2010 2011 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
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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.
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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
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
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
VBH Provider View
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
Soldiers who felt the interview was helpful 100 90 80 70 60 50 40 30 20 10 0 % 87 88 86 FTF VTC Webcam %
Soldiers who felt satisfied with the overall process 100 90 80 70 60 50 40 30 20 10 0 % 96 97 95 FTF VTC Webcam %
Prefer FTF 100 90 80 70 60 50 40 30 20 10 0 % 91 34 36 FTF VTC Webcam %
There were concerns I did not feel comfortable discussing 30 % 25 24 20 19 15 % 10 5 0 6 FTF VTC Webcam
Number of Referrals Made 35 30 25 31 N 26 24 20 15 N 10 5 0 FTF VTC Webcam
Technical Issues 12 10 8 % 10 6 % 4 2 0 0 1 FTF VTC Webcam
Provider comfort with the process 100 90 80 70 60 50 40 30 20 10 0 100 % 89 56 FTF VTC Webcam %
Provider s tired by the process 35 30 25 % 33 20 15 % 10 5 0 5 5 FTF VTC Webcam
Other Findings No significant difference in provider s perceived ability to assess and treat 94-96% of Soldiers felt there was adequate privacy
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
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
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
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
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
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
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.
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
Virtual Behavioral Health For Redeploying Troops Program Consultation Dr. Moira Shaw Allison Pompey, M.A. Public Health Assessment Program 26
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