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Army Behavioral Health Program Focuses on Coordination

Children of military families celebrate after completing a puzzle during "Kids Chat", a service provided by the Army's family advocacy program at Fort Carson, Colo. (US Army photo/Nathan Thome)
Children of military families celebrate after completing a puzzle during "Kids Chat", a service provided by the Army's family advocacy program at Fort Carson, Colo. (US Army photo/Nathan Thome)

JOINT BASE LEWIS-McCHORD, Washington -- Officials with an Army mental and behavioral health program here want their system to be a model for providing the medical and emotional support they say military families desperately need after 16 years of war.

The Child and Family Behavioral Health System (CFBHS), based out of Madigan Army Medical Center, has put in place something its organizers say is unique in the Defense Department health system.

Instead of giving families a bevy of mental health services that can be confusing for users and difficult to coordinate, the CFBHS works to sync a central repository of providers and resources.

Officials said primary-care physicians; school-based behavioral health providers who coordinate with the medical treatment facilities; a walk-in behavioral health clinic; individual therapy; group therapy; in- and out-patient programs; and even free yoga sessions are all a regular part of the care model that works together to produce one outcome: healthy military families.

"We're trying to build a system of care that takes care of all family members, but has as much of early intervention as possible that takes care of problems before they become big problems," said Dr. Michael Faran, who leads the Madigan program. "It's a work in progress, as is everything."

The result, Faran said, is a highly used "system of care" helping families get help within the military treatment facility instead of pushing them out to private providers.

The program first got its start near Tripler Army Medical Center in Hawaii more than 15 years ago, officials said. Now it's expanded to 33 Army military treatment facilities.

More than 70 on-base schools offer an integrated program in which a provider trained in military issues is available to work with students who need the support. The Army is also running a pilot program with a similar provider placed at three off-base in schools in Hawaii.

Thanks to the system's rollout, Faran said, Army behavioral health has "recaptured," or moved back into the Army health system from private providers, about 50 percent of potential patients. Doing so could be a large long-term cost savings for the service and the military health system.

"We know that family members, from what they say to us, want their care in the system because our providers know what families go through," he said. "We haven't studied it, there's no studies to show it, but that's our experience."

The rate of mental health problems and even suicides among military family members can be nearly impossible to track.

Unlike troops, family members are often seen through programs not connected to base, and there is no central system tracking their problems or the help they receive.

Even if such a system existed, military family members do not always self-identify as such.

Military family suicides that occur off base, where the vast majority of DoD dependents live, may not be reported to military officials. And military kids' mental and emotional challenges addressed by officials in off-base schools are likely not reported either.

Thanks to a nationwide shortage in child psychologists -- there are only about 8,000 in the U.S., Faran said -- the military medical system has to rely on other types of providers and a system that trains them to identify issues that they can treat in-house before referring them to specialists.

Part of that system, Faran said, is a call center program staffed by child psychiatrists rolling out on Fort Bragg, North Carolina; Fort Hood, Texas; Landstuhl Regional Medical Center, Germany; and Tripler Army Medical Center in Hawaii.

General Army providers can call one of those locations and get specific, expert advice for their individual patients. That program started Sept. 1, he said.

Although the implementation of the system seems sluggish, there is no question that the need for the services will continue to exist, officials said.

During a recent tour of the mental health clinic on Joint Base Lewis-McChord, U.S. Public Health Service Capt. Amy Park, who oversees the location, said her receptionists check in about two patients every 15 minutes, seeing about 80 patients per day.

At Carter Lake Elementary School on the McChord side of the base, more than 400 children have easy access to a behavioral health provider and a Madigan employee and behavioral health specialist, said Raquel Shoch, who works exclusively out of the school.

Shoch is the first line of defense when children start to show signs of mental health stress at school and, if needed, she can refer kids for more care with the clinic-based providers.

Jeff Murrell, the school's principal, said he didn't understand the need for someone like Shoch until he saw her work firsthand.

"We have students that have a lot of high needs," he said. "We all work in concert together."

-- Amy Bushatz can be reached at amy.bushatz@military.com.

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