Commissioned Corps Research Articles

The US Public Health Service Commissioned Corps Response During COVID-19: A Call for Appreciation.

The US Public Health Service Commissioned Corps Response During COVID-19: A Call for Appreciation.

Project ECHO interprofessional telementoring: Using a novel case-based approach for building the U.S Public Health Service clinical response in pain and substance use disorder

The opioid overdose crisis is a US public health emergency that caused over an estimated 93,000 deaths in 2020. To build the clinical capacity of the Commissioned Corps of the US Public Health Service (USPHS), the US Centers for Disease Control and Prevention and Prevention (CDC) collaborated with Project ECHO in pain and substance use disorder (SUD). The purpose of this article is to describe the evaluation results of an interprofessional telementoring program using novel clinical vignettes. Interprofessional Project ECHO Pain faculty and the CDC recruited a diverse group of 163 USPHS clinical officers to join one (of two) 16-week, hour-long ECHO Opioid and Pain (OP) telementoring sessions. The structured curriculum included chronic pain, substance use, harm reduction and mental health-related didactics, as well as novel clinical vignettes. During this OP telementoring training, novel clinical vignettes were used successfully to train USPHS officers in an interprofessional “all-teach, all-learn” team-based, interdisciplinary learning environment. Over 30% (n = 48) of the USPHS officers attended at least 9 of the 16 sessions. Cohort surveys demonstrated that participants (n = 26) self-reported significantly increased knowledge regarding chronic pain, SUD, and mental health issues when compared to baseline. Focus group participants (n = 41) noted increased self-efficacy in clinical skills and compassion regarding patient care. This interprofessional ECHO training using novel clinical vignettes demonstrates the potential to increase clinical response capacity in pain management and SUD treatment by improving both knowledge and self-efficacy among participants.

Road less traveled

When I graduated from pharmacy school in New York City back in 2015, a lack of desirable positions made me venture out to remote locations. My search afield led me to a position at a small Indian Health Service (IHS) clinic in South Dakota. While working there, I learned about the U.S. Public Health Service Commissioned Corps. It is one of the 8 uniformed services of the United States with a mission to protect, promote, and advance the health and safety of our nation.1 The members of the U.S. Public Health Service, including physicians, dentists, pharmacists, nurses, veterinarians, scientists, and engineers, are stationed at various federal agencies (e.g., IHS), including underserved locations, and are also called upon to deploy to meet the needs of the nation (e.g., coronavirus disease 2019 [COVID-19] public health emergency) when necessary.

Healthcare worker safety program in a coronavirus disease 2019 (COVID-19) alternate care site: The Javits New York Medical Station experience.

In March 2020, New York City became the epicenter of the coronavirus disease 2019 (COVID-19) pandemic in the United States. Because healthcare facilities were overwhelmed with patients, the Jacob K. Javits Convention Center was transformed into the nation's largest alternate care site: Javits New York Medical Station (hereafter termed Javits). Protecting healthcare workers (HCWs) during a global shortage of personal protective equipment (PPE) in a nontraditional healthcare setting posed unique challenges. We describe components of the HCW safety program implemented at Javits. Javits, a large convention center transformed into a field hospital, with clinical staff from the US Public Health Service Commissioned Corps and the US Department of Defense. Key strategies to ensure HCW safety included ensuring 1-way flow of traffic on and off the patient floor, developing a matrix detailing PPE required for each work activity and location, PPE extended use and reuse protocols, personnel training, and monitoring adherence to PPE donning/doffing protocols when entering or exiting the patient floor. Javits staff who reported COVID-19 symptoms were immediately isolated, monitored, and offered a severe acute respiratory coronavirus virus 2 (SARS-CoV-2) reverse-transcriptase polymerase chain reaction (RT-PCR) test. A well-designed and implemented HCW safety plan can minimize the risk of SARS-CoV-2 infection for HCWs. The lessons learned from operating the nation's largest COVID-19 alternate care site can be adapted to other environments during public health emergencies.

