Slide 1

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

Lets Find Out Who Is Here

Family memberStudentEducatorService ProviderMilitary Family memberMilitary-Active DutyMilitary- ReservesMilitary GuardOtherIn what primary setting do you interact with military connected children?

Public SchoolDODEA SchoolPrivate SchoolHome SchoolFamily SettingMedical SettingFMWROther3Families 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/

Family systems theory provides a framework for understanding what a family is and how a family functions and helps in establishing trusting partnerships with family members.

Interdependence implies that individual family members and the subsystems that comprise the family system are mutually influenced by and are mutually dependent upon one another

We cannot understand the needs of an individual child without understanding those of the family. 5

Sisyphus from Greek mythology has to continually start over5Strengthening Our Military Families: Meeting Americas Commitments (Presidential Report) National Leadership Summit on Military Families: Final Report Military Family Needs AssessmentExceptional Family Member Program: Focus Groups Final ReportWhat Transitioning Military Families with Children who have Special Needs Currently Experience Phase IWhat Transitioning Military Families with Children who have Special Needs Currently Experience Phase IISYNTHESIS OF SIX MILITARY-RELATED REPORTS ON NEEDS OF MILITARY FAMILIES

Beach Center on Disability, 2012Emotional Well-BeingMaterial Well-BeingHealthFamily InteractionParentingDisability-Related SupportsSources of ResourcesFamily membersFriendsCommunity resourcesEducational resourcesOne-to-one peer support Parent groups/ organizations Community human servicesEarly intervention servicesDisability specialistsCultural CompetenceLegislation, Policies, and Administrative InfrastructuresTypes of Resources1Family Support FrameworkFamily Strengths/NeedsInformationInstrumentalEmotionalProvided 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, 2012

Beach Center on Disability, 2012

Sources of ResourcesFamily membersFriendsCommunity resourcesEducational resourcesOne-to-one peer support Parent groups/ organizations Community human servicesEarly intervention servicesDisability specialistsEmotional Well-BeingMaterial Well-BeingHealthFamily InteractionParentingDisability-Related SupportsCultural CompetenceLegislation, Policies, and Administrative InfrastructuresTypes of Resources1Family Support FrameworkFamily Strengths/NeedsInformationInstrumentalEmotionalProvided 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, 2012

FAMILY SUPPORTJan. 26, 2011Collaboration is at the heart of the governments 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=62593PerceptionsIn 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

10Social perceptions of people with disabilities are grounded in long-term notions and misunderstandings about disabilities that have persisted over the centuries.Culture plays an important role in defining, interpreting, and evaluating disabilities. A disability has a social character because culture and society define, and in some cases, impair or impede people with disabilities from accomplishing their goals and objectives.

PerceptionsWhen 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 peoples 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

11When perception changes your world changes.To what extent do you agree that collaboration is at the heart of support to military families in the months and years ahead

Strongly Disagree, collaboration is not the answer Disagree, collaboration might help but is not the answerNeutral, collaboration could help but Im not sure Agree, collaboration might help us make better use what is already availableStrongly Agree, collaboration across the military, the families and schools and the communities is criticalTo what extent have you experienced effectivecollaboration in your work or your services?

Never, I have not experienced an example of good collaborationRarely, I have experienced very few examples of good collaborationSometimes, once in a while I have experienced things coming togetherOften, more often than not things come together for meAlways, I expect and experience good collaboration

School-wide Integrated Framework for Transformationhttp://www.swiftschools.org

Child and Family Behavioral HealthCouncil for Exceptional ChildrenPaul Ban, Ph.D.Child, Adolescent and Family Behavioral Health OfficeUnited States Army Medical Command05 April 2013UNCLASSIFIED

15DISCLAIMERPaul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil UNCLASSIFIED Slide 2 of 20 05 April 2013The 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.We have some persuasive green suiters at JBLM who would like us to tell you that ..

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Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil UNCLASSIFIED Slide 3 of 20 05 April 2013Military kids know the pain of saying good bye to a parent for a year or more, and the joy of welcoming them back home.

Often, they meet their parent for the first time. Someone whose picture they had only seen in a photo book or a deployment doll.

Military kids know how to Skype.

They know words like deployment, block leave, reintegration, PCS and ARFORGEN cycle.

