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Child and Family Behavioral Health

Child and Family Behavioral Health. MCEC 2012 National Training Seminar. Paul Ban, Ph.D. Child, Adolescent and Family Behavioral Health Office United States Army Medical Command. 28 June 2012. UNCLASSIFIED. DISCLAIMER.

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Child and Family Behavioral Health

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  1. Child and Family Behavioral Health MCEC 2012 National Training Seminar Paul Ban, Ph.D. Child, Adolescent and Family Behavioral Health Office United States Army Medical Command 28 June 2012 UNCLASSIFIED

  2. DISCLAIMER 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) / paul.ban@us.army.mil UNCLASSIFIED Slide 2 of 17 28 June 2012

  3. Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil UNCLASSIFIED Slide 3 of 17 28 June 2012

  4. BEHAVIORAL HEALTH SYSTEM OF CARE Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil UNCLASSIFIED Slide 4 of 17 28 June 2012

  5. 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) / paul.ban@us.army.mil UNCLASSIFIED Slide 5 of 17 28 June 2012

  6. 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) / paul.ban@us.army.mil UNCLASSIFIED Slide 6 of 17 28 June 2012

  7. CHILD AND FAMILY ASSISTANCE CENTERS Integrate and provide direct Behavioral Health Support for Army Children and their Families • -- 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 Manages Interface Embedded C & F Beh. Health Services (in housing areas, Primary Care, Medical Homes, units, Child Devlpt. Cntrs., Schools (SBH), and others as desired Interface Civilian Services in the Local Community Installation Management Command Services (IMCOM) Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil UNCLASSIFIED Slide 7 of 17 28 June 2012

  8. CAFAC DEVELOPMENT: PROBLEMS WITH THE PREVIOUS SYSTEM AT 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) / paul.ban@us.army.mil UNCLASSIFIED Slide 8 of 17 28 June 2012

  9. 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) / paul.ban@us.army.mil UNCLASSIFIED Slide 9 of 17 28 June 2012

  10. 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) / paul.ban@us.army.mil UNCLASSIFIED Slide 10 of 17 28 June 2012

  11. SCHOOL BEHAVIORAL HEALTH PROGRAMS Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil UNCLASSIFIED Slide 11 of 17 28 June 2012

  12. 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) / paul.ban@us.army.mil UNCLASSIFIED Slide 12 of 17 28 June 2012

  13. 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) / paul.ban@us.army.mil UNCLASSIFIED Slide 13 of 17 28 June 2012

  14. TIERED INTERVENTION SBH services capture High-Risk students (Tier 3) Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil UNCLASSIFIED Slide 14 of 17 28 June 2012

  15. …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 TIERED INTERVENTION(2) …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) / paul.ban@us.army.mil UNCLASSIFIED Slide 15 of 17 28 June 2012

  16. Continuous Feedback Loop Process Action Team Advisory Group Advisory Council • Shared Goals • Sense of Community • Increased Awareness/Education • Support of School’s Needs • Desire to Contribute (resources, subject matter expertise, time, etc.) Consultation Triage Support of Military Children and Families Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil UNCLASSIFIED Slide 16 of 17 28 June 2012

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