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Behavioral Health Integration Using Joint Doctrine U.S. Marine Corps Behavioral Health Conference Sept. 29, 2011 Dr. Mark Bates, Ph.D. Director, Resilience and Prevention directorate Dr. Jeff Rhodes, D.Min . Performance Enhancement, Resilience and Prevention directorate. Disclaimers.

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  1. Behavioral Health IntegrationUsing Joint Doctrine U.S. Marine Corps Behavioral Health Conference Sept. 29, 2011Dr. Mark Bates, Ph.D.Director, Resilience and Prevention directorate Dr. Jeff Rhodes, D.Min. Performance Enhancement, Resilience and Prevention directorate

  2. Disclaimers No disclosures related to financial interest or other relationship with manufacturers of commercial products and / or providers of commercial services discussed. The presentation provides a high level review of core themes and identifies where to find more specific information.

  3. Overview • Integration discussion • Two key premises • BH Integration overview • Two doctrine-based approaches to BH integration • Resources from DCoE

  4. Discussion Question 1 When you hear: “behavioral health integration”… What are your concerns? http://www.youtube.com/watch?v=Pk7yqlTMvp8 http://www.youtube.com/watch?v=Pk7yqlTMvp8

  5. Discussion Question 2 … and what potential opportunities can you see? http://www.youtube.com/watch?v=Pk7yqlTMvp8 http://www.youtube.com/watch?v=Pk7yqlTMvp8

  6. Integration and Nested Levels http://www.youtube.com/watch?v=Pk7yqlTMvp8 http://www.youtube.com/watch?v=Pk7yqlTMvp8

  7. Central Theme 1 “Joint warfare is team warfare.” Joint Publication (JP) 1, Doctrine of the Armed Forces of the United States (Washington, DC: The Joint Staff, March 20, 2009), i.

  8. People win wars and the mission of behavioral health is all about protecting and supporting the human weapon system  “Marines take care of Marines” Central Theme 2 • “The U.S. military is composed of many • parts: exceptional ships, planes and • ground systems. • The essence, the core of our military is and always will be its people: men and women who raise their right hands and recite the oath of enlistment” • – Gen. David Petraeus

  9. Senior Leaders on Human Capacity Chairman, Joint Chiefs of Staff (CJCS) “We will improve the health-of-the-force by caring for our people and their families and by restoring our readiness…”“Adopt "Total Force Fitness" (TFF) for changing how we understand, assess and maintain our people's well-being…”“Suicide, divorce, substance abuse, post-traumatic stress, domestic violence and homelessness will probably get worse…” - Adm. Mike Mullen

  10. Commandant’s Guidance Priority # 4: We will keep faith with our Marines, our Sailors and our families • The Deputy Commandant for Manpower and Reserve Affairs will present recommendations on how best to integrate Behavioral Health programs • Combat and Operational Stress Control (COSC) • Suicide Prevention • Family Advocacy • Sexual Assault • Substance Abuse Prevention

  11. Stovepiped Programs – Old Way Supported Programs Training Requirements Training Requirements Supported Programs Coordination Training Goals Strategic Direction Funding Training Goals Strategic Direction Funding Training Goals Strategic Direction Funding

  12. Integrated Behavioral Health (BH) Programs – New Way • Priority # 4 Task - Integrate BH efforts • Program integration, allocation of resources, strategic planning, and communication with commanders • Better Support to the Commander • Coordinated training requirements • Eliminated redundancies • Uncovered gaps • Validated practices • Operational efficiencies Suicide Prevention Strategic Planning and Communication Unified Policy Common Vision Funding Evidence Based Practices Sexual Assault Reporting & Prevention Substance Abuse Prevention Family Advocacy Combat & Operational Stress Control

  13. What are “Integration” and “Joint Operations”? Integration: “The arrangement of military forces and their actions to create a force that operates by engaging as a whole.” JP 1 Joint Operations: “A general term to describe military actions conducted by joint forces and those Service forces employed in specified command relationships.” JP 3-0

  14. What Is Joint Doctrine? Informs joint commanders on how to war fight Guidance for determining capabilities and required forces Informs the organization, training and execution of war-fighting principles Provides descriptive guidance (in contrast with prescriptive Department of Defense directives and Marine Corps orders)