Military kids have their own month of recognition.

It is not uncommon for them to see people in uniform in their schools picking up other kids, helping them with their homework or volunteering in class.

However, it is also not uncommon for their teachers to not understand their lifestyle.

Military kids often dont understand the requirements of wearing the uniform why a parent cant hug in formation or why they often have to say goodbye

17BEHAVIORAL 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 20 05 April 2013THIS IS WHAT IT WILL LOOK LIKE. Care should be part of a Community of Practice that incorporates all aspects of the community that impinges on the Care and welfare of Children and Families. And Prevention needs to take a lead role in delivery of services. Integrating and coordinating agencies that share the welfare of Families. The Community of Practice framework offers a Learning System that includes the domain of Family welfare, the community comprised of organizations both the military and civilian that support Army Families and the practitioners within these agencies who come in contact with Families. This CoP share the wellbeing of Families as a common goal and work together to develop and coordinate services. BH providers work with Chaplains, Teachers, CPS, Army Community Services, civic organizations to eliminate duplication of services, strengthen interventions and have a positive impact on community climate.

18Goals Population Based Medical/Behavioral ProgramsChild/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 20 05 April 2013ARMY STRONG, SOLDIER STRONG, MUCH OF WHICH IS DEPENDENT ON FAMILY STRONG!

THESE ARE THE GOALS! HEALTHY RESILIENT FAMILIES. SO THE GOALS ARE WHAT WE ALL STRIVE FOR IN OUR OWN LIVES. IT IS BASED ON A COMMUNITY THAT IS ORGANIZED TO SUPPORT, FILL GAPS, ELIMINATE STOVEPIPING AND DUPLICATION OF SERVICES, AND MAXIMIZE SOLDIER AND FAMILY VALUES.

19To What Extent Do You AgreeThe military family is the deployable unit

DisagreeSomewhat disagreeNeutralAgreeStrongly agreeOUTREACH & PREVENTIONDefinitions 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 7 of 20 05 April 2013The 3 main products of the CAF-BHO are: describe. The coordination and integration of other stakeholders that share the common domain of the welfare of Army Families is what really makes this a system of care. THE PURPOSE OF THE CLINICAL PROGRAMS OF THE CAF-BHO ARE AGAIN TO PROMOTE OPTIMAL MILITARY READINESS AND WELLNESS, the principal programs being the child and family assistance centers, school behavioral health programs and the medical home model with support via TeleBH that is being piloted at JBLM. (Next Slide)

21CHILD 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) CAFACIntegrate 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 desiredManagesInterfaceInterfaceInstallation Management Command Services (IMCOM)Civilian Services in the Local CommunityPaul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil UNCLASSIFIED Slide 8 of 20 05 April 2013CAFAC DEVELOPMENT: PROBLEMS WITH THE PREVIOUS SYSTEM AT JOINT BASE LEWIS-McCHORD (JBLM)Difficult for providers and families to know where to get careMultiple points of entryMultiple phone numbersOverlap of servicesDuplication of effortGaps/white space in servicesLack of communication between disciplinesFrequent 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 9 of 20 05 April 2013Care that is EASILY ACCESSIBLE WITH INCREASED CAPACITY USING A SINGLE PHONE NUMBER SO THAT FAMILY MEMBERS HAVE READILY AVAILABLE SERVICES. The CAFAC provides direct BH care that is evidence based care and tied to the ARFORGEN cycle. 2. 3. Care that includes prevention as well as evaluation and treatment using standardized approaches. 4. Consultation to PCMs--Communication between providers in the primary care clinics WITH the behavioral health providers. 5. Within the CAFAC an Emphasis on behavioral health services for which the demand has greatly increased as a result of multiple deployments, such as marital and family therapy. 6. And last in the CAFAC personnel that integrate all BH resources on an installation, so that programs in ACS or Chaplains are identified and coordinated to eliminate gaps and duplications in services. THE CAFACS WORK WITH THE HEALTH PROMOTIONS COUNCIL TO ESTABLISH A PROCESS ACTION TEAM THAT ORGANIZES AND COORDINATES AGENCIES ACROSS THE COMMUNITY. THE IDEA IS TO GET SERVICES (NOT ONLY BH) TO WHERE SOLDIERS AND FAMILIES LIVE AND WORK IN A HOPE TO EVOKE A CULTURAL CHANGE IN HOW BH IS VIEWED. THAT IT BECOMES A NORMAL PART OF HEALTH MAINTENANCE LIKE IMMUNIZATIONS, GETTING CHOLESTEROL AND BP CHECK. THERE ALSO NEEDS TO BE CONTINUITY IN SERVICES FROM ONE INSTALLATION TO ANOTHER WITH A SMOOTH HANDOFF. THIS STILL NEEDS MORE WORK. (next slide)

