Warrior Care and Transition Program Case Management through the Transition Process

1. Warrior Care and Transition Program Case Management through the Transition Process 20 June 2012 COL Catherine Mozden, Clinical Support Division, Warrior Transition Command

2. Our Mission WOUNDED ILL INJURED Provide centralized oversight, guidance and advocacy empowering wounded, ill and injured Soldiers, Veterans and Families through a comprehensive transition plan for successful reintegration back into the force or into the community with dignity, respect and self-determination. Mr. Mark Jackson (703) 325-1969

3. WCTP Entrance Criteria Soldier is Wounded, Ill, or Injured • Active Component - Must have complex medical conditions that require extensive (greater than six months) treatment and rehabilitation and intensive nurse case management. • Reserve Component - Reserve Component Soldiers who, during mobilization, pre-deployment, post-deployment, or separation, are in need of definitive healthcare based on medical conditions identified, incurred or aggravated while in an Active Duty status may volunteer to remain on Active Duty for treatment, are placed on Medical Retention Processing orders (Title 10) and are attached to a Warrior Transition Unit. • The installation Senior Commander is the General Officer with final approval authority for entrance to a Warrior Transition Unit. Is Soldier Evacuated from Theater Assign/Attach to a WTU Yes No Is Soldier ARNG or USAR Yes No Does Soldier Meet Entrance Criteria Return to Unit No Yes Triad of Leadership* Review Approved Disapproved Return to Unit • * Triad of Leadership – Senior Commander, Military Treatment Facility Commander, WTU Commander 7

4. FRAGO 3 outlines eligibility for COMPO 1 Soldiers: Soldiers with complex medical conditions that require extensive case management qualify for assignment or attachment to the WTU. Soldiers with medical conditions that do not require case management should remain in their units and utilize standard healthcare system and access to care standards. COMPO 2/3 Soldiers with medical conditions that do not require complex medical case management and qualify for MRP/MRP2/ADME are assigned/attached to a CBWTU for completion of medical management. Exceptions are as follows: The level and type of medical care required is not available in the Soldier’s community. The RC WT is evaluated as “High Risk” in accordance with MEDCOM risk assessment criteria. The RC WT lives within the 50 miles of an MTF with a WTU. For all Components: Commissioned Officers in the Grade of O4 and above, Warrant Officers in the grade of CW3 and above, Non-Commissioned Officers in the grade of E8 and above; are not eligible for assignment to a WTU unless approved by the Senior Commander or the first General Officer in the chain of command. FRAGO 4 Eligibility Criteria Review(1 of 2)

5. The following Soldiers from all COMPOs in the following categories are not eligible for entry into a WTU unless unusual circumstances are present: Soldiers with uncomplicated pregnancy. Soldiers who are in initial entry training, advanced individual training or one station unit training. Soldiers whose permanent profiles require an MOS/Medical Retention Board (MMRB). Soldiers in Temporary Disabled Retirement List (TDRL) status. FRAGO 4 Eligibility Criteria Review(2 of 2)

6. Triad of Care Warrior Transition Unit Community Based WTU • For all components • Traditional Chain of Command • (Squad Leader - Battalion Commander) • Focused “Triad of Care” for each Soldier • Army Wounded Warrior (AW2) Advocate for most seriously injured • Best facilities on post; priority medical care • Dedicated Family Support • Family Readiness Support Assistant (FRSA) • Soldier Family Assistance Center (SFAC) • Primarily for Reserve Component Soldiers • Modified Chain of Command • (PSG – Company Commander ( LTC) • Focused “Triad of Care” for each Soldier • Live at home; medical care available CBWTU allows wounded, ill, and injured RC Soldiers to heal at home • Duty at approved Title 10/federal duty site • Army Wounded Warrior (AW2) Advocate for most seriously injured • Dedicated Family Support • Virtual Soldier Family Assistance Center (VSFAC)

7. Warrior Transition Unit and Community Based Warrior Transition Unit Map Joint Base Elmendorf- Richardson ME WI VT Joint Base Lewis-McChord Ft Drum NH MT ND NY MN Massachusetts CT OR WI West Point Heidelberg Northern Regional Medical Command ID SD MI NJ JB McGuire-Dix-Lakehurst PA Western Regional Medical Command WY Ft Meade MD IA OH Walter Reed NMMC NE IN Ft Belvoir JB Langley Eustis NV WV Illinois California Ft Carson Virginia KY Utah Ft Leonard Wood Ft Riley NC KS CO Ft Knox MO Ft Irwin Ft Bragg Schofield Barracks AZ Balboa Ft Jackson Europe Regional Medical Command TN NM Ft Huachuca OK Ft Campbell SC Ft Gordon Ft Sill Arkansas Ft Bliss TX GA Pacific Regional Medical Command Alabama MS Ft Stewart Ft Hood LA Ft Benning Ft Polk Florida Joint Base San Antonio Brigade (2) Battalion (16) Separate Company (11) Community Based Warrior Transition Unit (9) (color by Area of Responsibility) AW2 Advocate (196) Southern Regional Medical Command Puerto Rico as of 27 Feb 12 Mr. Bill Crowley (703) 428-8232

