Colonel Christopher Priest Director, Reserve Medical Programs Force Health Protection and Readiness

1. DEPLOYMENT HEALTH ASSESSMENT 2012 USAR LEADERSHIP CONFERENCE SEPTEMBER 21, 2012 Colonel Christopher Priest Director, Reserve Medical Programs Force Health Protection and Readiness Office of the Assistant Secretary of Defense for Health Affairs

2. Purpose Provide an overview of the Department of Defense policy guidance, reported data trends and observations of program management concerns

3. Agenda Why do we need a Post Deployment Health Assessment/Reassessment? Integrating the Health Assessment Cycle Current policy and statutory requirements Health Affairs Quality Assurance Program Observations on compliance Referral Management QA follow-up Conclusion

4. PDHRA – Good for the Army • Critical Commander tool for promoting wellness and enhancing unit readiness • Drives early identification of health issues post-deployment • Prioritizes treatment of potentially serious conditions that result from deployment • Promotes post-deployment reintegration

5. PDHRA – Good for the Soldier • Enhances the deployment-related continuum of care • Provides screening and opportunity for Soldier education • Identifies resources; facilitates access to care • Can serve as a tool to guide restoration of health and functioning after deployment

6. PDHRA – A Collaborative Effort • Health Affairs – Establishes DoD policy, develops the tool, monitors adherence • Army G-1 – Leads the effort; ensures Army policy consistency, develops procedures for implementation • Human Resources – Oversees the program; ensures timelines are met • Medical Community – Ensures proper screening and follow-up care if needed • Line Leadership – Involvement and support are crucial to success • The Soldier – It’s always about the Soldier and their Families…keep the main thing the main thing

7. Retirement/ Separation & Beyond Operations Pre-Deployment Post-Deployment Deployment Periodic Health Assessment Post-Deployment Re-assessment Primary Prevention In Garrison Tertiary Prevention Secondary Prevention Accession Baseline Health Assessment Health Assessment Cycle Mental Health Assessments

8. Review of Current Policy • DoDI 6490.03 is the principal DoD policy guidance • Assessments required for: • Readiness to deploy • Negative effects of deployment on health • Requires pre- and post-deployment health assessments, and; • PDHRA conducted 90-180 days following return from deployment • Enhanced in late 2007 • Added coverage for TBI, alcohol abuse, impact of physical or emotional problems on work, relationships, etc. • Standardized questions in the PDHA wherever possible • Re-certified in September, 2011 • Pertinent Army Regulations: 40-66, 40-501 • Revising Assessments • All deployment assessments are being revised • Goal: Make as science-based and user-friendly as possible

9. Incorporate Mental Health Assessment per NDAA12 Question sequence Comment space for Soldier responses Alcohol audit-C questions – raise cut off Deleting TBI questions Additional guidance for provider Modify demographic information Additional comment space for clinician Soldier unsure response options deleted Exposure open ended question Modify force protection questions Deleting Major/Minor Concerns Changes to DD 2900 (PDHRA)

10. Review of Current Policy: 2012 NDAA Section 702 • Mental Health Assessment mandate • Updates requirements mandated in NDAA10, Sec 708: • Conducted in a private setting • Administered by qualified clinicians • Results recorded in medical record; • Change in scheduling • Pre-deployment: beginning 120 days before deployment • Post-deployment: 180-365 days after redeployment; 18-30 months after redeployment • PDHRA formrevised to incorporate mental health assessment • RCs lack electronic means to conduct MH assessments and upload to MEDPRO • Manual System; form storage and retrieval issues? • Case Management?

11. TRICARE and the VA • TRICARE Eligibility and Access • Transition Assistance Management Program (6 mos) post -deployment is an invaluable tool for Soldier Reintegration • Full TRICARE benefit at no-cost to the Soldier • Resolved the concurrent benefit issue for those Soldiers retained on Active Duty for medical care • Services authority to retain or return to Active Duty those Soldiers who meet the criteria for Medical Retention Processing • Care authorized by the Medical Management Support Office (MMSO) for documented LOD conditions resulting from the period of active duty • This is a Hot Topic issue with TMA and the Services • Documentation is the key

12. TRICARE and the VA • Veterans Affairs • Is an invaluable partner to provide continuity of care • Provides up to five years of care post-mobilization • DD214 • Provides full access to the VHA as a category 6 beneficiary • Military Health Record data (AHLTA) is available to the VA • VA record data is not readily available to the RC… you have to ask for it • Bi-directional data feeds is a key topic in the DoD-VA working groups • Other challenges • Difficulty in integrating personal health insurance utilization • Referred care conducted by means other than the Federal programs is difficult to coordinate

