4/15/20131Collaboration througha Shared MissionCollaboration through aShared Mission:Creating a network of trained behavio...
4/15/20132Military Family Research Institute• Institute that conducts research and outreachabout and for military families...
4/15/20133Military-affiliated people160500,0001,000,0001,500,0002,000,0002,500,0003,000,0003,500,000Select Reserve Active ...
4/15/20134Indiana is Select Reserve “Heavy”13VA is not the answer for everyone• Access to services– Eligibility for servic...
4/15/20135Issues with Community Health11“It’s been difficult to getcare in rural areas ofAmerica,” she said.“The farther y...
4/15/20136Military Family Research InstituteSTRATEGIC GOALS• Support the militaryinfrastructure that supportsfamilies.• St...
4/15/20137The missionTo advocate, promote,and guide NationalGuard members andtheir families bysupporting psychologicalfitn...
4/15/20138Since these agencies were able to organize,mobilize, come together through leadership andparticipation around th...
4/15/20139Each organization contributes to theprocessCreate  Training ScheduleLocate donated venues & refreshment sponsors...
4/15/201310Result’sPageClick provider name for additional informationOverview of providersStrategies that created success1...
4/15/201311Targeted OutcomesOVERALL MILITARY PROVIDERS CONSUMERS# of providersw/skills specific to the military% of SMs wh...
4/15/201312Learning / BehaviorLEARNINGSignificant gains in• Perceivedknowledge• Accurate responsesto content questionsBEHA...
4/15/201313Benefits for our state• Benefits to all of the collaborators– Every entity has gained something unexpectedfrom ...
4/15/201314Collective Impact Initiative 15• Built on existing systems– Mental health providers within communities existed•...
4/15/201315StrengthenThe Military through mental health References8) Schell, T., Tanielian, T., Farmer, C., Jaycox, L., Ma...
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Collaboration through a Shared Mission Priester conf 2013

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Collaboration through a Shared Mission Priester conf 2013

  1. 1. 4/15/20131Collaboration througha Shared MissionCollaboration through aShared Mission:Creating a network of trained behavioral healthcivilian providers with knowledge to more effectivelytreat military personnel and their familiesApril 17, 2013Ann M. ShallenbergerKathy BroniarczykShelley MacDermid WadsworthPresentation Objectives• Understand the background of behavioral healthissues for military and veteran families.• Learn what made SBHP a service that wasneeded for Indiana, and specifically the IndianaNational Guard members and their families.• Learn strategies that were used to create thisunique collaboration and how the strengths ofeach afforded the creation.• How your state may benefit from this approach.
  2. 2. 4/15/20132Military Family Research Institute• Institute that conducts research and outreachabout and for military families• Purdue University, West Lafayette, IN• Only Land Grant University in Indiana– “Extension provides the link between Land Grantresearch and Indiana citizens. In doing that weprovide practical solutions to local issues.”1Call to Action for military personnel 7Strengthening our military families: Meeting America’s commitment. 2011Priority #1 – “Enhance the overall well-being and psychological health of themilitary family.”• “…early recognition of mental health conditions”• “…effective, evidence-based treatments…”• “…strengthen behavioral health care systems for returning service members,Veterans, and their families.”• “…enhance the availability of mental health providers to increase the quality ofcare available to service members and their families.”“The mental health effects of combat on the soldier and his or her significant other remain a challenge for National Guard families, who often reside in communities that show little understanding of the psychological costs of war.”11 Military affiliated: A unique population• Exposure to exceptional circumstances– Culture– Separation from families– Higher education challenges– Employment challenges– Combat exposure– TBI, PTSD, Substance Use, Suicide, Insomnia
  3. 3. 4/15/20133Military-affiliated people160500,0001,000,0001,500,0002,000,0002,500,0003,000,0003,500,000Select Reserve Active DutyFamilyMembersServiceMembersAND…     22,328,000    Veterans4Select Reserves vs Active Duty11,17• Dispersion• Access to resources• Suddenly military• Civilian occupation• Level of family immersion• Level of support from the community• Higher rates of mental health issues upon returnBehavioral health problems existRAND (Tanielian et al, 2008)9• 14% screen positive for PTSD• 14% screen positive for Depression• 19% report probable TBITreatment• Those with a mental disorder who sought medical care – just over halfreceived “minimally adequate care.”Need• Accessibility to care• Quality of careSuicides in 20112• 46.69% - known failure in a relationship• 46.69% - deployment experience