8. WTC Population Map w/CBWTU AORs (Data Source: MODS WT, 29 MAY 2012) Joint Base Elmendorf- Richardson Europe RMC ME Western RMC WA MA Northern RMC VT Joint Base Lewis-McChord Ft Drum NH ND MT NY MN CT OR WI West Point Heidelberg ID SD MI NJ JBMDL PA WY Ft Meade MD Pacific RMC IA OH WRNMMC NE IN Ft Belvoir NV WV IL Ft Carson CA JBLE VA Ft Riley KY UT Ft Leonard Wood NC CO KS Ft Knox MO Ft Irwin Tripler Ft Bragg Ft Jackson AZ Balboa TN NM Ft Huachuca SC OK Ft Campbell Ft Gordon Ft Sill Southern RMC AR TX GA MS AL Ft Stewart Ft Bliss Ft Hood LA Ft Benning Ft Polk FL Joint Base San Antonio PR Brigade (2) Battalion (16) Separate Company (11) CBWTU (color by AOR) (9)

9. WTU/CBWTU Population over Time (Data from MODS WT, 29 May 2012) FRAGO 3: Entrance Criteria Remote Care Review Army directs movement of MEBs and Non-deployables to WTUs FRAGO 4: RC Management FRAGO 3: Review WTU Est Active Component Army National Guard United States Army Reserve

10. Continuum of Care(Comprehensive Transition Plan (CTP)) “The CTP provides Soldiers and Families clarity, purpose, hope, and direction as they prepare to move forward with the next phase of their lives.” Lieutenant General Patricia D. Horoho, The Surgeon General COAD COAR Return to Duty 186 10072 1424 8462 Train Reset Army Force Generation WTU CBWTU Veterans / Ready “Path to Independence…One Step at a Time” Available Operation Iraqi Freedom/ Operation Enduring Freedom/ Operation New Dawn Care Management Team Soldier and Family Assistance Center Chaplains Legal Support Pharmacists Transition/Career Counseling Social Workers VA Liaison for Healthcare MEB Physician Federal Recovery Coordinator Career and Education Readiness Physical Evaluation Board Liaison Officer Caregiver Support Coordinators Education Counseling Employment Counseling Occupational Therapists Physical Therapists Transition Counseling Specialty Care Return to Duty / Release from Active Duty Triad of Care and Interdisciplinary Team Army Wounded Warrior Advocate (Life Cycle Management Plan) Warrior Transition Unit/ Community Based Warrior Transition Unit Veterans Affairs Integration and Hand Off Medical Retention Decision Point Transition Review Inprocessing Integrated Disability Evaluation System Veterans Affairs Rehabilitation Rehabilitation Goal Setting Post Transition Reintegration Family/Friends Comprehensive Transition Plan (Domains – Career, Physical, Emotional, Social, Family, Spiritual) as of 1 Mar 12 Mr. Mark Jackson (703) 325-1969

11. Nurse Case Management in the WCTP All clinical case managers in the WTU and CBWTU are registered nurses: civilian or military. Case Managers are assigned at a 1:20 ratio. New NCMs attend a three week training which covers a range of topics including CM standards and goals (CSMA), processes, assessment, and care plan development , motivational interviewing, VHA/VBA, transition planning, polypharmacy, BH, Legal and ethical concerns, patient safety, mTBI , TRICARE, PDES, and documentation (MODs, AHLTA)

12. WCTP Transition Eligible / Transition Ready

13. Transition Processes For RC Soldiers who will REFRAD (partial list): Contact with Transition Assistance Advisor (TAA) Referral to VBA and ensure completion of 1010EZ Referral to VHA Liaison; Follow on appts with VHA* Ensure information on TRICARE programs is provided MODS data entry- clinical notes available to DSS* Discharge note completed in AHLTA* Clinical Record copied and returned to unit/State * NCM responsibilities

14. Transition Challenges/Concerns Reintegration – home, work, community, unit Communication- State/RSC, RC unit command team, health care providers Follow on care

15. Questions COL Catherine Mozden Warrior Transition Command Chief, CBWTU Remote Care Catherine.a.mozden@us.army.mil Office: 703-325-0371 BB: 571-224-4816