13. Force Health Quality Assurance • Pertinent findings from 2011/12 QA Visits: • PDHRAs are being administered, however: • PDHRAs are not getting into AFHSC’s Defense Medical Surveillance System (Service data feed, not a compliance issue) • Compliance with meeting the 90-180 day timeline has improved! • There's little evidence Service Members are getting help for identified issues, especially within the Guard and Reserve • Disconnects between Personnel and Medical • Lack of a referral tracking tool • Lack tracking of referral recommendations, limited case management • Follow-up largely unknown after initial screening except for encounter data from the Military Health System • A lot of focus on pre-deployment and post-mobilization medical issue identification, but not enough focus on PDHRA medical issue tracking and follow-up

14. Deployment Health Assessment Process Electronic Health Record (AHLTA) Sent to VA Navy, Marine, Coast Guard members initiate health assessment Assessment printed and put in Service Member’s record DHIMS Meets AFHSC business rules Assessment sent to AFHSC (electronic) Assessment stored in DMSS Army members initiate health assessment Completed by Provider Data available for analysis Does not meet AFHSC business rules (a non-valid SSN or a non-valid form date (including future dates)) Assessment stored in Service system (electronic) Air Force members initiate health assessment Services notified of assessment forms requiring adjudication Available to Providers who have ability to assess Service System

15. Completion of PDHRA (DD2900) based on CTS Roster FHP&R Proponent: Col Butel Data Source: DMSS (AFHSC) Related Policy: DoDI 6490.03 RC data reflects completion as of certification date, and removal of those deployed to unknown deployment location Data Source: DMSS Prepared by: Armed Forces Health Surveillance Center (AFHSC) • This metric reflects the proportion of those returning from deployment who have completed the DD2900 health assessment within 60 days prior and up to 210 days post deployment end based on the “Provider Certification Date” • Deployment dates are based on DMDC rosters and includes deployments lasting longer than 30 days • Excludes those without a deployment end date and those with an unknown deployment location

16. Deployment Health Assessments, Feb - Jul 2012% Active Duty Army – Top % Army Reserve/National Guard – Lower

17. TBI Recommended Referrals and Types of MHS Encounters (60 days) - PDHA FHP&R Proponent: Ms. Elizabeth Fudge Related Policy: 10744f of Title 10 US Code of Public Law 108-375 • This metric reflects the proportion of those returning from deployment as indicated in the CTS Roster who have completed the DD2796 health assessment within 60 days prior and up to 60 days post deployment return based on the “Provider Certification Date” • Follow-up encounters include those encounters that occurred following a TBI referral within 60 days of the provider certification date on the DD2796 • Includes only deployments to OEF or OIF greater than 30 days in duration and only civilians that seek care within the MHS • *Other refers to Civilians not associated with Army, Navy, Air Force, Marine Corps, & Coast Guard Data Source: DMSS data compiled and summarized by AFHSC

18. Mental Health Recommended Referrals and Types of MHS Encounters (60 days) - PDHRA FHP&R Proponent: Lt Col Lawson Related Policy: NDAA 2012, Section 702; 10744f of Title 10 US Code of Public Law 108-375 • This metric reflects the proportion of those returning from deployment as indicated in the CTS Roster who have completed the DD2900 health assessment within 90 days to 180 days post deployment return based on the “Provider Certification Date” • Follow-up encounters include those encounters that occurred following a positive MH Referral within 60 days of the provider certification date on the DD2900 • Includes only deployments to OEF or OIF greater than 30 days in duration and only civilians that seek care within the MHS • *Other refers to Civilians not associated with Army, Navy, Air Force, Marine Corps, & Coast Guard Data Source: DMSS data compiled and summarized by AFHSC

19. The Challenge… • Essential to track PDHRA referrals and document Line of Duty requirements • USAR must shift into a case management mentality • It is not enough to simply comply with the PDHRA requirements . There are tools to ensure Soldiers get follow-on care but the clock is ticking • Stratify the effort, what do you care about most? • Impacts on a fit and healthy operational force, capable of sustained operations

20. The Way Ahead • Avoid assessment fatigue • Command must emphasize importance of assessments • Provide help for identified concerns to show value • Make assessments easy and efficient for personnel and providers • Enhance efficiencies and increase Soldier compliance • Work to synchronize timing of all deployment-related required assessments to reduce soldier burden, reduce time away from training and for RC, time away from civilian employment • PDHRA timeliness is critically important • Health issues tend to worsen if not addressed • 180-day TAMP eligibility facilitates seeking care • Follow-up is key • Failure to act negatively impacts everyone – Soldiers/civilians, their families, and the Army • Track the referrals to conclusion • The Gold Standard: Integrated delivery of health care

21. You Are Critical to Success • The Armyand Line Leaders • Leadership and support • Positively affects Soldier attitude • Maximizes operational readiness • Day-to-day program execution • Human Resources – Oversees the program • Ensures timelines are met • Medical Community • Identifies concerns • Provides early treatment and intervention • Conference Organizers • Conveys program importance • Increases program effectiveness Automate the Process!

22. Conclusion Thank You!