USAMEDDAC Ft Hood, TX Fort Hood Behavioral Health Brief 19 May 05 Bernard. DeKoning, M.D. CO, MC
Purpose To gain support for a comprehensive Behavioral Health Support plan at Fort Hood that: Mitigates the realities of continued combat and deployment-related stress Addresses family care and crisis intervention Provides optimal support to an expeditionary Army at war, from alert through postdeployment.
Behavioral Health Needs for an Expeditionary Army at War There are a lot of data points, EPICONs, and studies telling us what we already know. With war comes stress With stress comes a portion of the force unable to adjust With unattended failure to adjust comes risk taking behavior and profiling conditions Result is loss of forces and enormous amounts of time attempting to deal with troops manifesting maladjustment. Do we have a process to deal with it??
Our Charge Making appropriate and timely counseling available to our men and women is essential to mitigating longer term effects. All Soldiers must be knowledgeable about available mental health services and feel comfortable using them. Dr. William Winkenwerter, ASD for Health Affairs
Why a Comprehensive Behavioral Health Support Plan? The realities of continual deployments and combat-related stress in an expeditionary Army has created unique needs for both the Soldier and families Existing services and processes intended to identify, refer, treat, and follow-up Soldiers and their families are not effectively integrated or adequately resourced to handle new requirements Distinct lack of preventive services that identify early signs and symptoms of behavioral health problems
Why a Comprehensive Behavioral Health Support Plan? There is a critical need for a comprehensive and interdependent BHS plan that formally aligns participating agencies and sets levels of effort in formal MOUs/MOAs We anticipate continued behavioral health needs for redeployed Soldiers and their families
Assumptions for OIF2 Redeployment Significant mental health demand will begin o/a 3-4 months post deployment and may continue for several years Demand will be high based on experience of OIF 2 deployment. Failure to meet this increased demand raises significant patient safety issues: domestic violence, suicide, and substance abuse
Current Organization of Behavioral Health Assets Where do I start? FRG TRICARE Network Emergency Room SWS AFTB 2005 Chaplain ASAP BSMC RSRP FAP Unit ACS Schools? Military One Source TMC SRP VA Civilian Providers Red Cross
Behavioral Health Forum Behavioral Health Forum met from 15-17 Feb 05 at the AMEDDC&S to develop a template for a business plan Reps present: OTSG IMA FORSCOM MEDCOM VA TRADOC HQDA TRICARE Regional Office
Endstate is a Behavioral Health plan that: Addresses unique patient care needs for soldiers and families Involves all Behavioral Health partners Is supportable by data and studies Utilizes new means to identify, track and care for those identified Optimizes chain of command visibility and responsibilityensures their involvement Uses means of prevention to reduce bad outcomes Has identified metrics to track and present process outcomes to Command
Mission Essential Task ist Screening Increase confidence to seek Behavioral Health Services (No Harm) Integrate screening and education Identify all high risk Soldiers for intervention/screening Training for BHS providers Analyze data and share results w/ command Referral Establish a coherent and effective referral system
Mission Essential Task ist Treatment & Intervention Optimize provision of mental health services to AC, RC, NG and families (MTF, TOE, TRICARE, IMA, Military One Source) Support families with challenges due to separation, reunion, and special duty assignments Provide healthy ways for families to manage stress and deal with conflict. Provide healthy ways for families to manage stress and deal with conflict positively Address family violence
Mission Essential Task ist Follow-up Identify post deployment related MH needs of AD and their families Ensure the continuity of BH care between DoD and VA health care systems Identify post deployment MH needs of the USAR / ARNG Forces and families