Therapists in the Uniformed Services: Improving Care in Emergency Response Medical Missions.

People diagnosed with COVID-19 who require hospitalization are primarily admitted secondary to shortness of breath because of hypoxia but also display difficulties with overall muscle weakness, which could impair gait, activities of daily living, speech, cognitive-linguistics, or swallowing. This article provides a clinical perspective of how a physical therapist, occupational therapist, and speech language pathologist in the US Public Health Service Commissioned Corps were deployed with an augmentation team and how they improved care at a hospital that was overwhelmed with patients diagnosed with COVID-19. The rehabilitation team completed 246 evaluation and treatment encounters in a 12-day period and began seeing patients within 24 hours on-site. After the rehabilitation team arrived, patients were noted to be more mobile, independent in activities of daily living, and able to tolerate the least restrictive diets without signs and symptoms of aspiration. As a result of rehabilitation services, safe discharges were expedited, length of stay was reduced, and the hospitals' inpatient admission capacity was maximized. The augmentation team learned the importance of including rehabilitation specialties for treating patients with COVID-19. Mobilizing rehabilitation specialties along with medical and nursing staff helps maximize the overall recovery, health, and outcomes for patients. Leadership that is responsible for the development and deployment of future medical teams in military, emergency response, and public health efforts should consider all therapy disciplines as an essential component for each team.

USPHS Corps Care : Force Health Protection for Public Health Officers During the Ebola and COVID-19 Responses.

Force health protection (FHP) is defined as "the prevention of disease and injury in order to protect the strength and capabilities" of any service population. FHP was the foundational principal of the US Public Health Service (USPHS). President John Adams' signing of An Act for Sick and Disabled Seamen on July 16, 1798, marked the first dedication of US federal resources to ensuring the well-being of US civilian sailors and Naval service members. On January 4, 1889, President Cleveland enacted the USPHS Commissioned Corps, creating the world's first (and still only) uniformed service dedicated to promoting, protecting, and advancing the health and safety of the United States and the world. Building on the lessons of the 2014-2015 response to the Ebola virus pandemic, the Corps Care program was formalized in 2017 to establish and implement a uniform and comprehensive strategy to meet the behavioral health, medical, and spiritual needs of all Commissioned Corps officers. Its role was expanded in response to the coronavirus disease 2019 (COVID-19) pandemic, which has placed unprecedented demands on health care workers and spotlighted the need for FHP strategies. We describe the FHP roles of the Corps Care program for the resiliency of Commission Corps officers in general and the Corps' impact during the response to the COVID-19 pandemic. Qualitative analysis of FHP discussions with deployed officers highlights the unique challenges to FHP presented by the pandemic response.

Supporting Public Health Employee Engagement and Retention: One U.S. National Center's Analysis and Approach.

Background: Employee engagement, exemplified by positive perceptions of supervisors, workplace, and job, improves productivity and employee retention. We identified the extent of and barriers to employee engagement at Centers for Disease Control and Prevention's (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP). Methods: In 2015, NCHHSTP's leadership collected baseline data through a centerwide Employee Engagement Pulse Survey (EEPS) from NCHHSTP's full-time Civil Service employees, U.S. Public Health Service Commissioned Corps officers, and Title 42 service fellows. EEPS included six demographic questions; nine Likert-type scale questions measuring 26 perceptions related to immediate supervisors, the work environment, and job satisfaction; and four open-ended questions soliciting recommendations for improvement. Findings: Among 727 of 1,171 staff (response rate = 62%), positive perceptions of supervisors ranged from a high of 94% (supervisor conducts performance reviews) to a low of 63% (supervisor assists employees with career development). Perceptions of work experience ranged from 98% (respondents were willing to put in extra effort to get a job done) to 68% (respondents' talents were used well in the workplace). Perceptions of job satisfaction ranged from 87% (support from their coworkers) to 69% (satisfaction with opportunities to learn or grow professionally). Conclusion/Application to Practice: Overall, NCHHSTP staff have positive perceptions of their work, their leaders, and the agency. Other public- and private-sector employers might be able to improve their employees' engagement and retention by listening to their opinions and needs and frequently recognizing their individual achievements. NCHHSTP's workforce development initiatives can be used as a model for assessing a baseline of their employees' engagement.

