MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. -- The military has a robust system for behavioral health. Blending services in the community with those in military medicine can be challenging, though. That's where connection is key.

Madigan hosted the first "Connect with Community" Behavioral Health Conference at the Club at McChord Field on Dec. 6, 2018 to develop vital communication and relationships.

"I don't believe in change; I believe in improvement," said Lt. Col. (Dr.) Kevin Goke, chief of Madigan's Department of Behavioral Health to the conference attendees. "That's what today is for -- the network to see what our services are so that we can improve that connection," he added.

While there have been conferences, summits and symposiums over the years, this one is unique in that it is framed around the new connect care management element in Army behavioral health.

Mary West is one of eight connect care managers in the Army who are specifically tasked with ensuring that service members can move back and forth between military medicine and care in the network without getting lost.

West has built relationships with entities in the community that touch service members.

"I've gone out into the community and talked to some of the people in the hospitals. There's a hunger out there to know what we need; they want to know what we have," West said.

West's interest in bringing the community together in this way has been building for some time.

"I go way back. I was a little tiny lieutenant in the Army with psych. I grew up to be a head nurse in psych. And then I did evening/night nursing supervising with a lot of psych issues. I've been around and this is something I've always felt needed to be done," she added.

"The whole purpose is bringing everybody together for our high risk behavioral health which is anybody inpatient," she said. "Those are the ones we want to make sure don't fall through the cracks."

In opening the conference, Goke explained how he started his career as a nurse who worked in the Army. After deployment, he recognized military medicine is more involved than that.

"I was in Iraq," he said. "We all come back and have our adjustments to some of the situations we've been through. There is a reality that happens; my life changed during deployment."

He specifically wanted to express to the external attendees how deployment affects care.

"We have to meet the clinical needs. But we have to do it through a lens of readiness and deployability," he said.

Lourdes Alvarado Ramos, the director of the Washington State Department of Veterans Affairs, also welcomed the assemblage by saying, "It is heartwarming to be among you and feel the energy and the passion for serving our service member and their families."

As a former command sergeant major at Madigan, she easily voiced both the desire to work in concert with entities in the community and the importance of providers understanding the uniqueness of the military mindset and experience.

"We are in lock step with you to be able to make our network stronger. Also, a military cultural awareness should be part of every provider's clinical portfolio," she said.

Two panels of program or case managers and coordinators, those who work in clinics internally and those who work with external entities, informed representatives from outside organizations about programs and processes at Madigan.

The panel discussions were followed by a leadership roundtable with representatives from the Washington State Department of Veterans Affairs, the U.S. Department of Veterans Affairs, Army, Navy, Air Force, Marines, National Guard and Reserves, TRICARE and Health Net Federal Services, the managed care support contractor for TRICARE in this region.

One point of interest for representatives of outside facilities was the need to inform the patient's employer of their medical situation. This runs counter to the civilian understanding of the Health Insurance Portability and Accountability Act of 1996 and its requirements of patient confidentiality.

Col. (Dr.) Matthew Cody, the chief of Inpatient Psychiatry and Madigan's residential treatment facility, addressed this concern by explaining the nature of accountability for personnel in the military. He added that he does not tell the commands of his own patients any in-depth details about their care. He tells the command enough for them to understand that their service member needs to be in his care to the degree he has recommended, be it inpatient, in an intensive outpatient program or as an outpatient.

In addition to learning many of the intricacies of how care is provided in military and veteran medicine, attendees got a chance to make personal connections, communicate directly and build relationships that will serve their patients later.

Representatives from one of the local inpatient treatment facilities that service members are referred to expressed their appreciation for what they were getting from the event.

"We do get active service members from time to time, and honestly that's been an area where we've been uncertain what we should be doing with them aside from what we would normally do with our civilian patients. So, it was very helpful to get a better understanding of what the expectations from Madigan are for the active service members, and who we should contact," said Stephanie Hill who does case management with Fairfax Hospital.

Paula Hornberger, a registered nurse with Fairfax, added that she would like to attend again next year and bring materials from their facility to give more insight into their organization's services.

As West closed the external portion of the conference, she shared her thoughts on the day.

"The best way for us to serve the Soldiers and dependents is for us to communicate," she said.