  4. 4. 4/15/20134Indiana is Select Reserve “Heavy”13VA is not the answer for everyone• Access to services– Eligibility for services• Service Member• Family– As of 09/20124• 821 VA Community-Based Outpatient Clinics• 300 VA Vet Centers• 152 VA Hospitals– Service Members live throughout the country• Rural Areas10– Nearly 50% of Veterans want services in theircommunity8VA has challenges• There are 22,328,000 veterans but just8,760,000 enrolled in VA Health Care System4• 58% of Veterans & 54% of National Guard andReserves indicated they would only use VAhealth care benefits if they did not have anyother source5• Active Duty 17% males & 16.3% females plan touse VA only as a safety net5
  5. 5. 4/15/20135Issues with Community Health11“It’s been difficult to getcare in rural areas ofAmerica,” she said.“The farther you getaway, the less awarepractitioners may be.”3• Lack of knowledge of militaryexperiences• Lack of awareness of thedeployment process• Accessibility to high-quality care• Penalties for seeking mentalhealth care• Reimbursement: TRICARE,Military OneSource, Give anHourThe Solution …"This government-wide review will bring togetherthe resources of the Federal Government, identifynew opportunities across the public and privatesectors, and lay the foundation for a coordinatedapproach supporting and engaging militaryfamilies for years to come.”7~ Michelle ObamaAssessing Community Capacity6– Characteristics that “affect their ability to identify,mobilize and address social and public healthproblems.”• MFRI, CDP, National Guard saw the need to educate andcome together to address behavioral health challenges– “…cultivation and use of transferable knowledge, skills,systems and resources that affect community- andindividual-level changes consistent with public health-related goals and objectives.”• CDP had EBT training• SBHP created the delivery method and access system
  6. 6. 4/15/20136Military Family Research InstituteSTRATEGIC GOALS• Support the militaryinfrastructure that supportsfamilies.• Strengthen the motivation andcapacity of civiliancommunities to support militaryfamilies.• Generate important newknowledge about militaryfamilies.• Influence policies, programs,and practices supporting militaryfamilies.Held trainings taught by the CDPFeedback from participants was• Wonderful training• Helpful information• Wanted military clients• Too much information to absorbin short time frame• One week is too long away fromtheir practiceThe Center for DeploymentPsychologyCDP MissionThe Center for Deployment Psychology (CDP)trains military and civilian behavioral healthprofessionals to provide high-quality deploymentrelated behavioral health services to militarypersonnel and their families.Indiana Behavioral HealthIndiana National Guard - Behavioral Health Officer inChargeTask: Care for Indiana’s National Guardbehavioral health issuesLimitation: Cannot treat themNeed: Referral database of trained andculturally sensitive mental healthproviders
  7. 7. 4/15/20137The missionTo advocate, promote,and guide NationalGuard members andtheir families bysupporting psychologicalfitness for operationalreadiness.The VisionTo honor the commitmentour nation has made toprotect the Americanpeople by ensuring theNational Guard’s soldiersand airmen have theresources and ability tomaster psychologicalhealth challenges in theirlives.• Indiana Family & Social Services Administration– 1991 -- consolidate and better integrate thedelivery of human services by state government– Division of Mental Health and Addiction• Education for Mental Health Providers to care forservice members throughout Indiana• Long history of paying attention to veteran issues• SAMHSA support of service members, veterans andtheir families & building interagency collaboration12Bringing groups together to increasecapacityGovernment:Federal & StateUniversityMilitaryMental Health care of military & familyInfrastructure & Community CollaborationTrain & Create Stronger CommunitiesFitness for Duty &Caring for SM’s
  8. 8. 4/15/20138Since these agencies were able to organize,mobilize, come together through leadership andparticipation around this population and theirbehavioral health needs, Indiana now hasCommunity Capacity.6Indiana SolutionSimply put, SBHP is:a training, dissemination and referralsystem aimed at expanding access totrained behavioral health providers forservice members, veterans and theirfamilies.SBHPTraining• Get mental health providers trained on caring for unique needs of the military‐affiliated population• Teach EBTsDissemination• Create infrastructure to get information from University to clinical setting• Keep clinicians engaged in learningReferral• Offer website database; confidential; 24/7• Locate providers who want to care for them & trained