Portals for Screening and Identification A. External Cluster -FRG -CSC - Chaplain -ACS - Self: Soldier and Family - One Source B. Special Circumstances - Hospitalized soldier - Distant civilian MTF - Inprocessing/Outprocessing C. SRP Cluster - R-SRP #1 (0 days) - R-SRP#2 (90-120 days) - R-SRP #3 (360 days) - Other SRPs / In-Processing D. Internal Cluster -ED -FAP - PCM - Care Mgr - Sick Call - Case Mgr - ASAP - Redeployed HCP CHCS/SF 513 E. Command Referral / Unit Identification - No Change Ft Hood Template Behavior Health Support Cell (MEDDAC) Roles: - Triage - Screening -Website - Phone in Multi-Agency Mental Hlth Providers Div Mental Hlth Dept of Psychology Dept of Psychiatry (O/P) Dept of Psychiatry (I/P) Tricare VA ACS FAP/DSW ASAP One Source Combat Stress Control Care/Case Mgr
Main Features of Ft Hood Business Plan Operational ownership with DHS across the installation for behavioral health services MOUs and MOAs with all Installation agencies Specific Goals, Objectives, and Tasks with identified lead Unified referral management process
Task Assignments (1 of 3) Tasks MEDDAC ACS PAO-DACH/ III Corps Chaplain 4ID 1CD VA Tricare III Corps MHS MHS Installation/Hospital PAO to formulate articles on DCS/ High Risk (30 Apr 05) Hospital PAO to advertise DCS careline (30 Mar 05) Interview Senior eaders ref DCS to reduce stigma (30 May 05) A Town Hall/Mayor s meetings to discuss DCS (30 May 05) A Develop questionnaire to determine best avenues of care (1 May 05) A Develop training curriculum for ACS/care managers (30 Apr 05) A A A Identify possible training venues for curriculum (15 May 05) A Develop and conduct training (15 Jun 05) Interview BH professionals on deployment stress (15 May 05) A A A Identify local resources and educate community (30 May 05) A = ead A = Assist
Task Assignments (2 of 3) Tasks MEDDAC ACS PAO-DACH/ III Corps Chaplain 4ID 1CD VA Tricare III Corps MHS MHS Identify and establish assessment tool for SRP/ in/outprocessing (15 Apr 05) Educate medical staff in use of tool (15 May 05) Establish database to capture results (30 May 05) Train FRP assistants to present DCS (15 Jun 05) A FRG assistants present curriculum (1 Jul 05) Require FRG assistants to contact families (1 Jul 05) A Conduct ASIST training (ongoing) Case management for DCS patients (completed) Share best business practices (ongoing) Share DCS data with Risk Reduction (15 Jul 05) = ead A = Assist
Task Assignments (3 of 3) Tasks MEDDAC ACS PAO-DACH/ III Corps III Corps Chaplain 4ID MHS 1CD MHS VA Tricare Establish integrated BHS for Fort Hood (completed) Develop Installation SOP on DCS (1 Aug 05) Develop MOU/MOAs with offpost partners (15 May 05) DHS to appoint Director of BHS (1 Jul 05) Develop policy mandating post-deployment screening (initial 90-120 days, 270-360 days) (1 Jun 05) Conduct mental health screenings at annual SRP/ in/outprocessing (1 Jun 05) Digitize screening tool (1 Jul 05) A NG/RC soldiers debriefed on VA/Tricare (completed) Ensure seamless handoff to VA (completed) = ead A = Assist
Behavior Health Plan Milestones Care line established (8 Mar 05) Being PAO campaign (30 Mar 05) Training curriculum established (30 Apr 05) MOA w/va (15 May 05) Begin in/ outprocessing screening (1 Jun 05) Begin DCS training to units, FRG Assistants (15 Jun 05) Appoint BHS Director (1 Jul 05) Installation Policy on DCS (1 Aug 05) Decentralize BHS Mar 05 Continue ASIST training (ongoing) Apr 05 Screening Tool formalized (15 Apr 05) May 05 Jun 05 Establish/ educate community coalition (30 May 05) Jul 05 1 st VA slice on board with 1CD/4ID MH Sections (1 Jul 05) Aug 05 Reassess need for 2 nd VA slice Seamless transition to VA (ongoing) Soldier/family questionnaire developed (1 May 05) Begin 90 day Screening (1 Jun 05)
Additional Installation TDA Staff needed to implement Baseline Plan MEDDAC- 3 (Social Worker, Administrator, Data Technician) ACS- 1 Info & Referral GS-6; 1 Mob & Dep GS-7 Chaplains- TBD FAP-TBD
Additional required MEDDAC Assets for a surge of high risk Soldiers (eg: Redeployment of a Division) Required additional FTE s at MEDDAC: GS-11 ASAP: 1 provider to 3400 GS-15 Psychiatrist: 1 provider to 7000 GS-07 Social Worker: 1 to 4000 GS-12 Psychologist: 1 to 5000 GS-12 Psychiatric NP: 1 to 5000 GS-09 icensed Prof. Counselor: 1 to 2500 GS-06 Psych Tech: 1 to 3000 GS-04 Med Support Assist: 1 to 2500 GS-06 Psychometric Technician: 1 to 20000 GS-07 Automation Technician: 1 to 20000 GS-07 Social Service Assistant: 1 to 5000 Personnel would be phased in as workload dictates.