medcom comprehensive behavioral health system of care
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From DCoE's April 2011 webinar "Supporting Military Children in School Settings" Dr. Michael Faran Director, Child, Adolescent and Family Behavioral Health Proponency Madigan Army Medical Center Webinar audio: http://www.dcoe.health.mil/Content/Navigation/Media/192783672.mp3TRANSCRIPT
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 1
MEDCOM Comprehensive Behavioral Health System of Care (CBHSOC)
School Behavioral Health ProgramMichael E. Faran, MD, PhD
Child, Adolescent and Family Behavioral Health OfficeHQ, USA MEDCOM
UNCLASSIFIED
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 2
• Overview of the Child, Adolescent and Family Behavioral Health Office
• Overview of Family Behavioral Health Campaign Plan
• School Behavioral Health Program
• Summary
AGENDA
UNCLASSIFIED
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 3
• Promote, Sustain and Enhance Soldier Health• Train, Develop and Equip a Medical Force that Supports
Full Spectrum Operations • Deliver Leading Edge Health Services to Our Warriors and
Military Family to Optimize Outcomes
America’s Premier Medical Team Saving Lives, Fostering Healthy and Resilient People | ARMY MEDICINE | Bringing Value…Inspiring Trust
Maximize Value in Health ServicesEffectively and efficiently
provide the right care at the right time to promote a healthy
population and ready force.
Provide Global Operational ForcesAgile and adaptive medical
teams ready to execute relevant, responsive health services in any operational
environment and in combination with any partnered team.
Build the Team
A compelling place to serve and a preferred partner in leading
joint interagency health services.
Balance Innovation with Standardization
A culture of innovation which provides standardized solutions
to support best practices and optimal outcomes.
Optimize Communication and
Knowledge Management
Leverage Communication to impart knowledge and build
meaningful, positive relationships.
* This has been a dynamic, living document since 2001
Pat
ient
/Cus
tom
er/
Sta
keho
lder CS 5.0
Inspire Trust in Army
Medicine
CS 3.0 Responsive Battlefield
Medical Force
CS 2.0 Improved Healthy and
Protected Families, Beneficiaries and
Army Civilians
CS 1.0 Improved
Healthy and Protected Warriors
CS 6.0 Improved
Patient and Customer
Satisfaction
IP 1.0 Optimize Medical
Readiness
IP 8.0 Build Relationships and Enhance Partnerships
LG 2.0 Improve
Training and Development
IP 2.0 Improve
Information Systems
CS 4.0 Optimized Care and
Transition of Wounded, Ill, and Injured Warriors
IP 3.0 Implement
Best Practices
IP 9.0 Tell the Army Medicine
Story
LG 4.0 Improve
Knowledge Management
LG 1.0 Improve Recruiting and Retention of
AMEDD Personnel
Inte
rnal
Pro
cess
Lear
ning
and
G
row
th LG 3.0 Promote and
Foster a Culture of Innovation
IP 6.0 Improve Quality,
Outcome-Focused Care and Services
IP 5.0 Maximize Physical and Psychological
Health Promotion and Prevention
IP 7.0 Improve
Access and Continuity of
Care
IP 11.0 Synchronize
Army Medicine to Support Army
Stationing & BRAC
R 1.0 Optimize
Resources and Value
R 2.0 Optimize Lifecycle
Management of Facilities and IT Infrastructure
R 3.0 Maximize Human Capital
END
SM
EA
NS
WAY
SR
esou
rce
IP 10.0 Leverage Research,
Development and Acquisition
Feedback Adjusts
Resourcing D
ecisions
To deliver the
Strategic Processes..
.
To deliver the
Strategic Processes..
.
That achieve our
Strategic Ends
That achieve our
Strategic Ends
We marshal our
Resources…
We marshal our
Resources…
And enable our
People…
And enable our
People…
To deliver the
Strategic Processes..
.
That achieve our
Strategic Ends
We marshal our
Resources…
And enable our
People…
IP 4.0Provide
Safe Patient Care
Strategic Themes &
Results
Mission Vision
ARMY MEDICINE STRATEGY MAP
UNCLASSIFIED
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 4
• As an integral part of the CBHSOC-CP, MEDCOM will develop and implement a comprehensive behavioral health system of care using a public health model, with evidenced-based interventions and standardized outcome measures throughout the enterprise, coordinated and integrated with IMCOM and FORSCOM resources to support Army children and families. Behavioral health is about readiness.