COVID-19 emergency responders in FDA’s Center for Drug Evaluation and Research

COVID-19 emergency responders in FDA’s Center for Drug Evaluation and Research

Commissioned Corps Deployments & Family Resiliency

Established in 1889, the United States Public Health Service Commissioned Corps (Corps) is one of the seven uniformed services and is part of the U.S. Department of Health and Human Services. The Corps is committed to protecting, promoting and advancing the health and safety of the nation with a history that dates back over two centuries, beginning as the U.S. Marine Hospital Service. Today, the Corps responds and serves in many areas impacted by natural disasters, disease outbreaks, terrorist attacks and public health emergencies. Corps officers have deployed to provide assistance during national public health emergencies (e.g., hurricanes, bombings, flooding and wild fires); to combat the Ebola epidemic in West Africa; and to provide humanitarian assistance in Latin America and the Caribbean. Corps deployments impact not only service members but also their families. This article offers a brief overview of the Corps and discusses how deployments impact families. Family resiliency and future implications for research and practice will also be examined.

Ebola Response: A study of the Psychosocial Factors of Preparedness Among Commissioned Corps Officers of the United States Public Health Service.

The purpose of the cross-sectional study was to explore the relationships between occupational and general-self efficacy, and perceived preparedness among Commissioned Corps officers in the United States Public Health Service (Commissioned Corps). Commissioned Corps officers fight to protect the United States from diseases and care for the survivors of natural disasters and terrorist attacks. Commissioned Corps officers play a vital role in the fight to protect the United States from diseases and care for the survivors of natural disasters and terrorist attacks. The Commissioned Corps provided healthcare services in Liberia during the 2014 Ebola crisis that underscored the challenges of emerging diseases in a globalized community. It is imperative that these health professionals maintain a high level of self-efficacy and feel confident in their overall preparedness training as they respond to public health emergencies. This study used assessment instruments derived from Albert Bandura's concept of self-efficacy to analyze the occupational and general self-efficacy, and perceived preparedness levels of health services officers in the Commissioned Corps. 82 Commissioned Corps officers completed the assessment survey. To date, no study has examined the relationship between these constructs in this population. There was a statistically significant relationship between feeling confident in one's Commissioned Corps training and perceived preparedness (rs = 0.55, p < 0.001). This study reflects the training perceptions and self-beliefs of Commissioned Corps officers, fills an important gap in the empirical research in this population, and advances previous investigations, which suffered from an underrepresentation of female service members.

Twenty-first century emergency response efforts of the Commissioned Corps of the US Public Health Service.

The impact of the Commissioned Corps of the US Public Health Service (Commissioned Corps) on the health and safety of the nation spans more than two centuries. The public health efforts of the highly qualified health professionals of this often-underreported uniformed service include fighting threats like the great flu pandemic of 1918, the anthrax attacks, Ebola, and natural disasters such as Hurricanes Maria, Irma, and Katrina. As we near the first quarter of the twenty-first century, it is important to take a snapshot of the critical contributions and response efforts the Commissioned Corps has made in the first 18 years of the twenty-first century. Today, the Commissioned Corps faces new challenges in the form of emerging diseases and a rapidly growing opioid epidemic, but under the guidance of the US Surgeon General, it remains vigilant and fully capable of minimizing any public health threat it encounters.

United States Public Health Service Nurses: Deployment in Global Crisis

Nurses serving in the uniformed forces are often first responders to medical crises throughout the world. The U.S. Public Health Service Commissioned Corps is an elite team of full-time, well-trained, highly qualified public health professionals who respond to public health crises at home and abroad. This article briefly describes responsibilities and roles of nurses during deployments; offers an exemplar of deployment to West Africa for Ebola response; and reviews the outcomes of the response effort. The author then offers reflections about her deployment experiences.

