advocates who specialize in sexual assault to provide information and resources to the group and certified sexual assault nursing examiners from community hospitals, when necessary, to ensure the women in the program get the medical, mental and legal attention they need.

Approximately 125 service members from across the Pacific region have participated in this program since October 2017.

The 8 to 10 participants per cycle have the efficacy of their treatment assessment through surveys of their expressed levels of depression, anxiety, post-traumatic stress disorder and stress response with a clinical outcome survey being conducted both prior to and just following treatment.

Hampton expects that by the end of the fiscal year DHA will visit and begin their onsite assessment and program development process. Madigan's program has already been studied in terms of agenda, materials and outcomes, leading to its selection as a pilot site. DHA representatives will soon see it firsthand and apply their own metrics to determine the areas that will inform an enterprise-wide program and the ones that it will want to alter.

"It'll probably be some changes mostly to create a standard program to work across the enterprise," Hampton suspected.

"We have a great program and we are hoping to make it greater," she said.