  9. 9. 4/15/20139Each organization contributes to theprocessCreate  Training ScheduleLocate donated venues & refreshment sponsors t/o IndianaManage logisticsPrint MaterialsHold TrainingsAward CEUsInvite licensed attendees to attend additional trainings & join registryManage database of attendees, evaluations, and SBHP websiteEvaluate the entire processTraining Content UpdatedAdd EBT TrainingsRegular Collaborator MeetingsLandingPageProvider webpagesConsumer webpagesProviderLandingPageTraining registrationRegistry link
  10. 10. 4/15/201310Result’sPageClick provider name for additional informationOverview of providersStrategies that created success15Common Agenda• Focused on end-result for Indiana’s Service Members, Veterans and their families• Created a better infrastructure for behavioral healthcare in IndianaShared Measurement System• Defined and agreed to a measurement system collectivelyMutually Reinforcing Activities• Decided on answers using a democratic decision-making style• Obtained wins for their each organization’s personal mission / vision• Sold the program to each agency’s leadership by talking gains to their agencyContinuous Communication• Strong relationships with regular meetings and group inputBackbone Support Organizations• Leadership with paid staff to keep the project moving & people accountableAdditional strategies• Team member & agency diversity– Strengths of each drove their role “resourceexchange”6• MFRI had grant funds, research experts• CDP had grant funds, subject matter experts• State Governments relationship with the licensingboard• Military access to venues, Command, ServiceMembers
  11. 11. 4/15/201311Targeted OutcomesOVERALL MILITARY PROVIDERS CONSUMERS# of providersw/skills specific to the military% of SMs who are MND due to BHAssess for military affiliationUse the websiteAssist consumerswith locating trained providersaccess to providers  who want to work with this populationLearn new information & skillsEasier access to providers who have specialized training# of providers in military  insurance networks communication with community providersUse evidence‐basedtherapeutic techniquesReceive evidence‐based treatments# of military suicides# of providers with relevant trainingObtain referrals from the websiteGet betterBuild Indiana Capacity to care for this populationReport value in the trainingEvaluationTRAINING ATTENDEES:• At each training:– Pre survey– Post survey– Follow-up survey• For the EBT trainings:– Pre/Post/Follow-up &sub-sample for phoneinterviewCONSUMER:• Website searches• National Guard referralsKIRKPATRICK MODEL:14• Participation• Reaction• Learning• Behavior• ImpactParticipation / Reaction08.11.11 – 10.25.12PARTICIPATIONTraining• 540 uniqueparticipants• Nearly 1,000participants overallREACTIONQuality of trainings• 90% satisfiedPresenter ratings• 3.86/4.00• Quality of previoustrainings most oftencited as reason forattending additionaltrainings
  12. 12. 4/15/201312Learning / BehaviorLEARNINGSignificant gains in• Perceivedknowledge• Accurate responsesto content questionsBEHAVIORIncreases in• Professionalsscreening for militaryaffiliation• Providers who joinedTRICARE, MOS, GAH• Using EBT withclients*• Using recommendedassessments**Phone Interviews with subset of EBT participantsImpact• 4,489 unique visitorsto the website• 196 providers joinedthe registry• 56 of 92 countiesimpacted by SBHP• Increasing the # ofservice members andfamilies treated bytrained providers(preliminary finding)• Educating TRICAREproviders• Strengthening thebehavioral healthinfrastructure in thestate
  13. 13. 4/15/201313Benefits for our state• Benefits to all of the collaborators– Every entity has gained something unexpectedfrom the initiative• Benefits to the counseling profession• Benefits to the behavioral health consumers– Military and civilian• Benefits to the communities where servicemembers reside– Behavioral Health problems are treatableBeta state: Michigan• Worked with Dr. Adrian Blow; Department ofHDFS at Michigan State University– Worked collaboratively to prepare a proposal forfunds within Michigan– Manualized the program for other states toimplement– As a Beta state, Michigan is receiving• Technical assistance• Michigan-specific SBHP materials• EvaluationSteps to think about• Examine the capacity for the behavioral healthcare of military-affiliated people in your state• Who is invested in this population (or anypopulation)• Find collaborators where there is a win-win &each organization brings a different strength• Have an organization that takes the leadershiprole