VISION
Child, Adolescent and Family Behavioral Health Office (CAF-BHO) is the lead office within MEDCOM for integrating and coordinating Child and Family behavioral health programs for the AMEDD
Family Readiness is Soldier Readiness!!
UNCLASSIFIED
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 5
THE SURGEON GENERAL BH CAMPAIGN PLANCHILD AND FAMILY PROGRAMS
• Promote wellness (proactive/preventive care) demonstrated to strengthen soldier and family readiness
• Embed behavioral health resources in key installation locations – BCTs, MTFs, primary care clinics & schools
• Establish behavioral health well-being as a core element in overall health maintenance
• Create parallel system of behavioral health care for children and families to complement what is provided for soldiers
• Standardize methods and metrics for clinical evaluation (outcome measurements, performance improvements)
• Implement evidence-based behavioral health interventions across the enterprise
• Integrate with IMCOM, FORSCOM, TRICARE, and civilian behavioral health resources – eliminate stove-piping and duplication of services
UNCLASSIFIED
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 6
• To promote optimal military readiness and wellness in Army children and families:
– Child and Family Assistance Center (CAFAC): Integrate and provide direct behavioral health support for Army children and their families, including marriage and family therapy and the family advocacy program
– School Behavioral Health (eBH for kids): Implement a cost-effective, comprehensive array of school behavioral health programs and services to support children, their families, and the Army community at the schools (and potential child development centers -- CDCs currently being piloted)
– Medical Home Behavioral Health Support – Pilot TeleBH supported consultations into new medical home facilities at Puyallup, Wash.
CAF-BHO CLINICAL SERVICES PROGRAMS
UNCLASSIFIED
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 7
• Primary Care Managers - Evaluation and treatment of common behavioral health problems using evidenced-informed clinical and education practices
• Behavioral Health Providers - Evidenced-based interventions, establishing standard of care across enterprise
• Civilian School Administrators and Teachers - Familiarity with military families and stress associated with deployments
• Families – Resiliency building, prevention and early detection of behavioral health issues affecting children
• School Behavioral Health Workshop – Week-long workshops for SBH directors, clinical providers and school district /building leaders to learn and observe state-of-the-art processes and practices.
* All above ICW the AMEDDC&S
CAF-BHO STANDARDIZED TRAINING*
1 UNCLASSIFIED
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 8
• Embedded behavioral health in natural setting to improve early identification, resiliency and soldier readiness
• Gateway to behavioral health services for soldiers and spouses• Significantly decreases stigma• Enhances accessibility and capacity• Aligns with ARFORGEN cycle• Low no-show rates• Coordinated with existing installation/community/school programs• Provides clinically sound, evidenced-based services and interfaces with
the schools programs
SCHOOL BEHAVIORAL HEALTH PROGRAM
UNCLASSIFIED
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 9
SCHOOL BEHAVIORAL HEALTH ORGANIZATIONAL STRUCTURE
• Advisory Board: Regional. Provides overall guidance and direction, quality assurance.
• Advisory Group: At each school. Provides specific advise to the SBH program, policy development, performance improvement. Ensures effective collaboration of all care providers.
• Process Action Tm: At each school. Handles day‐to‐day operations/decisions.
• Triage Team: At each school. Responsible for clinical case/problem review – referral, management, monitoring.
