Embedded teams bring help to soldiers
November 26, 2012
JOINT BASE LEWIS-MCCHORD, Wash. - As soldiers with 2nd Stryker Brigade Combat Team, 2nd Infantry Division, return this winter from Afghanistan, they will face many changes. New routines, friends, family and too many choices at the grocery store - nearly forgotten lives will return in sharp focus.
The transition from a combat zone to the home front is stressful. The change can be overwhelming to some; however, one new way soldiers can find help may be a change for the better.
In August, U.S. Army Medical Command ordered an Army-wide, phased transition to the Embedded Behavioral Health Model, said Dr. Daniel Christensen, the program director of embedded behavioral health at Madigan Army Medical Center.
Thirteen behavioral health professionals - psychologists, psychiatrists, social workers, substance abuse counselors and administrators - will embed with each brigade across the Army.
The first embedded behavioral health team to open their doors at JBLM cares for soldiers assigned to 2nd SBCT.
At the end of the first phase of the transition in October 2013, Madigan behavioral health professionals will support JBLM's three Stryker brigade combat teams. Eventually, every brigade on the installation will have its own team, Christensen said.
The embedded behavioral health pilot program began in Fort Carson in 2009.
Christensen said studies at Fort Carson found that embedded teams provide soldiers easier access to treatment and support groups, as well as reduce the stigma attached to behavioral health treatment.
"Soldiers get used to it. Its kind of a normalization of behavioral health," he said. "The centralized, hospital-based care tends to have more barriers."
Maj. Diana M. Colon, a social worker, is the officer in charge of 2nd SBCT's embedded behavioral health team.
"Soldiers returning from deployment benefit from having quick and easy access to behavioral health services," she said.
Colon said she experienced the effects of combat stress first hand while deployed with 4th Infantry Brigade Combat Team, 1st Infantry Division to Iraq "as part of the surge" from 2007 to 2008.
"It defined my entire existence. I learned what it really meant to be an Army social worker from that tour," said Colon, a Monroe, Mich., native.
Christensen said Colon was handpicked to lead the first team at JBLM because she spent 90 days working with embedded behavioral health teams at Fort Carson.
"It's very much like when I was deployed. You can get right down to the soldier level by reducing the barriers to care," Colon said. "Our providers are building relationships with commanders and first sergeants. That's the key. Building relationships right here."
The teams help soldiers and commanders address behavioral health issues as a unit while maintaining patient confidentiality.
Christensen said that providers are obligated to inform commanders about a specific soldier's condition under only two circumstances: If a soldier plans to harm themselves or someone else, or if a "significant psychiatric condition leads to duty limitations," like if a soldier should not carry a weapon.
"Commanders benefit from it because they have less confusion with what is going on with their soldiers," he said.
The embedded model streamlines more than accessibility to care. At just 13 members, the small teams are more manageable than large, centralized departments, Colon said.
Colon, as an active duty officer in charge, is an exception to the Army-wide model which calls for an entirely civilian staff. Christensen said civilian behavioral health professionals offer stability because they are not required to move every few years like active-duty officers.
However, Christensen still prefers to hire providers who are familiar with the military's health care system. While scouting for new staff members to fill the first three teams, he said he looks for clinicians with prior military, preferably Army, service.
Dr. Devin Marsh, a psychologist and member of the team embedded with 2nd SBCT, provides care to soldiers assigned to 4th Battalion, 23rd Infantry Regiment. A former active duty Air Force officer, Marsh volunteered for the new position.
Marsh said his proximity to the unit he supports and being on a team that provides multifaceted assistance is similar to his experience working at smaller bases overseas.
"It's great. It's already been great in the first three months we've been doing it in terms of improved communication with the units and improved outcomes for soldiers," he said.
Marsh said he established a working relationship with 4-23 Infantry Battalion's rear detachment commander resulting in more contact with soldiers. Unfortunately, opportunities to provide care rarely occur due to positive events. The commander invited Marsh to attend a memorial for one of the unit's soldiers - a somber first in Marsh's career.
But just by being there, he was able to directly offer assistance to those who may have lost a friend.
"A couple of the NCOs had heard my name," Marsh said. "I was able to interact with them and say 'If you have guys that are having trouble, tell them they can come see me.' In my four years previous here, I had never had that opportunity."
Christensen said outreach like Marsh experienced at the memorial is difficult to generate when working from a hospital.
The embedded model allows behavioral health professionals to tailor care toward each phase of a deployment - before, during and after. As 2nd SBCT's soldiers return home and move on to new assignments, providers like Marsh will be there to support the brigade's next mission.