  14. 14. 4/15/201314Collective Impact Initiative 15• Built on existing systems– Mental health providers within communities existed• Use of collective impact– Multiple sectors came together for common goal,outcomes, un-ending collaboration“…large-scale social change comes from better cross-sector coordination rather than from the isolatedintervention of individual organizations.”• Avoidance of isolating individual organization’simpact– All equally impacting the programFuture challenges• Budget cuts – sequester– Loss of collaborator’s time– Loss of in-kind contributions• OPTEMPO decreasing– Lack of interest– Lack of funding– Behavioral health concerns will continue to surfacefor many years to come• Replication fidelity for other statesThank youReview the SBHPwebsitestarproviders.orgContact MFRI atmfri.purdue.eduContact me atashallen@purdue.eduAnn Shallenberger, LCSW,LMHC, ACSW“I want every servicemember who’s deployed toknow that when you’re overthere taking care of thecountry that you love, yourcountry is back here takingcare of the families that youlove,” Obama said.10
  15. 15. 4/15/201315StrengthenThe Military through mental health References8) Schell, T., Tanielian, T., Farmer, C., Jaycox, L., Marshall, G., Vaughan, C., & Wrenn, G. (2011). A needs assessment of new york state veterans. Final Report to the New York State Health Foundation, doi: TR‐920‐NYSHF. Retrieved from http://www.rand.org/pubs/technical_reports/TR920.html9) Tanielian, T., Jaycox, L., Schell, T., Marshall, G., Burnam, M., Eibner, C., Karney, B., Meredith, L., Ringel, J. and Vaiana, M. (2008). Invisible Wounds of War: Summary and  Recommendations for Addressing Psychological and Cognitive Injuries, RAND Corporation.10) Salzer, D. American Forces Press Service, National Guard Bureau. (2011). Dr. biden keeps national guard in mind. Retrieved from website: http://www.defense.gov/News/NewsArticle.aspx?ID=6260511) Gorman, L., Blow, A., Ames, B., & Reed, P. (2011). National guard families after combat: Mental health, use of mental health services, and perceived treatment barriers. Psychiatric Services, 26(1), 28‐34. Retrieved from http://ps.psychiatryonline.org/data/Journals/PSS/1831/pss6201_0028.pdf12) (2012). SAMSHA’s service members, veterans, and their families technical assistance center fact sheet. Substance Abuse and Mental Health Services Administration, Retrieved from http://www.samhsa.gov/militaryFamilies/TAcenter/SMVF‐TA‐Center‐Fact‐Sheet.pdf 13) Defense Manpower Data Center (2011) The Citizen Soldier Support Program, “Number of Reserve Component Service Members Deployed to OIF/OEF since September 11, 2001” http://www.unc.edu/cssp/datacenter/RC/Indiana.pdf14) Kirkpatrick, L. (2005). Attachment, evolution, and the psychology of religion. New York: The Guilford Press.15) Kania, J., & Kramer, M. (2011). Collective impact. Stanford Social Innovation, 54, Retrieved from http://www.ssireview.org/articles/entry/collective_impact16) (2011). Demographics profile of the military community department of defense. Office of the Deputy Under Secretary of Defense, Retrieved from https://mymail.purdue.edu/service/home/~/2011 Demographics Report.pdf?auth=co&loc=en_US&id=24560&part=217) Blow, A., MacInnes, M. D., Hamel, J., Ames, B., Onaga, E., Holtrop, K., Gorman, L., Smith, S. ((2012).  National Guard Service Members Returning Home After Deployment: The Case for Increased Community Support. Adm Policy MentHealth , 39:383‐393.1) What is Purdue Extension?. (2010). Retrieved from http://www3.ag.purdue.edu/extension/Pages/aboutUs.aspx2) Luxton, D., Osenbach, J., Reger, M., Smolenski, D., Skopp, N., Bush, N., & Gahm, G. Department of Defense, Suicide Event Report. (2011). Dodsercalendar year 2011 annual report. Retrieved from National Center for Telehealth & Technology (T2) website: www.t2health.org3) Daniel, L. Department of Defense, (2012). Nursing community pledges support for troops, families. Retrieved from American Forces Press Service website: http://www.defense.gov/news/newsarticle.aspx?id=678984) National Center for Veterans Analysis and Statistics, (2012). Department of Veterans affairs statistics at a glance. Retrieved from website: http://www.va.gov/vetdata/docs/Quickfacts/Stats_at_a_glance_09_30_12.pdf5) Aponte, M., Giambo, P., Helmick, J., Hintze, W., Sigman, R., Winglee, M., Dean, D., Ragan, M., Shumway, C., Manglitz, C. & Rajapaksa, S. Department of Veterans Affairs, (2010). National survey of veterans, active duty service members, demobilized National Guard and reserve members, family members, and surviving spouses (101‐G87089). Retrieved from Westatwebsite: http://www.va.gov/VETDATA/docs/SurveysAndStudies/NVSSurveyFinalWeightedReport.pdf6) Goodman, R., Speers, M., McLeroy, K., Fawcett, F., Kegler, M., Parker, E., Rathgeb Smith, S., Sterling, T. & Wallerstein, N. (1998). Identifying and defining the dimensions of community capacity to provide a basis for measurement. Health Education & Behavior, 25(3), 258‐278. Retrieved from Http://deepblue.lib.umich.edu/bitstream/handle/2027.42/67070/10.1177_109019819802500303.pdf;jsessionid=5D69860C3EF6090841F61AF41580E57E?sequence=27) The White House, (2011). Strengthening our military families: Meeting america’s commitment. Retrieved from website: http://www.defense.gov/home/features/2011/0111_initiative/strengthening_our_military_january_2011.pdf

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