Transcript Slide 1

U.S. Army Medical Command
Behavioral Health Division
FOR World-Wide Family Advocacy Program Conference
LTC Kathleen P. Foreman, MSW, LCSW
MEDCOM, Deputy Social Work Programs Manager
10 Aug 09
UNCLASSIFIED
MEDCOM Behavioral Health Division
Outline
PURPOSE: To provide Behavioral Health Division (BHD) informational brief
regarding current missions and initiatives with emphasis on the Family
Advocacy Program (FAP).
1.
“One Staff”, Behavioral Health Proponency (BHP) and BHD
2.
FAP
3.
Social Work Care Managers (SW CM)
4.
Marriage and Family Therapy (MFT)
5.
Army Substance Abuse Program (ASAP)
6.
Educational and Developmental Intervention Services (EDIS)
7.
Exceptional Family Member Program (EFMP)
8.
Combat Operational Stress Control (COSC)
9.
Challenges
10.
The Way Ahead
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
UNCLASSIFIED
Slide 2 of 22
MEDCOM Behavioral Health Division
Take Away Messages
—Current BH activity is enormous and complex and all involved are under
intense pressure to meet the ever increasing BH needs of the Force
—Provider compassion fatigue is extremely high
AMEDD Command Climate Survey, 2009
—“We can’t get enough counselors. Quite frankly, they’re not there.”
GEN Peter Chiarelli , Army Times, 1 Aug 2009
—FAP (Treatment ) is tenuous due to operations tempo, staffing levels,
turnover rates and increased demands
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
UNCLASSIFIED
Slide 3 of 22
MEDCOM Behavioral Health Division
“ONE STAFF”
Office of the Surgeon General
/ OTSG /
Falls Church, VA
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
U.S. Army Medical Command
/ MEDCOM /
San Antonio, TX
UNCLASSIFIED
Slide 4 of 22
MEDCOM Behavioral Health Division
OTSG / MEDCOM “ONE STAFF”
LTG Eric Schoomaker
Army Surgeon General
Mr. Herbert Coley
MG David Rubenstein
MEDCOM CofS
Deputy Surgeon General
Vacant
Asst. Surgeon General
Force Sustainment
BG Richard Thomas
BG Gary Cheek
Asst. Surgeon General
Force Projection
Asst. Surgeon General
Warrior Care and Transition
COL Jonathan Jaffin
Director, Health Policy and Services
Dr. David Orman
Proponent, BH Proponency (BHP)
COL Elspeth Ritchie
Director, BH Proponency
COL Samuel Mack
Chief, BHD
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
UNCLASSIFIED
Slide 5 of 22
MEDCOM Behavioral Health Division
BHD Organization
COL Samuel Mack
Chief, BHD
Mr. Danny Gonzales
Admin Asst.
MAJ(P) Graeme Bicknell
Deputy Chief, BHD
(Incoming)
Dr. Rene Robichaux
Social Work Program
Manager
(FAP, Care Manager & MFT)
Dr.
