Cognitive behavioral therapy for insomnia treatment in a military deployed operational setting utilizing enlisted combat medics: a Quality and Process Improvement Project.

Abstract

Insomnia disorder is a prevalent condition especially among the American military, affecting up to 50% of service members. It is shown to affect military performance. Guidelines recommend the use of nonpharmacologic approaches as initial treatment of insomnia. Cognitive behavioral therapy informed insomnia treatment (CBT-I) has the greatest evidence, however it requires specialized training. While deployed in the Middle East in support of US military operations, we faced a resource challenge while caring for service members with insomnia. In order to meet the needs of the population, we created a checklist based CBT-I informed treatment to enable our health extenders, including combat medics and behavioral health specialists. Following institutional review board determination of this project as nonresearch, we implemented this as a Quality Improvement/Process Improvement Project (QI/PI). Here we describe the 4 phases of this QI/PI and our outcomes. This process can be easily reproduced in either the deployed or garrison setting with minimum efforts and resources, enabling delivery of high quality, evidence-and guidelines-based treatment while using combat medics and behavioral health specialists to their maximum potential.