Military Health System Conference. Virtual Behavioral Health Program at TAMC

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1 Military Health System Conference Virtual Behavioral Health Program at TAMC The Quadruple Aim: Working Together, Achieving Success Raymond A. Folen, Ph.D., ABPP Sharing COL (Ret) Suzanne Knowledge: D. Martin Achieving Breakthrough Performance Brenda H. Edmonds, Psy.D. 25 Jan 2011 Tripler Army Medical Center

2 Report Documentation Page Form Approved OMB No Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. 1. REPORT DATE 25 JAN REPORT TYPE 3. DATES COVERED to TITLE AND SUBTITLE Virtual Behavioral Health Program at TAMC 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Tripler Army Medical Center,1 Jarrett White Rd,Honolulu,HI, PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR S ACRONYM(S) 12. DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release; distribution unlimited 11. SPONSOR/MONITOR S REPORT NUMBER(S) 13. SUPPLEMENTARY NOTES presented at the 2011 Military Health System Conference, January 24-27, National Harbor, Maryland 14. ABSTRACT 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT a. REPORT unclassified b. ABSTRACT unclassified c. THIS PAGE unclassified Same as Report (SAR) 18. NUMBER OF PAGES 27 19a. NAME OF RESPONSIBLE PERSON Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18

3 The views expressed in this presentation are those of the presenter and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.

4 Tripler s Area of Responsibility: 52% of the Earth s Surface (l;zlu. ~oolulu IIJ U \\'ilk" hl.md IJ.~ llmmtl Nor MARSHALL ISI.ANDS C\ROLI.\1 lsi 1\P<; * Mo11uro Kingman Red V'>. f'ilhli)tii \loll l - 'T.1r.1w.1 * 1\IIIIIV.II!WI Ill lit I'> I I \II\ I TUVALU 11owland sl.md,u~ 111\1'11\1 il'lllll \1\,,, ""''' (JIIIIIliATI) ; I ; IORIBA'I / lora! Sc,, l\lojnd~ C.dtal '.t : VANU1\TU < I'IJI ~ * \l~l.l UI U \\r~.'t'~;:?;d nw!uj. '"'a Anl<'r!Wn!\!>olmo.t * 115 1'.1);1' l'.ljlo Cook Islands (.Z.)

5 Virtual Behavioral Health Program A system of care that uses modern communication technologies to: Maximize utilization of Behavioral Health assets Provide uniform surge support BH encounters to Soldiers throughout the ARFORGEN cycle Increase access to care Insure continuity of care Promote a cultural change in the Force 4

6 TAMC VBH Pilot Study Face-to-Face (FTF) Traditional and familiar Provider and Patient/Client need to be in same locality Video Teleconference (VTC) High quality picture High bandwidth requirements ISDN secure; IP less so Webcam Fast setup Does the job

7 VBH Pilot: 520 Redeployed Soldiers Conroy Bow l N:1 br ief er briefer brief (5 min) arrival = 45 per hour fed into process every 1 min starting on the hour N:5 FTF pr ovider s questionnaire (7-8 min) check-in and booking (1 min) N:7 N:1 tech com put er s suppor t computers tech support N:1 appt cler ks appt clerks N:1 OIC OIC FTF providers face-to-face (20 min) visit VTC (20min) DCO (20 min) N:3 escor t escort N:1 A- V suppor t A-V support N:5 N:5 TAMC DCO pr ovider s DCO providers remote VTC visit remote DCO visit VTC pr ovider s VTC providers checkout N:1 sur vey m onit or survey monitor N:4 NCM NCM survey and follow -up (5 min) analysis provider survey exit

8 VBH Provider View

9 Structure of VBH Post-Deployment Interviews Positive psychology approach focusing in strength and resiliency Normalizing of the readjustment process Screening and referral of high risk issues Identification of other potential issues/problems with referrals and recommendations Reducing stigma Maximizing access to care

10 Soldiers who felt the interview was helpful % FTF VTC Webcam %

11 Soldiers who felt satisfied with the overall process % FTF VTC Webcam %

12 Prefer FTF % FTF VTC Webcam %

13 There were concerns I did not feel comfortable discussing 30 % % FTF VTC Webcam

14 Number of Referrals Made N N FTF VTC Webcam

15 Technical Issues % 10 6 % FTF VTC Webcam

16 Provider comfort with the process % FTF VTC Webcam %

17 Provider s tired by the process % % FTF VTC Webcam

18 Other Findings No significant difference in provider s perceived ability to assess and treat 94-96% of Soldiers felt there was adequate privacy

19 VBH Implementation at Ft. Richardson, AK 3324 Soldiers from the 4-25 ABCT participated in VBH (99% participation rate) 983 (30%) were recommended by the BH Provider to receive a BH referral 686 (70%) accepted the referral Satisfied Soldiers: 86.5% 73.9% felt that the interview was helpful 64.8% disagreed that members of their unit would have less confidence in them if they went for behavioral health care service 18

20 VBH Implementation at Ft. Richardson, AK 59.4% of providers felt comfortable using this method of interview Provider credentialing process was fast Provider training was inadequate All workload credit went to remote site IT and logistical issues were primary concern 19

21 Lessons Learned: Soldier Perspective Soldiers view the VBH encounter very positively Soldiers are comfortable with the process Telehealth screening questionnaires and webcam interviews work 20

22 Lessons Learned: Provider Perspective Providers need thorough training on positive psychology approach Providers need thorough training on skills specific to providing care via telehealth Camera position Volume levels Explanations to the recipient Movement Telehealth is tiring 21

23 Lessons Learned: Safety and Backup Phone in VTC/Webcam room Need dedicated phone line at remote site Staff on standby at remote site to pick up call Phone needs to be always on Need backup procedures in place Power goes out Patient/client is at risk Home-based treatment presents unique challenges

24 Lessons Learned: Enterprise Issues AHLTA has major limitations across regions; work arounds implemented but cumbersome Culture changes are needed (e.g., shift from region-focus to enterprise-focus) Need to remain mindful of the VBHP concept and vision when efforts at enterprise-wide deployment are meet with resistance 23

25 Behavioral Telehealth at TAMC Staffing 10 Clinical Psychologists 1 Psychiatrist 3 Nurse Case Managers 3 Psychology Technicians 3 IT Support Staff 2 Admin Staff 22 Total Provided the clinical, technical and military cultural training required to do the job.

26 Services Worldwide surge support Services to soldiers down range Services to military units in the Pacific Regional Medical Command s area of responsibility to include Japan, Korea, and Guam Services to National Guard/Army Reserve Families and Soldiers living on the Hawaiian Islands and remote islands of the Pacific Services to uniformed service members living on Oahu who would like to avoid the two hour commute it may take to get to Tripler from their place of duty. 25

27 Virtual Behavioral Health For Redeploying Troops Program Consultation Dr. Moira Shaw Allison Pompey, M.A. Public Health Assessment Program 26

28 Weather for Honolulu, HI Weather for Washington, DC Tue 80 F 69 F Wed 80 F 70 F Thur 78 F 69 F Mahalo! Tue 50 F 35 F Wed 41 F 34 F Thu 39 F 27 F Fri 78 F 68 F raymond.folen@us.army.mil suzie.martin@us.army.mil brenda.edmonds@us.army.mil Fri 39 F 30 F 27

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