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

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• 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

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