Breaking barriers in patient-centered care through integrating behavioral health and chaplain services

By Capt. Christopher Joe, LMSWMarch 23, 2023

CH Pyun
1 / 2 Show Caption + Hide Caption – Staff Chaplain (MAJ) Jeff Pyun speaks to a group of chaplains and behavioral health professionals at Madigan Army Medical Center on Joint Base Lewis-McChord, Wash., on Feb. 24, 2023. (Photo Credit: Ryan Graham) VIEW ORIGINAL
LTC MacDonald
2 / 2 Show Caption + Hide Caption – Lt. Col. James Macdonald, the clinical director of the Behavioral Health Service Line at Madigan Army Medical Center on Joint Base Lewis-McChord, Wash., talks with his BHSL team on Feb. 24, 2023. (Photo Credit: Ryan Graham) VIEW ORIGINAL

MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. – For over 130 years, social workers have worked to enhance the lives of individuals and communities by breaking down barriers to delivering patient-centered care.

With the impact of the global pandemic in mind, the Army Public Health Center’s Health of the Force report highlighted the importance of treating Service Members holistically. Neglecting or failing to treat the whole person can be a barrier to patient-centered care since physical, mental, spiritual, social and cognitive aspects all impact an individual.

Putting the patient’s overall health at the center of their care requires providers to work across disciplines to maximize the effectiveness of any treatment plan.

Madigan Army Medical Center and units on Joint Base Lewis-McChord (JBLM), Wash., are doing just that by bringing the resources of behavioral health and chaplains together for their patients.

These types of collaborative health efforts were piloted by the Department of Veterans Affairs (VA) in 2009 and came to fruition in the Army with its 2020 Holistic Health and Fitness (H2F) system which highlighted the importance of strengthening five key domains of Soldier wellness – physical, nutritional, mental, spiritual and sleep readiness.

“Soldiers have a spiritual domain and identity that, if neglected, can directly impact the other domains of his or her life,” said Antoinette “Tonie” Stewart, a chaplain clinician at Madigan.

While previously focused primarily on the physical aspects of fitness, the Army’s shift to a holistic approach to health and wellness has proven timely during the global pandemic, showing the importance of mental and spiritual readiness as well on overall health.

The importance became so apparent that the chief of chaplains began the Spiritual Readiness Pilot (SRP) in conjunction with the chief of staff of the Army’s priority of “People First” and Dr. Lisa Miller’s Spirituality Mind Body Institute’s research on “innate spirituality”.

The SRP was created to address some of the Army’s biggest challenges facing Service Members, including drug abuse, depression and suicidal ideations by improving the innate spiritual core of Service Members.

Drawing from the SRP and prior VA research, a process improvement (PI) team at Madigan’s Behavioral Health Service Lane (BHSL) was created.

The PI team’s purpose was to figure out how to better integrate behavioral health and chaplain resources during a time of increasing demand and pressure placed upon the behavioral healthcare system. Additionally, it would address how integrated efforts would better connect Service Members to appropriate resources, increase access to care and improve Service Member readiness and resilience.

“Some Service Members might find meeting with a chaplain to be less threatening or more comfortable given a chaplain’s ultimate confidentiality or an approach that might integrate spiritual elements with which they are more familiar. It is also possible that a Service Member might be more familiar or trusting with a chaplain that they may see more regularly around their formation,” stated Lt. Col. James Macdonald, the clinical director of the Behavioral Health Service Line at Madigan on JBLM.

Consisting of behavioral health providers, behavioral health students, clinically-trained chaplains and with support from both behavioral health and chaplain senior leaders across JBLM, the team has worked this past year on building the foundation of what integrated, collaborative chaplain and behavioral health support looks like on JBLM.

The team’s first goal was the development of a BHSL standard operating procedure (SOP) for co-facilitating psychoeducation groups across BH clinics on the installation. These types of groups consist of a BH provider and chaplain providing education to those seeking mental health services. This effort included the development of a cross-disciplinary training protocol and the start of a group at the Rainier Embedded Behavioral Health (EBH) clinic.

“It gives the Service Member hope that they are not alone. The more assistance they can get, the more affirmed they feel. For those who are feeling insecure in different facets of life and those who can find spiritual meaning in life, I have found that they have a stronger resolve,” noted Simoneice Walker, a Rainier Embedded Behavioral Health civilian provider.

These integrated groups not only provide holistic care to Service Members in attendance, but the group also builds comfort for all involved. The integration in these groups reinforces the knowledge that there are professionals and resources available on JBLM other than just behavioral health, such as chaplains.

In addition, behavioral health providers’ increased awareness of these other professionals and resources will hopefully increase referrals to chaplains for patients that may not need the level of care an EBH clinic provides.

“Currently, I work with some great chaplains that I believe have the heart of a social worker. The ones I work with believe in a symbiotic relationship with EBH and the chaplaincy,” said Tim Larson, a Rainier Embedded Behavioral Health civilian provider.

The next steps involve sharing lessons learned across JBLM through educational tours.

These educational tours will share the history and research, cross-disciplinary training and importance of integrated care to JBLM behavioral health providers, clinic staff, multi-disciplinary care team members, chaplains and military leaders.

Eventually, the goal is for behavioral health providers and chaplains to work seamlessly within a system of screening, assessing, referring, communicating and helping Service Members.

“As a military BH provider, I have not been on a deployment where I wasn’t working collaboratively with a chaplain. It has always been a natural pairing in those environments and necessary to meet the needs of Service Members. For some reason, there is less of this in garrison, which should be remedied,” Macdonald stated.

Integrating behavioral health and chaplain resources involves education, mutual understanding and shared goals. The benefits to holistic, patient-centered care are unlimited and continues the role of social workers in breaking barriers to improve patient’s lives.

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