Seven Prevention Priorities of USPHS Scientist Officers.

The article talks about seven prevention priorities of scientist officers for the Commissioned Corps of the U.S. Public Health Service (USPHS). It comments on the National Prevention Strategy (NPS) federal agenda promoting tobacco-free living, preventing excessive alcohol use and drug abuse, and healthy food habits. It talks about the NPS priority on encouraging active living and living injury- and violence-free. It talks about sexual and reproductive health, and emotional and mental well-being.

A history of PAs in the US Public Health Service.

Since 1798, the men and women of the Commissioned Corps of the US Public Health Service (USPHS), one of the seven US uniformed services, have served on the front lines of public health. Two hundred years after the start of the USPHS, the first physician assistant (PA) entered the service to carry on the tradition of protecting, promoting, and advancing the health and safety of the nation. These dedicated clinicians are involved in healthcare delivery to underserved and vulnerable populations, disease control and prevention, biomedical research, food and drug regulation, and national and international response efforts for natural and man-made disasters. This article describes how PAs in the Commissioned Corps of the USPHS have impacted the health and safety of not only the United States but also the international community.

For Schweitzer, shifts in perspective help pharmacy move forward.

Advancing the pharmacy profession is a lot like climbing a mountain, says Rear Admiral Pamela Schweitzer, chief professional officer for pharmacy and assistant surgeon general in the U.S. Public Health Service (USPHS). “You just keep going, … and eventually you get there, one step at a time,” Schweitzer said while delivering the 2016 William A. Zellmer Lecture on September 20 in Bethesda, Maryland. Schweitzer is the seventh person to present the annual lecture, which was established by ASHP and the ASHP Research and Education Foundation. The lecture is presented each year as part of ASHP’s Policy Week activities and expresses the speaker’s views on the interface between public policy and pharmacy practice. Schweitzer’s views on the topic were shaped during her career in the USPHS Commissioned Corps. Her assignments have included tours of duty with the Indian Health Service (IHS) and the Department of Veterans Affairs (VA). She is currently stationed in Baltimore, Maryland, serving the Centers for Medicare and Medicaid Services (CMS).

Behavioral health: A natural nursing fit.

Maryann E. Robinson is an active duty United States Public Health Service Commissioned Corps Officer and the chief of the Emergency Mental Health and Traumatic Stress Services Branch of the Substance Abuse and Mental Health Services Administration, Rockville, Md. The author has disclosed no financial relationships related to this article.

Strengthening the U.S. Public Health Service Commissioned Corps: A View From The Assistant Secretary for Health.

To summarize the results of the major management review of the U.S. Public Health Service Commissioned Corps (2009-2010) and note related outcomes. Narrative from the U.S. Assistant Secretary for Health, who directed and oversaw the management review. The management review led to 46 recommendations, all of which have since been implemented. The subsequent organizational and operational changes have unified reporting structures, streamlined the administrative Corps organizational structure, and transferred support services to providers with expertise in uniformed services to create a new integrated personnel and payroll system. Related processes have also prompted a systematic billet review as well as establishment of explicit criteria for eligibility to become a Corps officer. Corps leaders report improvements in recruiting talented officers, increased selectivity from the candidate pool, and enhanced matching of incoming officers with agency assignments. Furthermore, Corps activity has grown in both traditional and innovative ways. The Corps has enjoyed heightened activity and outcomes in the era of health reform. The management review and its implementation have strengthened the Corps, helping officers to do their job and achieve their mission.

