JOINT BASE LEWIS-MCCHORD, Wash. - For one Madigan Army Medical Center intern, a daylong health care summit offered the perfect complement to the training she is receiving through military medicine.

"I already have the hands-on experience, but the behavioral health summit was a good way to augment that experience, as well as learn about the resources for when I go out of the clinic and go to my other rotations," said Capt. Tegan Michl, clinical psychology intern, Madigan. "I'll have these resources, and I'll know how I can continue to provide patients with the right care."

Michl was one of more than 50 participants in the first Puget Sound Military Health System Behavioral Health Summit Jan. 10 at the Club at McChord Field, JBLM.

The summit brought together primary care chiefs, medical directors, nursing staff, population health nurses and behavioral health consultants from across the military treatment facilities in the Puget Sound MHS: Madigan, Naval Hospital Bremerton, Naval Health Clinic Oak Harbor and the Air Force's 62nd Medical Squadron.

"Our commonalities far outweigh our service differences, so it's exciting to have us all here today to exchange different ideas and thoughts," said Thomas Axtman, chief, Division of Community Health, Department of Soldier and Community Health, Madigan.

Regardless of service affiliation, Axtman reminded attendees of the common priority they share.

"Readiness is the top priority; it doesn't matter which service you are supporting at this point in time," Axtman said. "And a critical point in readiness, as we all know, is behavioral health. I think that it is underrecognized and underappreciated across the force when we start talking about primary care and how behavioral health falls into that."

Michl's experience at the summit is exactly what summit organizer and Puget Sound MHS nurse consultant Michelle McIntosh was hoping would come out of the event.

"I'm hoping for sustainment ... I'm hoping that attendees can apply what they learned today and use it in their practice tomorrow," McIntosh said.

McIntosh said this is not only the first behavioral health summit as an integrated market, but it is also one of the first that engages the "end-level" user versus top-level leadership, ensuring immediate utilization of lessons learned.

The morning was focused on implementing the primary care behavioral health model, or PCBH, and the use of internal behavioral health consultants, or IBHCs.

Through the PCBH model, psychologists, social works or psychiatric nurse practitioners serve as IBHCs within a primary care medical home, with the ability to provide a brief assessments and intervention for a wide range of behavioral health and chronic medical problems like obesity, diabetes, anxiety and depression.

McIntosh said this session, and the ones that followed, came out of the desire of the primary care and behavioral health consortiums, two of the markets six working groups that work to improve and integrate care across military services.

"The topic of IBHCs is something that consistently both the primary care consortium and the behavioral health consortium discuss ... it's the link between primary care and specialty behavioral health so by bringing the IBHCs together than we can help support both," she said. "Sometimes their role is not fully understood, so by us placing emphasis on that it provides awareness and hopefully utilization that will help both primary and behavioral health."

Michl, who serves as an IBHC, said she was encouraged to see how much the primary care managers, or PCMs, want to engage with and understand the role of IBHCs

"Our role is almost like triaging; so when a patient comes in and the PCM notices that something is going on behaviorally but they're not really sure, they'll have them meet with us so we can set them up with the right care while giving them some tools to manage their symptoms at that moment to make them feel better in the meantime," she said, adding that often a patient can find relief from symptoms in a few visits without having to be referred to another clinic or more typical therapy regimens.

Navy Lt. Cmdr. Jeremy Ennis, family medicine physician, Naval Health Clinic Everett and primary care consortium lead, said he has also seen IBHCs in action, even while in a deployed environment.

"I did two overseas tours where IBHCs were a tremendous resource on the Navy side," he said. "We don't always have that rapid, easy access to specialty mental health. With a lot of high-stress environments overseas, IBHCs have been a tremendous help, resource, and partners in bridging the gap and extending out the abilities of primary care."

The summit was a "great opportunity to bring together a lot of fantastic minds and subject matter experts," he said.

The afternoon included a community resource fair and networking. Additional sessions included topics like introducing clinical pathways, managing attention deficit and hyperactivity disorder in primary care, working in child and family behavioral health sciences, and managing behavioral health pathways.

McIntosh said she believes these summits will continue on an annual basis.

About the Puget Sound MHS
The Puget Sound Military Health System is an integrated health care market that includes Army, Navy and Air Force hospitals and clinics in Western Washington. They provide care to more than 281,000 local TRICARE beneficiaries.

About the Defense Health Agency
The Defense Health Agency (DHA) is a joint, integrated Combat Support Agency that enables the Army, Navy, and Air Force medical services to provide a medically ready force and ready medical force to Combatant Commands in both peacetime and wartime. The DHA supports the delivery of integrated, affordable, and high quality health services to Military Health System (MHS) beneficiaries and is responsible for driving greater integration of clinical and business processes across the MHS.

DHA will officially assume administration and management responsibilities for military treatment facilities as a part of Military Health System reform mandated by Congress in the National Defense Authorization Act of 2017. The transition to DHA of more than 50 hospitals and 377 clinics currently administered by the armed services will be accomplished in phases by Sept. 30, 2021. DHA will be responsible for all facilities with respect to budgetary matters; information technology; health care administration and management; administrative policy and procedure; and military medical construction. The ultimate goal of this transition for the Department of Defense is a more integrated, efficient, and effective system of readiness and health that best supports the lethality of the force.