  15. What Joint Doctrine did we consider? JP 1: Doctrine for the Armed Forces of the United States (March 20, 2009) JP1-02: Department of Defense Dictionary of Military and Associated Terms (Jan. 31, 2011) JP 3-0: Joint Operations (Aug. 11, 2011)

  16. Why Use Joint Doctrine to Inform Integration of Behavioral Health? BH mission is focused on the central capacity in modern military operations, the people Principles that inform joint force commanders in war-fighting efforts are equally applicable to a fully integrated BH approach Joint principles offer ways to optimize BH services and increase credibility with the operational community

  17. Unity of Command in the pursuit of a common purpose optimal use of resources accomplishment of the mission (JP 1) Themes: Centralized direction Standardized (“prescribed”) approaches Interoperability Predictable and reliable product Command and Control

  18. Coordination and cooperation toward common objectives Requires team players and willingness to share credit Trust and confidence are essential to synergy and harmony Themes “Esprit de Corps” associated with teamwork and common mission Campaign targets key risk and protective factors, many of which are common to multiple bad outcomes Unity of Effort

  19. Synergy multiplies effects of individual actions by: Complementary missions across team (JP 3-0) Encouraged and activated at lowest echelons (JP 3-0) Themes Team approach is critical All programs are necessary but not sufficient alone Can do more together Team approach can also evolve services faster with integrated feedback loops and adjustments Synergy

  20. Integrated Behavioral Health (BH) Programs Command & Control Unity of Effort Synergy • Better Support to the Commander • Coordinated training requirements • Eliminated redundancies • Uncovered gaps • Validated practices • Operational efficiencies Suicide Prevention Strategic Planning and Communication Unified Policy Common Vision Funding Evidence Based Practices Sexual Assault Reporting & Prevention Substance Abuse Prevention Family Advocacy Combat & Operational Stress Control

  21. Total Force Fitness: Complimentary Emerging Paradigm • CJCS Total Force Fitness (TFF) • Paradigm shift toward a multi-dimensional and holistic understanding of resilience and well-being • Four mind domains (spiritual, psychological, behavioral, social) and four body domains (physical, nutritional, medical, environmental) • Compliments all efforts in the Marine Corps’ integration of Behavioral Health Branch

  22. Total Force Fitness • CJCS Emerging Initiatives • CJCS Instruction on TFF • JP 1 Revision • TFF Joint Test Publication 3-70

  23. Total Force Fitness Domains

  24. Social Fitness Domain:Compliments Integrated Behavioral Health End State • Social Fitness: • Optimized social networks between the individual, unit, family and community that support optimal performance and well-being, and the overall end state of Total Force Fitness • Harmonious and complementary relationships across: • Units • Families • Peers • Communities

  25. Social Fitness and Unit Fitness • Key Takeaways: • Total Force Fitness represents a “paradigm shift” in the way the military views the overall health and fitness of service members • Unit Fitness is characterized by the healthy bonds within the social network of the unit structure – promoting optimal performance and overall well-being • Unit Fitness conveys short- and long-term benefits to mission success, troop readiness and resilience and Total Force Fitness

  26. Components of Unit Fitness

  27. Social and Unit Fitness: Cohesion

  28. Flexibility / Adaptability

  29. DCOE Resources Web-based resources and help lines available to leaders DCoE 24/7 Outreach Center: 866-966-1020 Real Warriors Campaign: http://www.realwarriors.net/ afterdeployment.org DCoE sponsored workshops targeting leaders Warrior Resilience Conference Suicide Prevention Conference DCoE sponsored reports and databases: RAND reports on Resilience and Suicide Prevention Review papers: TFF domains, peer to peer, mind-body skills, wellness programs (Integrative Health and Wellness page on DCoE website)

  30. Final Thoughts Importance of teamwork at local level is self evident More challenging to see and appreciate teamwork at the systems level because of many factors (e.g., increasing complexity and distance) Joint doctrine can help integration efforts by providing sample core concepts that can be tailored for Service needs Command and Control, Unity of Effort, and Synergy across the BH system Core fitness domains and sub-domains Marine BH Branch has made striking progress in a very short period of time!!

  31. Questions??

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