By Shannon Carabajal, Army MedicineNovember 17, 2011
FORT SAM HOUSTON, Texas (Nov. 17, 2011) -- After a successful pilot program aimed at reducing the emotional stress facing Soldiers and their Families by embedding behavioral health providers in units at Fort Carson, Colo., the Army is expanding the program to seven additional installations in fiscal year 2012.
The embedding behavioral health, or EBH, program has had a tremendous impact on Fort Carson. Redeploying units showed significant reductions in multiple areas, including acute psychiatric admissions, spouse abuse, sexually transmitted diseases, suicide attempts, child abuse and positive drug screens.
According to Maj. Christopher Ivany, psychiatrist, Evans Army Community Hospital, the program started after Fort Carson leadership identified a gap between Soldiers who required behavioral health care and the availability of behavioral health care providers. Senior leaders believed that gap may have contributed to a high rate of violent incidents amongst Fort Carson Soldiers in 2008, so efforts began to make behavioral care more accessible, beginning with the 4th Brigade Combat Team, 4th Infantry Division, and expanded to all BCT's over the following 18 months.
The 2nd BCT was the first to receive behavioral health support in the embedded model through a complete Army Force Generation cycle. From their redeployment in mid-2009 to deployment in June 2011, the BCT received embedded behavioral health support from a dedicated medical team that provided care from a clinic in the BCT's area of operation.
Mental health providers were aligned with each battalion so each battalion commander had a readily accessible behavioral health subject matter expert to evaluate and treat their Soldiers and assist them in optimizing mission readiness and safety.
The program improved access to care, improved continuity of care, enhanced BH provider communication with commanders, decreased inpatient hospitalizations, decreased referrals to the TRICARE network for behavioral health care and garnered high rates of commander and Soldier satisfaction. Additionally, compared to the unit's last deployment before the embedded program was implemented, 2nd BCT had 96 fewer Soldiers left on rear-detachment for a behavioral health reason after receiving a complete cycle of embedded behavioral health support.
Ivany said those results are significant, as the BCT was more prepared to accomplish their mission downrange and a greater percentage of Soldiers who were unable to deploy were identified and treated or transferred to non-deploying units, such as the Warrior Transition Battalion.
Each embedded team includes seven credentialed BH providers, usually three psychologists, three social workers and a psychiatrist or psychiatric nurse practitioner. A nurse case manager, two social service assistants (BH technicians), two front desk personnel and a licensed practical nurse provide critical support. The teams include both civilian and military personnel.
The program has made it easier and more convenient for Soldiers to seek help. Soldiers don't need an appointment to be seen and EBH services and contact information is widely advertised throughout the unit.
The teams work with the units to proactively identify and manage behavioral health risks before they become a serious problem. This approach to care maximizes diagnostic accuracy, removes barriers to care and improves treatment outcomes largely due to patient trust and consistency in care.
Ivany said Soldiers are more apt to seek help from providers embedded with their unit because the team is closer and Soldiers are likely to know someone who has sought treatment.
"The Soldier sees the same (BH) provider rather than multiple providers. Barriers are removed because brigade and battalion commanders are supportive of EBH and word gets around that (the team) knows what they are doing," he added.
Maj. James Wiles, 2nd BCT, 4th ID rear detachment commander, said the impact on the unit has been immeasurable.
"There are so many good parts to the program. In previous years, we had to go through the hospital and we saw different physicians every time. Now, our Soldiers have greater access to (behavioral healthcare professionals) and we see the same provider routinely," he said.
Wiles said the providers understand the challenges Soldiers face and interact weekly with leadership to help mitigate the high-risk cases.
"The stigma of seeking help has gone away. (The providers) are truly combat enablers."
EBH is a key component of Behavioral Health System of Care Campaign Plan that is intended to further standardize and optimize the vast array of behavioral health policies and procedures across Army Medical Command. The campaign aims to ensure seamless continuity of care to better identify, prevent, treat and track behavioral health issues that affect Soldiers and Families during every phase of the Army Force Generation cycle.
Based on the success at Fort Carson, the Army began expanding the program this fiscal year. EBH teams are currently supporting 4th Brigade, 1st Cavalry Division, at Fort Hood, Texas. The embedded model of care is also under development by key leaders at Fort Stewart, Ga.; Schofield Barracks, Hawaii; Fort Bragg, N.C.; Fort Bliss, Texas; Fort Drum, N.Y.; and Fort Knox, Ky.