Psychiatrists Should Be Involved in Assessing MH Status of U.S. Immigrants

Back to table of contents Previous article Next article Government NewsFull AccessPsychiatrists Should Be Involved in Assessing MH Status of U.S. ImmigrantsAaron LevinAaron LevinSearch for more papers by this authorPublished Online:25 Sep 2015https://doi.org/10.1176/appi.pn.2015.9b11AbstractProposed changes to a CDC rule would not require that the review board responsible for hearing appeals by immigrants regarding their mental health has a board-certified psychiatrist on it.In a letter to the Centers for Disease Control and Prevention (CDC) last month, APA asked the agency to continue employing psychiatrists to review the mental status of aliens seeking to enter the United States or to adjust their legal status.Currently, the Immigration and Nationality Act (INA) blocks admission of aliens with a physical or mental disorder that “may pose or has posed a threat to the property, safety, or welfare of the alien or others” or of those who are determined to be “drug abusers or addicts.”Individuals ruled inadmissible may appeal such decisions to a review board convened by the CDC. In the past, when the appeal involved a mental health issue, the CDC required that the review board include a board-certified psychiatrist. The CDC’s newly proposed regulation is less specific. Among other things, it calls for “at least one medical officer who is experienced in the diagnosis and treatment of the physical or mental disorder, or substance-related disorder for which the notification was made.” The CDC’s rationale for this change is that it would be easier and more efficient to convene a review board. Changes to the CDC rule would also end the requirement that medical officers be physicians in the U.S. Public Health Commissioned Corps, expanding the pool from which psychiatrists could be drawn.“Nonpsychiatric physicians do not have the expertise to perform the necessary dangerousness-based risk assessments and cannot ensure that the determination of inadmissibility is valid,” APA CEO and Medical Director Saul Levin, M.D., M.P.A., wrote in a letter to CDC Director Thomas Frieden, M.D., M.P.H. “Psychiatrists are both the highest qualified physicians and the highest qualified mental health clinicians to ensure the validity of the type of determinations that rest in the relevant statute.”The goal, said Levin, quoting the CDC’s own words, should be “to meet the needs of the alien.”While medical reasons to exclude foreign travelers to the United States are mostly based on the active presence of communicable diseases, the psychiatric criteria are much more vague and appear to conflate mental illness with dangerousness, said Steven Kenny Hoge, M.D., chair of APA’s Council on Psychiatry and the Law.“Presumably, someone who was dangerous but did not have a mental illness could be permitted to enter the country,” Hoge told Psychiatric News. Even before the CDC issued its proposed regulations, the council was already examining how the criteria had been applied in the case of several people stopped at the Canadian border, said Hoge.In Levin’s letter to the CDC, he expressed his concerns over the CDC’s maintenance of policies and language that stigmatizes people with mental illness by assuming that aliens with mental illness were likely to be violent.“The inadmissibility framework does not address those aliens who may be dangerous and have never been diagnosed with a mental illness,” he said.In addition, the use of the terms “drug abuser” and “drug addict” in the regulations are outmoded and discriminatory and should be replaced with terms more compatible with current behavioral or medical standards, said Levin. However, those changes must be made legislatively by the Congress.APA did applaud the CDC’s recently proposed change to make explicit the use of the “most recent edition” of the Diagnostic and Statistical Manual for Mental Disorders as the standard for defining drug abuse, drug addiction, and mental disorders. Some reviewers had been using earlier editions of the DSM, with obsolete definitions of disorders.The CDC is now evaluating all the comments received about the proposed regulations. ■The text of Levin’s letter to the CDC can be accessed here. ISSUES NewArchived

U.S. Public Health Service Response to the 2014-2015 Ebola Epidemic in West Africa: A Nursing Perspective.

The 2014-2015 Ebola epidemic in West Africa has been the deadliest Ebola epidemic to date. In response to this deadly epidemic, the U.S. government declared this a top national security priority and members of the Commissioned Corps of the United States Public Health Service were tasked to provide direct patient care to Ebola virus disease patients. Commissioned Corps nurses provided the highest level of care under the most austere conditions. This article discusses the training, ethical dilemmas, and constant risk for potential exposure while working in an Ebola Treatment Unit.

Editorial introductions

Editorial introductions