23In your experience, which is the most frequent challenge

Multiple points of entryMultiple phone numbersOverlap of servicesDuplication of servicesGaps in servicesLack of communication between servicesChanges in availability of services due to change in assignmentOtherCAFAC CLINICAL SERVICESMultidisciplinary ServicesPsychiatry, Nurse Practitioner, Psychologists, LCSWs, Case Management

Individual

Family

Couples/Marital

Group

Outreach & PreventionPaul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil UNCLASSIFIED Slide 11 of 20 05 April 201337 employees at 5 sites plus 6 on-post schools

25EXAMPLES OF CAFAC OUTREACH & PREVENTIONOutreach efforts are tied to the Armys deployment cycle

Community events: Expectant/New Parents Health & Wellness Expo Kids Fest, Military Family NightsWA Military and Kids Summit (Tacoma) Foster Care Partnership (Pierce County) Parent UniversityWA State Childrens Justice Conference

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

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

Groups:Relationship WorkshopsEmotional RegulationTrauma Focused Couples Therapy

Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil UNCLASSIFIED Slide 12 of 20 05 April 2013SCHOOL BEHAVIORAL HEALTH (SBH) PROGRAMS

Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil UNCLASSIFIED Slide 13 of 20 05 April 2013The other main program is SCHOOL BEHAVIORAL HEALTH. The school behavioral health programs provide services in the schools where students spend approximately 1/3 of their day. This is a natural environment. The programs are based on collaboration and integration of community professionals, such as School liaison officers, military family life consultants, school counselors, and others responsible for caring for children. It provides a full continuum of behavioral health support and care for children in both general and special education. SBH is not just a clinic. PREVENTION, INTERVENTION AND PARTNERSHIP AROUND CARING FOR ARMY FAMILIES ARE THE GUIDING PRINCIPALS (next slide)

27SBH CLINICAL SERVICESPartnership between Madigan Hospital, JBLM and Clover Park School DistrictServes six post elementary schools; expanding beyond the gatesEmbedded Behavioral Health:Licensed Child & Adolescent PsychiatristTwo Licensed Clinical Psychologists (Child and Adolescent specialty; Pediatric Neuropsychologist)Six Licensed Clinical Social WorkersOne provider asset per school; works with existing resourcesChild Psychiatrist - mobilizedEvidence Based Treatment

Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil UNCLASSIFIED Slide 14 of 20 05 April 2013SBH CLINICAL SERVICES (2)Psychiatric diagnosis / evaluationPsychiatric medication evaluation and management Psychiatric emergency evaluation Individual and Family TherapyBehavioral Health case management for SBH studentsPsychoeducational and therapeutic groupsPrevention and wellness/resilienceCurbside consultationUniversal Emotional Screening Pilot

Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil UNCLASSIFIED Slide 15 of 20 05 April 2013Individual, family, group; classroom interventionsMedication Evaluation & ManagementCrisis ManagementCase Management; Coordination of ServicesResilience & Prevention Individual, Classroom, Parent, Teachers, AdministrationPsychoeducationCommunity Coordination

29To what extent does this model have the potential to provide better service?

Little chance for changeMay make some improvementWill have an positive impactWill have a significant positive impactWill change the way things are done for the betterTIERED INTERVENTIONSBH 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 17 of 20 05 April 2013Top diagnoses; Primary diagnosis of ADHD is the most prevalent, with Anxiety and adjustment as second and third highest, respectively.

We also have a high rate of deployment related referrals, with about a third of our referrals having a deployment related issue to address.

One thing to note is the effectiveness of triaging within the schools - 0% Academic related diagnoses. We put a great amount of effort into careful screening and communicating with the academic and BH teams to determine the best resources and level of care for each child referred to SBH.