Clayton
Gable
Research
Cell / ACR
MAJ Terry Martinez
Combat Opn Stress
Control
Dr. Wanda Kuehr
Army Substance Abuse
Program
LTC Thomas Martin
Forensic Toxicology
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
UNCLASSIFIED
Ms. Audrey Ardison
Educational and
Developmental
Intervention Services
Dr. Carl Grube
Exceptional Family
Member Program
Slide 6 of 22
MEDCOM Behavioral Health Division
Mission
To provide services, policies and oversight to promote behaviors
that enhance Soldier and Family Readiness
—MEDCOM responsible for:
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Medical “fixed facilities” / Table of Distribution and Allowances (TDAs)
Medical care delivered in physical structures that don’t move
—FORSCOM first line responsibility for:
– Table of Organization and Equipment (TO&E) units
– Medical care that deploys and moves
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BH care in Combat Support Hospitals
Combat Stress Detachments
Combat Stress Companies
Brigade Combat Teams
Other (Detainee OPS, Area Support MED CO)
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
UNCLASSIFIED
Slide 7 of 22
MEDCOM Behavioral Health Division
BHP and BHD Tasks
—Strategic Planning
—Provide guidance, interpret, evaluate and develop BH policies
—Analyze Data
—Business Case Analysis for BH Projects
—BH Contract Development and Management
—Information Papers/White Papers
—Assist Army Medical Department Center & School in Training
(Post-Traumatic Stress Disorder, Suicide Prevention I & II,
Battlemind, Master’s Program, Provider Resiliency Training)
—Congressional and Public Affairs Responses
—Training and Briefing
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
UNCLASSIFIED
Slide 8 of 22
MEDCOM Behavioral Health Division
Suicide Prevention
Army Campaign Plan for Health Promotion, Risk Reduction and
Suicide Prevention (ACPHP)
From GEN Peter W. Chiarelli, Vice Chief of Staff of the Army:
“In calendar year 2008, the Army’s confirmed suicide rate reached an all-time high of
20.2 per 100,000, a measure of tragedy and loss to our Army and Nation that we will
simply not allow to continue. The intent of this Campaign Plan is to take a strategic
approach to mitigating suicides and high-risk behavior across the Army. The Army will
employ every available resource, and every member of the Army team, towards
promoting overall Soldier and Family health.”
“The Army’s charter is more about holistically improving the physical, mental and
spiritual health of our Soldiers and their Families than solely focusing on suicide
prevention. If we do the first, we are convinced that the second will happen.”
29 March 09
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
UNCLASSIFIED
Slide 9 of 22
MEDCOM Behavioral Health Division
Suicide Prevention
ACPHP / Suicide Prevention Task Force Critical Tasks
– Program / Service Integration
• Comprehensive Health Promotion, Risk Reduction, and Suicide-Prevention Plan
• Strategy to Increase Awareness – Aggressive Marketing
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Specific Programs / Staffs (ASAP, FAP, AFAP)
Primary and Behavioral Health Care
Family / Friends Participation
Warrior Transition Units
Reducing High Risk Behavior
Education and Training [Suicide Prevention (I & II)]
Medico-legal and Command Systems (Tracking)
Postvention and Investigations
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
UNCLASSIFIED
Slide 10 of 22
MEDCOM Behavioral Health Division
BHD Initiatives
—Suicide Prevention Task Force Initiatives / Impact on FAP
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Evaluate combining FAP (Prevention and Treatment)
Army Central Registry database
Installation In and Out-processing through BHD
Suicide Prevention Training I & II
Tele-BH support for FAP case consultation (assessment and treatment)
—Medical Management of Victims of Sexual Assault
—Provider Resiliency Training (Regional) / Professional Quality of Life Scale
—BH Case Managers for Soldiers referred to Tri-Care Network
—BH Providers added to BH staff at FORSCOM installations / MTFs
—Post-Traumatic Stress Disorder (PTSD) and Mild Traumatic Brain Injury
(mTBI) Chain Teach
—AMEDD Battlemind Training (Soldier, spouse, child, sustainment, advance,
First Aid)
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
UNCLASSIFIED
Slide 11 of 22
MEDCOM Behavioral Health Division
Family Advocacy Program
Mission: Effectively evaluate and treat child and intimate partner abuse
Organization:
U.S. Army
Chief of Staff
ACSIM
OTSG/MEDCOM
FMWRC
MTF/SW
IMRs
FAP
ACS
• Assessment
FAP
• Case Review Committee
• Case Management
• Treatment