Key features• Early detection• Care and prevention provided where the child is • Integrated effort; complement to school liaison officers,
military family life consultants, etc.• Opportunities for training and education
UNCLASSIFIED
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 10
Stakeholders
• Principal• District Representative• Parent• Military School Liaison• Army Community Service• School Behavioral Health• Director School Behavioral Health• Community Leaders
ADVISORY GROUP AND PAT
UNCLASSIFIED
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 11
TeacherCounselor
Principal SBBH PsychologistSocialWorker
TRIAGE TEAM
Psychiatrist
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 12
• SERVES : 3,000 children and adolescents
• STAFF : 11 (psychiatrists, psychologists, social workers, administrative staff)
SCHOOL BEHAVIORAL HEALTH MODULE
UNCLASSIFIED
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 13
CURRENT ARMY SCHOOL BH (SBH) PROGRAMS
INSTALLATION CURRENTSCHOOLS
STATUS
Schofield Barracks, Hawaii
5 Mature (Recently added CDC operations)
Joint Base Lewis -McChord
6 Implementation phase
Fort Campbell, Kentucky
9 Mature/ Growth UFR to expand to CDCs
Fort Meade, Maryland 7 Mature
Fort Carson,Colorado
1 Footprint in place
Bavaria, Germany 5 Mature / Growth UFR submitted
Landstuhl, Germany 3 Expanding/ Growth UFR submitted
UNCLASSIFIED
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 14
CURRENT SBH DATA
1848 2172 1886
3523.95
4035.26
3320.73
0
1000
2000
3000
4000
5000
October November December
SBH Monthly Encounters and RVUsFY 2011
EncountersRVU's
• Embedded behavioral health model within schools demonstrate a low (averaging 1.7 percent) no-show rate
• Improved access to care -- “Delivering care where the kids live” (EBH-like)
• Early interventions to decrease progression of behavioral healthpathology
• Aggregate data of seven SBH programs
• Number of patient encounters and corresponding relative value units by month
• High levels of clinical service represent current demand for behavioral health care
0
500
1000
1500
2000
October November December
1.7 % Mean No Show
Aggregate SBH No Show RateOctober-December 2010
AppointmentsNo-Shows
UNCLASSIFIED
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 15
School Behavioral Health Cost Per Student Served FY 2010
• 35 Schools’ Population 22,127
• Financial data for the seven SBH programs
• Reflects clinical intervention and preventive care delivery
• Standardized clinical assessment tool for children measuring resiliency through strengths and weaknesses
• Lower SDQ values reflect increased resiliency
• SBH demonstrates improved clinical outcome for students14.0
15.016.017.018.019.0
Pre - Treatment Post - Treatment
18.6
16.0Mean Subscale
Score
Mean SDQ Score For 226 Matched Cases
Strengths and Difficulties Questionnaire (SDQ )Improvement in Total Difficulties Scale
CURRENT SBH DATA
UNCLASSIFIED
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 16
SCHOFIELD SBH: IMPROVED ACCESS TO CARE
The above figure illustrates the different average times required of a parent to be away from duty and/or work for their child to receive behavioral health care in a traditional CAPS clinic (light blue) vs. through SBHT (dark blue). The comparison on the left is for appointments attended by both the parent and child; the bars on the right are for appointments that are held with the child only.
126120
68
00
20
40
60
80
100
120
140
Time Away from Duty/Work Avg Time away from Duty/Work - Child onlyAppts
Total Time Requiredfor BH Appointment
SBH vs. Clinic
CAPS
SBHT
UNCLASSIFIED
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 17
SCHOFIELD ALL COMPARISONS
131
65
126120
51
14
7
68
27
68
0
13
2 10
20
40
60
80
100
120
140
Avg Total Timefor Appt
Avg Time awayfrm School
Avg Time awayfrm Wk (AD) All
Appts
Avg Time awayfrm Wk (AD)
Child only Appts
Avg Drive Time Avg ParkingTime
Avg Wait time forAppt
CAPS
SMHT
UNCLASSIFIED
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 18
• Day 1: Critical Steps for Set Up of the School Behavioral Health Team
• Day 2: Organization and Staffing of School Behavioral Health; Administration & Oversight
• Day 3: Administrative Overview: Managing the Program, and Clinical Services in Schools
• Day 4: School On-Site Training
• Day 5: Practice Issues, Use of Technology, Record Keeping, Metrics, Operational Procedures
5-DAY ACADEMY
UNCLASSIFIED
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 19
QUALITY ASSESSMENT AND IMPROVEMENT (QAI) PRINCIPLES
• Emphasize access
• Tailor to local needs and strengths
• Emphasize quality and empirical support
• Active involvement of diverse stakeholders
• Full continuum from promotion to treatment
• Committed and energetic staff
• Developmental and cultural competence
• Coordinated in the school and connected in the community
UNCLASSIFIED
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 20
• Student level, e.g., decreased absences, increased grades, fewer behavior problems
• Family level, e.g., increased cohesion and functioning, decreased family violence, soldier readiness
• School level, e.g., decreased aggressive incidents, improved climate, better performance
• System level - develop resiliency and unit readiness• Develop standards for medical readiness that include prevention, early
identification and intervention
GOALS POPULATION BASED MEDICAL/BEHAVIORAL PROGRAMS
Recognition that behavioral health for family members is a readiness issue
UNCLASSIFIED
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 21
Questions?
UNCLASSIFIED
Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address 22