Military Connected Children and Families: Common Concerns and Shared Work

Military Connected Children and Families:Common Concerns and Shared Work

Martha Blue-Banning, Ph.DBeach Center

Paul Ban, Ph. D.Medical Command Joint Base Lewis Mc Cord

Joanne Cashman, Ed.DIDEA Partnership

Let’s Find Out Who Is Here…

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0% 0% 0% 0% 0%0%0%0%0%

1. Family member2. Student3. Educator4. Service Provider5. Military Family

member6. Military-Active Duty7. Military- Reserves8. Military – Guard9. Other

In what primary setting do you interact with military connected children?

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0% 0% 0% 0%0%0%0%0%

1. Public School2. DODEA School3. Private School4. Home School5. Family Setting6. Medical Setting7. FMWR8. Other…

Families as Systems

• Individuals cannot be understood in isolation from one another.

• Families are systems of interconnected and interdependent individuals, none of whom can be understood in isolation from the system. http://www.genopro.com/genogram/family-systems-theory/

5

Sisyphus from Greek mythology – has to continually start over

1. Strengthening Our Military Families: Meeting America’s Commitments (Presidential Report) 2. National Leadership Summit on Military Families: Final Report 3. Military Family Needs Assessment4. Exceptional Family Member Program: Focus Groups Final Report5. What Transitioning Military Families with Children who have Special Needs Currently Experience Phase I6. What Transitioning Military Families with Children who have Special Needs Currently Experience Phase II

SYNTHESIS OF SIX MILITARY-RELATED REPORTS ON NEEDS OF MILITARY FAMILIES

Beach Center on Disability, 2012

• Emotional Well-Being• Material Well-Being• Health• Family Interaction• Parenting• Disability-Related

Supports

Sources of Resources• Family members• Friends• Community resources• Educational resources• One-to-one peer support • Parent groups/

organizations • Community human

services• Early intervention

services• Disability specialists

Cultural Competence

Legislation, Policies, and Administrative Infrastructures

Types of Resources

1

Family Support Framework

Family Strengths/Needs• Information• Instrumental• Emotional

Provided via activities/ routines in natural settings and via practices based on an evidence-based practice approach whereby the best available research on “what works” is integrated with family and professional wisdom and values.

Beach Center on Disability, 2012

Beach Center on Disability, 2012Beach Center on Disability, 2012

Sources of Resources• Family members• Friends• Community resources• Educational resources• One-to-one peer

support • Parent groups/

organizations • Community human

services• Early intervention

services• Disability specialists

• Emotional Well-Being• Material Well-Being• Health• Family Interaction• Parenting• Disability-Related

Supports

Cultural Competence

Legislation, Policies, and Administrative Infrastructures

Types of Resources

1

Family Support Framework

Family Strengths/Needs• Information• Instrumental• Emotional

Provided via activities/ routines in natural settings and via practices based on an evidence-based practice approach whereby the best available research on “what works” is integrated with family and professional wisdom and values.

Beach Center on Disability, 2012Beach Center on Disability, 2012

FAMILY SUPPORT

Jan. 26, 2011—Collaboration is at the heart of the government’s new military family support directive and is the key to supporting service members and their families in the months and years ahead, a Defense Department official said today.

http://www.defense.gov/news/newsarticle.aspx?id=62593

Perceptions

In Europe, years ago, castles and homes were built with a small enclosed room used for making bread. Today, after generations of making bread in these rooms, it is unnecessary to add yeast to the bread dough. The yeast culture simply lives in the air and leavens any dough that happens to be placed there.

Source: Janet Vohs in Cognitive Coping, Families, and Disability. Baltimore, MD: Paul H. Brookes Publishing

Perceptions

When sailors and explorers thought the world was flat, they coped with that fact. That knowledge structured everything about how sailors thought and behaved. When word got out that the world was round, this news caused a shift in behavior and in people’s perceptions of what was possible. The world did not change, but what was thought to be true about it changed and people went about sailing their boats very differently based on the fact that the world was round.

Source: Janet Vohs in Cognitive Coping, Families, and Disability. Baltimore, MD: Paul H. Brookes Publishing

To what extent do you agree that collaboration is at the heart of support to military families in the months and years ahead

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0% 0% 0%0%0%

1. Strongly Disagree, collaboration is not the answer

2. Disagree, collaboration might help but is not the answer

3. Neutral, collaboration could help but I’m not sure

4. Agree, collaboration might help us make better use what is already available

5. Strongly Agree, collaboration across the military, the families and schools and the communities is critical

To what extent have you experienced effectivecollaboration in your work or your services?