• Prevention
• Education
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
UNCLASSIFIED
Slide 12 of 22
MEDCOM Behavioral Health Division
Family Advocacy Program
Initiatives / Working Issues:
– Department of Defense Instructions (DoDI) Updates
– Joint Basing (Supporting and Supported)
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Fort Lewis – McChord AFB
Fort Myer – Henderson Hall
Fort Bragg – Pope AFB
Forts Sam Houston, Dix, Monmouth, West Point, Richardson, Eustis,
Story, and Monroe
– Walter Reed – Bethesda NB
– Family Advocacy System of Records - Enhancements due out Summer 09
– Research (Intimate Partner Risk Assessment - Forts Hood and Riley)
– Medical Workload Coding - FAZF
– Recent Policies (Credibility Assessment & First Time Exclusion-Pending)
– AMEDD Center and School working on Standardized Patient Domestic Violence
exportable training package
– Pilots (Victim Impact Statement and FAP Intake Document)
– Tele-BH support to Reserve and National Guard
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
UNCLASSIFIED
Slide 13 of 22
MEDCOM Behavioral Health Division
Social Work Care Managers
Mission:
— Warrior Transition Unit (WTU): Provide a comprehensive behavioral health
psychosocial assessment, manage risk, ensure that behavioral health
counseling/treatment is provided
— Deployment Cycle Support (DCS): Provide behavioral health services / support to
Soldiers and Family with deployment-related needs (outreach and direct care)
Initiatives:
—WTUs and Community Based WTUs
• Automated Risk Assessment and Care Management Tool (Psychological and Behavioral Health
Tools for Evaluation, Risk and Management / PBH-TERM)
• BH Risk Estimate to focus assets on higher risk cases
• MEDCOM Regulation pending
—DCS
• Located in MTFs, Primary Care Clinics, Soldier Readiness Processing Centers and embedded with
Brigades
• Pending conversion to permanent
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
UNCLASSIFIED
Slide 14 of 22
MEDCOM Behavioral Health Division
Marriage and Family Therapy
Mission: Provide Marriage and Family Therapists at installations identified as
having inadequate support within a 50 mile radius and / or continuous
deployment / operational stress
Initiatives:
—Apr 09 - MFT contract in place / 60 total providers / 13 OCONUS /
19 installations
—Located in Departments of Social Work
—MEDCOM Quality Management policy in staffing that will allow Licensed
Marriage and Family Therapists to be credentialed to work independently
(must be graduates of programs with specific M&FT curriculum)
—Providing marital counseling to low-level, low risk FAP clients
—Regional training for MFTs in Military / Deployment Issues, PTSD, Substance
Abuse and Family Advocacy
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
UNCLASSIFIED
Slide 15 of 22
MEDCOM Behavioral Health Division
Army Substance Abuse Program
Mission: Provide policy and oversight management for all Army Substance
Abuse Program clinical functions
Initiatives:
— Jul 09 - Public Health / Prevention Model (treatment part of model)
— Vice Chief of Staff deciding whether ASAP which organization the program fall
under Installation Management Command or Medical Command
— Possible change in Manpower Staffing Ratio (1:1250) / SPTF
— AHLTA Policy
— Pilot Programs
• Self-referral without command notification (Hawaii, Lewis and Richardson)
• Revitalize inpatient programs (Eisenhower in Sep 09 / Fort Belvoir after
Base Realignment)
• Partial / intensive outpatient programs (Fort Hood TBD)
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
UNCLASSIFIED
Slide 16 of 22
MEDCOM Behavioral Health Division
Educational and Developmental Intervention Services
Mission:
– Provides services pursuant to the Individuals with Disabilities Education Act (IDEA) and as mandated
by Public Law 102-119, amending the Defense Dependent Education Act
– Early Intervention Services (EIS): Improves functional independence of eligible infants/toddlers with
developmental delays or disabilities and their Families
– Related Services (RS): Supports Special Education Programs in DoD Dependents Schools (DoDDS)
by providing Related Services (RS) to eligible special education students
Initiatives:
– Recommended Transfer of EDIS to DoD Education Agency (DoDEA)
– Comprehensive System of Personnel Development (CSPD), including staff training
modules (tiered certification of Early Childhood Intervention Specialists)
– Implementing routine-based Assessments and services in natural environments, per
nationally recognized best practices
– Converting the Special Needs Program Management Information System (SNPMIS)
