TBI/PH Requirements Background

1Apart from the war itself, we have no higher priority!For Official Use Only 12-11-08/1530JAM X

Supporting Projects

Programs

ExpandAccess to Care

ImproveQuality of Care

SupportTransition

Improve

Screening& Surveillance

Build Resilience

Conduct Research

Build a strong culture of Leadership & Advocacy

Seven Strategic Goals

• Provide strong, visible leadership and necessary resources • Create / disseminate / maintain excellent standards of care • If best practices are unavailable, conduct pilot or

demonstration projects to better inform quality standards• Monitor and revise access, quality, and program

implementation to ensure standards and consistent quality • Build a system where each can expect and receive the

same level of service and quality of Service, regardless of Service, Component, status, or geographic location

TBI/PH Requirements Background

Five Guiding PrinciplesTBI/PH Program Requirements

Task Force Documents Emerging Requirements

Enduring Programs


Strategic Framework

Mission: To create and sustain a TBI/PH continuum of care of the highest quality.

PH Programs• MH staffing model • Staff MH personnel

requirements• Coordinated PH

telemedicine system• Establish and monitor

MH access standards

TBI Programs• Staff TBI personnel

requirements

PH Programs• Behavioral Health

clinical practice guidelines

• Comprehensive PH training curriculum

TBI Programs• TBI clinical practice

guidelines• Comprehensive TBI

training curriculum• Coordinated TBI

telemedicine system

• TBI definitions and coding guidelines

PH Programs• Resilience outreach• Anti-stigma education• Core PH curricula in all

levels of leadership• Core curriculum to train

providers on responding to distressed service/family members

• MH providers integrated into primary care settings

TBI Programs• Leadership, Community,

Family Education & Awareness

PH Programs• Surveillance systems• Assess/ track

prevalence and management of PH

• Capability to disseminate surveillance data within DoD/VA

TBI Programs• Surveillance systems• Assess/track

prevalence and management of TBI

• Capability to disseminate surveillance data within DoD/VA

PH Programs• Center of Excellence • Outpatient programs

with advanced diagnostics and reintegration services

TBI Programs• Case Management

and Care coordination• Center of Excellence• Outpatient programs

with advanced diagnostics & reintegration services

PH Programs• Epidemiological

Studies• Families/Caregivers

Projects• Neurobiology/

Genetics• Etc.

TBI Programs• Treatment and

Intervention• Prevention• Measures in

Screening, Detection, and Diagnosis

• Etc.

Intent/Outcome

Timely access to comprehensive healthcare by providing staffing in areas to include outreach and prevention services, traditional MH care treatment, behavioral health in primary care, and inpatient care.

Intent/Outcome

World-class treatment for MH conditions, including PTSD and TBI through evidence-based practices, training in clinical practice guidelines, and providing the tools necessary for state-of-the-art care.

Intent/OutcomeBuild mental strength through the warfighter’s daily framework by optimizing the ability of the individual, family, community, and unit/ organization to thrive and be productive despite adversity, trauma, and stress.

Intent/OutcomeImprove quality and effectiveness of treatment through transition, coordination, and management of care across the DoD, VA and civilian support networks as patients transition between providers and duty status.

Intent/Outcome

Promote the use of consistent/effective assessment practices and accelerated development of electronic tracking, monitoring and management of PH and TBI conditions.

Intent/Outcome

Establish a strong foundation of medical and cross-functional research, continuously improving program vision and capabilities.

Leadership & Advocacy

Access to Care Quality of Care Resilience Screening & SurveillanceTransition of Care Research &

Development


SOC Accomplishments

Leadership and Advocacy

DECEMBER 2008MAY 2007

• No concentrated focus on PH/TBI issues

• DCoE established to provide leadership and expert guidance

• Conducted strategic summits to inform policies and programs

• National Center of Excellence, to be completed 2009


SOC Accomplishments

Quality of Care


• TBI specific ICD-9 codes do not exist

• Submitted proposed revisions to ICD-9 codes for publication in 2009 (will enable better tracking; clinical management)

• No Clinical Practice Guidelines for mild TBI

• Published clinical guidance for management of mild TBI in deployed / non-deployed activities

• Decentralized and non-standard PTSD and TBI training

• Trained over 1,100 DoD/ network providers on evidence-based treatment for PTSD; and over 1,600 providers in evidence-based TBI


SOC Accomplishments

Access to CareDECEMBER 2008MAY 2007

• Access standard for initial MH appointment: 30 days

• Standard updated to a 7 days; increasing compliance at MTFs

• Psychological health staffing not standardized

• Interim staffing model developed

• 233 MH providers hired (full implementation validation underway)

• Negotiated agreement with DHHS to provide 200 Public Health Officers for MTFs

• No Psychological Health Telemedicine capability

• Initiated multiple telemedicine pilot programs to provide MH services to personnel and families, regardless of geographic location


SOC Accomplishments

Transition of Care


• Case management and care coordinators for Wounded, Ill, and Injured Service members with TBI / MH conditions are not readily available

• Enhanced DVBIC Care Coordination for TBI

• Funded Case Managers / Care Coordinators for SMs with TBI/MH conditions


SOC Accomplishments

Screening and Surveillance


• Inadequate process to assess or document deployment TBI concerns

• Added TBI questions to Post-Deployment Health Assessment and Reassessment forms

• No method for assessing or evaluating changes in neuro-cognitive function

• Implemented NCAT across the enterprise; over 140,000 to date

• No common definition of TBI • Published DoD TBI definition / reporting policy


SOC Accomplishments

Resilience


• Aversion to seeking care for MH conditions

• Launched pro-resilience campaign

• Limited training for line leadership • Created Service awareness and understanding, including leadership education and training

• Lack of child and adolescent PH programs

• Sponsored Sesame Street production for children of returning ill and injured


SOC Accomplishments

Research


• Lack of evidence-based practices for resilience; gender- and ethnic-specific PTSD/TBI issues

• Funded numerous research programs to provide more understanding, and foundation for evidence-based practices