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0% 0% 0%0%0%

1. Never, I have not experienced an example of good collaboration

2. Rarely, I have experienced very few examples of good collaboration

3. Sometimes, once in a while I have experienced things coming together

4. Often, more often than not things come together for me

5. Always, I expect and experience good collaboration

School-wide Integrated Framework for Transformation

http://www.swiftschools.org

Child and Family Behavioral Health

Council for Exceptional Children

Paul Ban, Ph.D.Child, Adolescent and Family Behavioral Health Office

United States Army Medical Command05 April 2013

UNCLASSIFIED

DISCLAIMER

Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / [email protected] UNCLASSIFIED Slide 2 of 20 05 April 2013

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Army or the Department of Defense.

Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / [email protected] UNCLASSIFIED Slide 3 of 20 05 April 2013

BEHAVIORAL HEALTH SYSTEM OF CARE

Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / [email protected] UNCLASSIFIED Slide 4 of 20 05 April 2013

GOALS POPULATION BASED MEDICAL/BEHAVIORAL PROGRAMS

• Child/Student Level, e.g., decreased absences, increased grades, fewer behavior problems

• Family Level, e.g., increased cohesion and functioning, decreased family violence, Soldier Readiness

• Community/School Level, e.g., decreased aggressive incidents, improved climate, better overall performance

• System Level - Develop Resiliency and Unit Readiness

The Army Family is the deployable Unit!Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / [email protected] UNCLASSIFIED Slide 5 of 20 05 April 2013

To What Extent Do You Agree…‘The military family is the deployable unit’

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0% 0% 0%0%0%

1. Disagree2. Somewhat disagree3. Neutral4. Agree5. Strongly agree

OUTREACH & PREVENTION

“Definitions of Promotion and Prevention Interventions,” National Research Council and Institute of Medicine of the National Academics (2009). In: Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities.

Mental health promotion interventions (Definition): Usually targeted to the general public or a whole population. Interventions aim to enhance individuals’ ability to achieve developmentally appropriate tasks (competence) and a positive sense of self esteem, mastery, well-being, and social inclusion, and strengthen their ability to cope with adversity.

Universal preventive interventions (Definition): Targeted to the general public or a whole population that has not been identified on the basis of individual risk. The intervention is desirable for everyone in that group. Universal interventions have advantages when their costs per individual are low, the intervention is effective and acceptable to the population, and there is a low risk from the intervention.

Selective preventive interventions (Definition): Targeted to individuals or a population subgroup whose risk of developing mental disorders is significantly higher than average. The risk may be imminent or it may be a lifetime risk. Risk groups may be identified on the basis of biological, psychological, or social risk factors that are known to be associated with the onset of a mental, emotional, or behavioral disorder. Selective interventions are most appropriate if their cost is moderate and if the risk of negative effects is minimal or nonexistent.

Indicated preventive interventions (Definition): Targeted to high-risk individuals who are identified as having minimal but detectable signs or symptoms foreshadowing mental, emotional, or behavioral disorder, or biological markers indicating predisposition for such a disorder, but who do not meet diagnostic levels at the current time. Indicated interventions might be reasonable even if intervention costs are high and even if the intervention entails some risk.

Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / [email protected] UNCLASSIFIED Slide 7 of 20 05 April 2013

CHILD AND FAMILY ASSISTANCE CENTERS(CAFAC)

-- Provides range of direct care-- A convenient “gateway” for Children & Families (C & F)-- Manages the Child & Family System of Care for the Military Treatment

Facility-- Serves as principal interface for other agencies providing services

(Installation Mngt. Command, local community)

CAFAC

Integrate and provide direct Behavioral Health Support for Army Children and their Families

Embedded C & F Beh. Health Services (in housing areas, Primary Care, Medical Homes, units, Child Devlpt. Cntrs., Schools (SBH), and others as desired

ManagesInterface

Interface

Installation Management Command Services (IMCOM)

Civilian Services in the Local Community

Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / [email protected] UNCLASSIFIED Slide 8 of 20 05 April 2013

CAFAC DEVELOPMENT: PROBLEMS WITH THE PREVIOUS SYSTEM AT JOINT BASE LEWIS-McCHORD (JBLM)

• Difficult for providers and families to know where to get care– Multiple points of entry– Multiple phone numbers

• Overlap of services• Duplication of effort• Gaps/”white space” in services• Lack of communication between disciplines• Frequent changes in availability of services for adults

depending on the active duty mission.

Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / [email protected] UNCLASSIFIED Slide 9 of 20 05 April 2013

In your experience, which is the most frequent challenge…

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12% 12% 12% 12%12%12%12%12%1. Multiple points of entry2. Multiple phone numbers3. Overlap of services4. Duplication of services5. Gaps in services6. Lack of communication between

services7. Changes in availability of services

due to change in assignment8. Other

CAFAC CLINICAL SERVICES

• Multidisciplinary Services– Psychiatry, Nurse Practitioner, Psychologists, LCSWs, Case

Management

• Individual

• Family

• Couples/Marital

• Group

• Outreach & Prevention

Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / [email protected] UNCLASSIFIED Slide 11 of 20 05 April 2013

EXAMPLES OF CAFAC OUTREACH & PREVENTION

• Outreach efforts are tied to the Army’s deployment cycle

– Community events: • Expectant/New Parents Health & Wellness Expo • Kids’ Fest, Military Family Nights• WA Military and Kids’ Summit (Tacoma) • Foster Care Partnership (Pierce County) • Parent University• WA State Children’s Justice Conference

– Briefings: • Family Readiness Support Assistants training, units • Steering Committees • Community Speaking Engagements, Chaplain programs, Madigan staff

– Partnerships: • Army Community Services: shared briefings• Collaboration with chaplains (Marriage & Family therapists workshops with chaplains)• Ongoing coordination with the installation during redeployment of 18,000 troops

– Groups:• Relationship Workshops• Emotional Regulation• Trauma Focused Couples Therapy

Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / [email protected] UNCLASSIFIED Slide 12 of 20 05 April 2013

SCHOOL BEHAVIORAL HEALTH (SBH) PROGRAMS

Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / [email protected] UNCLASSIFIED Slide 13 of 20 05 April 2013

SBH CLINICAL SERVICES

• Partnership between Madigan Hospital, JBLM and Clover Park School District

• Serves six post elementary schools; expanding “beyond the gates”

• Embedded Behavioral Health:– Licensed Child & Adolescent Psychiatrist– Two Licensed Clinical Psychologists (Child and Adolescent

specialty; Pediatric Neuropsychologist)– Six Licensed Clinical Social Workers

• One provider asset per school; works with existing resources• Child Psychiatrist - mobilized• Evidence Based Treatment

Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / [email protected] UNCLASSIFIED Slide 14 of 20 05 April 2013

SBH CLINICAL SERVICES (2)

• Psychiatric diagnosis / evaluation• Psychiatric medication evaluation and management • Psychiatric emergency evaluation • Individual and Family Therapy• Behavioral Health case management for SBH students• Psychoeducational and therapeutic groups• Prevention and wellness/resilience• “Curbside” consultation• Universal Emotional

Screening Pilot

Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / [email protected] UNCLASSIFIED Slide 15 of 20 05 April 2013

To what extent does this model have the potential to provide better service?

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0% 0% 0%0%0%

1. Little chance for change2. May make some

improvement3. Will have an positive impact4. Will have a significant

positive impact5. Will change the way things

are done for the better

TIERED INTERVENTION

SBH services capture High-Risk students

(Tier 3)

Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / [email protected] UNCLASSIFIED Slide 17 of 20 05 April 2013

TIERED INTERVENTION(2)

…the “At-Risk” Students (Tier 2)• Groups:

– “Coping CAT” – Anxiety– Social Skills– Leadership-Positive Behavior – Communication & Feelings– “Buddy Lunches” & Mentoring Activities

(brigade basketball, Peer Mediators)– Sibling Communication & Behavior– Stress Management– Anger Management

…and Promotes Prevention (Tier 1)• Kids:

– Deployment Group (the effects of deployment and reintegration)

– Understanding and Combating Bullies– Transition Group (5th graders)

• Parents:– Parent-Child Play Group– Common Sense Parenting; 1-2-3 Magic – Parent Support Groups

• Teachers/Providers:– Child and Family Process Action Team; Health

and Resiliency Promotion Board– “Copier Chat” – targeted information delivery– Brown Bag Series – diagnostic and intervention

specific; “Ask a Doc” – Health & Fitness – Walk/Run group; Crafting– Participant in the WA State Autism Coalition– Campaign of Kindness – “filling someone else’s

‘bucket’”

Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / [email protected] UNCLASSIFIED Slide 18 of 20 05 April 2013

CONTINUOUS FEEDBACK LOOP

Triage

Advisory Group Advisory Council

Consultation

Support of Military Children and Families

Process Action Team

•Shared Goals

•Sense of Community

•Increased Awareness/Education

•Support of School’s Needs

•Desire to Contribute (resources, subject matter expertise, time, etc.)

Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / [email protected] UNCLASSIFIED Slide 19 of 20 05 April 2013

JBLM COMMUNITY PROJECT

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Facilitators

•ACS - Army Community Service•CYSS - Child, Youth & School Services•CAFAC - Child, Adolescent and Family Behavioral Health Office•SBH - School Behavioral Health•EFMP - Exceptional Family Member Program•JBLM Libraries •Military OneSource•USO•FAP - Family Advocacy Program•Madigan Army Medical Center•Harborstone Credit Union

Slide 35 of

Real Opportunities for CollaborationAre at the Intersection of People and Programs

• Common goals

• Common challenges

• Shared work

Nurturing Collaboration: Content, Context, Contact and Communication

• Define the common interests

• Learn the individual perspectives

• Identify the potential partners

• Do work together

• Build a relationship!

Where Are the Windows on Shared Work?

Ask:

• Who cares about this and why?

• What work in underway separately?

• Where are the possibilities?

• What will we do together?

• What will we do in support of each other?

• How will we each inform and build support in our own networks?

Leading by Convening

Ensuring Relevant Participation

Coalescing

around Issues

Doin

g the

W

ork T

oget

her

A New Framework for Stakeholder Engagement

How Have We Organized to Collaborate ?

• National CoP

• State CoPs

• National Organizations

• Federally Funded Technical Assistance Centers

• Practice Groups on Issues (including one PG that specifically connects our CoPs, the PG on Military Families)

The National Community of Practice (CoP) on School Behavioral Health

• Co-led by the IDEA Partnership at NASDSE (funded by Office of Special Education Programs) and the Center for School Mental Health at the University of Maryland (funded by Health Resources and Services Administration).

• The focus of this Community is to collaboratively work to create a shared agenda across education, mental health and families.

• The National Community now affiliates cross-stakeholder teams that have created 15 state CoPs modeled on the national exemplar.

• The Community affiliates 22 national organizations and 9 technical assistance centers and coalesces them around the issues they share.

• Together the states, organizations and TA centers lead 12 issue-based Practice Groups that develop the content and design the interaction for of the National Conference on Advancing School Mental Health .

States in the Community

• Hawaii • Missouri • North Carolina • South Dakota • Illinois • Montana • Ohio

• Utah• Maryland • New Hampshire

Pennsylvania • West Virginia

Minnesota • New Mexico • South Carolina

Practice Groups • Building a Collaborative Culture • Learning the Language/Promoting Effective Ways for Interdisciplinar

y Collaboration

• Connecting School Mental Health with Juvenile Justice and Dropout Prevention

• Psychiatry and Schools • Connecting School Mental Health and Positive Behavior Supports• Quality and Evidence-Based Practice • Education: An Essential Component of Systems of Care • School Mental Health for Military Families • Families in Partnership with Schools and Communities • School Mental Health for Culturally Diverse • Youth Improving School Mental Health for Youth with Disabilities• Youth Involvement and Leadership

Beyond This Session…• Share your views with each other and the CoP• Become a member of the Military Families Practice

Group• Become a leader in the Military Families Practice Group• Suggest how the Practice Group can inform and build

support across our various networks• Help us to create the opportunities to keep bringing

people together…in person and online.• … and so much more!

o Go to www.sharedwork.org, o Click on the Behavioral Health CoP on the front page.o View public pages in Behavioral Health …or join the CoP !

Lets find out…How likely are you to stay connected

and invite others to connect after this session?

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0% 0% 0%0%0%

1. Unlikely2. Somewhat unlikely3. Undecided4. Somewhat likely5. Very likely

Thanks very much for including us today…

We look forward to working with you in the future!

Presenter Contact Information

Martha [email protected]

Paul [email protected]

Joanne [email protected]