from service-based to web-based
– Added to Regulation: Family Protection Act (mandatory developmental screening by
EDIS when a victim of suspected child abuse or neglect is under 3 year old)
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
UNCLASSIFIED
Slide 17 of 22
MEDCOM Behavioral Health Division
Exceptional Family Member Program
Mission:
– Enroll Soldiers in EFMP by identifying, screening and registering Family
members with special needs in the Army’s EFMP database
– Screen All Family Members for OCONUS Travel
– Coordinate with HQDA Human Resources Command (HRC) on the
projected assignments of Soldiers with registered Family members
Initiatives:
– Implementing revised DoD forms for EFMP screening and enrollment
– Implementing new screening requirements for children with Autism Spectrum
Disorders
– Promoting Soldier compliance with mandated 3-Year Review of EFMP
enrollment information
– Designing a web-based EFMP Data System
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
UNCLASSIFIED
Slide 18 of 22
MEDCOM Behavioral Health Division
Combat Operational Stress Control
Mission: Implement the Army Combat and Operational Stress Control (COSC)
Program in accordance with DoD guidance, the Army Transformation, changing
missions and military operations
Initiatives:
– Restructuring of BH assets to the Brigade Combat Teams (BCT) / Brigades
(BDEs) / Aviation BDEs / Sustainment BDEs (2+2)
– Mental Health Advisory Teams I -VI (MHAT) Completed and Reports for
MHAT I-V Released; MHAT VI pending release
– Revision of Field Manuals and Regulations
• Renewed Combat and Operational Stress Control (FM6-22-5), 7 Mar 09
– Mandatory COSC training for all deploying BH providers
– Tele-BH support planned for consultation, assessment, diagnosis and
treatment
– Pilot: Dog Therapy in Iraq (2 Labrador Retrievers / Fort Gordon)
– Exploring Animal Assisted Therapies (Equine Pilot)
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
UNCLASSIFIED
Slide 19 of 22
MEDCOM Behavioral Health Division
Challenges for FAP
Staffing
— Multiple programs which require behavioral health providers
— Family Advocacy (losing experienced FAP providers to other jobs)
— Marriage and Family Therapy, Care Managers (DSC & WTU), Social Workers in the
Emergency Department, Behavioral Health Departments, ASAP, Sexual Assault,
Veteran’s Administration, Military Family Life Consultants, etc.
— Salaries for FAP not competitive with other programs
Funding
— Current FAP staff funding not meeting the current DoD staffing model / ratio
— Automation / Technological efforts
— Research
— DoD to POM for FAP funding
Space
— Unable to hire FAP personnel due to limited space
— New buildings on larger installations; however, limited space to house providers
Quality Assurance (QA)
— Need infrastructure within medical regions to regionalize QA initiatives
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
UNCLASSIFIED
Slide 20 of 22
MEDCOM Behavioral Health Division
The Way Ahead
BHP and BHD
— Improve physical, behavioral and spiritual health of the Soldier and Family
— Leadership and strategic communication to de-stigmatize BH
— Implement and sustain the ACP for Health Promotion, Risk Reduction and Suicide
Prevention recommendations by the Suicide Prevention Task Force
— Re-Initiate the Behavioral Health Campaign
— Standardize and automate BH processes
— Promote and standardize evidence-based practices
— Integrate services and cull out ineffective programs
FAP
— Staff program and retain FAP staff to support safe and quality care
— Continue to develop and pursue evidence-based program initiatives / Research
— Technology integration with BH and AHLTA / Automation improvements
— Ensure space allocated for FAP providers
— Continue to professionally train FAP staff and CRC members
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
UNCLASSIFIED
Slide 21 of 22
MEDCOM Behavioral Health Division
Questions?
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
UNCLASSIFIED
Slide 22 of 22
MEDCOM Behavioral Health Division
Information
Army BH website: http://www.behavioralhealth.army.mil/
BHD website on AKO: https://www.us.army.mil/suite/group/27327
BHP Policy: https://akocac.us.army.mil/pki/akocaclogin/external_silent_autologin.
jhtml?client_name=AKO&client_URL=https://www.us.army.mil/suite/kc/943142
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
UNCLASSIFIED
Slide 23 of 21
MEDCOM Behavioral Health Division
Information
FAP website on AKO: https://www.us.army.mil/suite/group/380
LTC Kathleen P. Foreman/MCHO-CL-H/(210)221-8625(DSN 471)/[email protected]
UNCLASSIFIED
Slide 24 of 21