31TIERED INTERVENTION(2)

the At-Risk Students (Tier 2)Groups:Coping CAT AnxietySocial SkillsLeadership-Positive Behavior Communication & FeelingsBuddy Lunches & Mentoring Activities (brigade basketball, Peer Mediators)Sibling Communication & BehaviorStress ManagementAnger Management

and Promotes Prevention (Tier 1)Kids:Deployment Group (the effects of deployment and reintegration)Understanding and Combating BulliesTransition Group (5th graders)Parents:Parent-Child Play GroupCommon Sense Parenting; 1-2-3 Magic Parent Support GroupsTeachers/Providers:Child and Family Process Action Team; Health and Resiliency Promotion BoardCopier Chat targeted information deliveryBrown Bag Series diagnostic and intervention specific; Ask a Doc Health & Fitness Walk/Run group; CraftingParticipant in the WA State Autism CoalitionCampaign of Kindness filling someone elses bucket

Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil UNCLASSIFIED Slide 18 of 20 05 April 2013Here is a brief example of the variety of small group and prevention services that SBH has provided within the schools.

The curb consultation aspect of services has been robust, with providers consulting about children in the classroom, teacher lounge, and hallway and on the playground.

SBH Clients:Social skills groups; Buddy Lunches Identification and communication of feelingsClassroom Programming:Deployment group discussing the effects of deployment and reintegrationUnderstanding and combating bulliesSchool Administration/Teacher ResourcesCopier Chat Providing quick read resources and short conversations at the copier and teacher break room targeted at delivering information about managing stress, identifying youth at risk, managing time and relaxation to teachers.Brown Bag lunch series for stress management and promotion of wellnessHealth and Wellness: Walk/Run group Health and Wellness: Crafting group (consideration of open membership to parents in the future)Parent Resources:Love and Logic Parenting ClassParenting strategies Provider Support:Presentation on Diagnostic Interviewing and DocumentationAutism Training to Child Development CentersParticipation as a member of the Washington State Autism Coalition Partnership between military, medical treatment centers, universities and local and state government to standardize and streamline identification, assessment, diagnosis and intervention for autism spectrum youth.

32Continuous Feedback Loop

TriageAdvisory GroupAdvisory CouncilConsultation

Support of Military Children and FamiliesProcess Action TeamShared Goals

Sense of Community

Increased Awareness/Education

Support of Schools Needs

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

Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil UNCLASSIFIED Slide 19 of 20 05 April 2013JBLM COMMUNITY PROJECTSlide 34 of

Facilitators

ACS - Army Community ServiceCYSS - Child, Youth & School ServicesCAFAC - Child, Adolescent and Family Behavioral Health OfficeSBH - School Behavioral HealthEFMP - Exceptional Family Member ProgramJBLM Libraries Military OneSourceUSOFAP - Family Advocacy ProgramMadigan Army Medical CenterHarborstone Credit Union

Slide 35 of

35Real Opportunities for CollaborationAre at the Intersection of People and Programs

Common goals

Common challenges

Shared workNurturing Collaboration: Content, Context, Contact and CommunicationDefine 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 ConveningEnsuring Relevant ParticipationCoalescing around IssuesDoing the Work TogetherA New Framework for Stakeholder EngagementHow 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 CommunityHawaii Missouri North Carolina South Dakota Illinois Montana OhioUtahMaryland New Hampshire Pennsylvania West Virginia Minnesota New Mexico South CarolinaPractice Groups Building a Collaborative Culture Learning the Language/Promoting Effective Ways for Interdisciplinary 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 DisabilitiesYouth Involvement and Leadership Beyond This SessionShare your views with each other and the CoPBecome a member of the Military Families Practice GroupBecome a leader in the Military Families Practice GroupSuggest how the Practice Group can inform and build support across our various networksHelp us to create the opportunities to keep bringing people togetherin person and online. and so much more!

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

Lets find outHow likely are you to stay connected and invite others to connect after this session?

UnlikelySomewhat unlikelyUndecidedSomewhat likelyVery likely Thanks very much for including us today

We look forward to working with you in the future!

Presenter Contact InformationMartha Blue-Banningmbb@ku.edu

Paul Banpaul.k.ban.civ@mail.mil

Joanne Cashmanjoanne.cashman@nasdse.org