increasing access to behavioral health resources for

Increasing Access to Behavioral Health Resources for Military and Veteran Children and Families

Webinar

March 12, 2020

Melissa Comeau, Director, Military and Veteran Caregiver Network, American Red Cross

Kelly A. Blasko, Ph.D., Lead, mHealth Clinical Integration,

Connected Health Branch, Clinical Support Division, Medical Affairs, Defense Health Agency

Erika R. Slaton, Associate Director, Military Community Support Programs, Office of the Deputy Assistant Secretary of Defense

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SAMHSA Welcome

Cicely K. Burrows-McElwain, L.C.S.W.-C.Military and Veteran Liaison

National Policy Liaison Branch,

Division of Regional and National Policy/Office of Policy, Planning, and Innovation, SAMHSA

The views, opinions, and content expressed in this presentation do not necessarily reflect the

views, opinions, or policies of the Substance Abuse and Mental Health Services

Administration (SAMHSA), or the U.S. Department of Health and Human Services

(HHS).

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Disclaimer

SAMHSA Background

SAMHSA leads efforts to ensure substance use and mental

health issues among all Americans, including SMVF, are

well understood.

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Since 2008, SAMHSA has partnered with states and territories to strengthen behavioral health systems serving Service Members, Veterans, and their families (SMVF), providing technical assistance (TA) through its SMVF TA Center.

• Strengthening ongoing collaboration among military and civilian stakeholders

• Providing a centralized mechanism for cities, states, and territories to learn, connect, and share

• Increasing awareness of and access to resources and programs that strengthen behavioral healthcare systems for Service Members, Veterans, and their families (SMVF)

• Supporting coordinated responses to the behavioral health needs of SMVF

• Encouraging cities, states, and territories to implement promising, best, and evidence-based practices

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SAMHSA’s SMVF TA Center

Technical Assistance Methods

The SMVF TA Center provides training and technical assistance through activities such as:

• Policy Academies

• Implementation Academies

• Crisis Intercept Mapping

• Webinars

• Learning Communities

• Onsite and virtual expert consultation

• Resource dissemination

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✓ Facilitate information dissemination, resources and tools for increasing connection, engagement, knowledge and skills related to behavioral health resources for military and veteran children and families

✓ Provide an overview of recent expansions to programs and benefits such as TRICARE and specifically related to military and veteran families

✓ Provide an overview of ongoing collaborative efforts and partnerships working to ensure a spectrum of behavioral health services and resources are available in healthcare networks serving SMVF

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Webinar Objectives

✓ Examine how military and civilian behavioral health

care providers can best support SMVF caregivers by

increasing access to best practice programs and

supports

✓ Explore opportunities for public-private collaboration

and partnerships as an option for supporting military

caregivers

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Webinar Objectives (cont’d)

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Our Presenters Today

Kelly A. Blasko, Ph.D.Lead

mHealth Clinical Integration

Connected Health Branch Clinical Support Division

Medical AffairsDefense Health Agency

Erika R. SlatonAssociate Director

Outreach and EngagementMilitary Community Support Programs

Military Community and Family Policy

Office of the Deputy Assistant Secretary of

Defense, DoD

Melissa ComeauDirector

Military and Veteran Caregiver Network

Service to the Armed Forces

American Red Cross

Increasing Access to Behavioral Health Resources for Military and Veteran Children and Families

Webinar

March 12, 2020

Kelly A. Blasko, Ph.D.

Lead

mHealth Clinical Integration

Connected Health Branch

Defense Health Agency

Increasing Behavioral Health Resources for

Military and Veteran Children and Families

Kelly Blasko, Ph.D.mHealth Clinical Integration Lead, Connected Health Branch, Defense Health Agency

March 12, 2020

“Medically Ready Force…Ready Medical Force” 11

Increasing Behavioral Health Resources for Military and Veteran Children and Families

∎Overview

❑TRICARE’s Benefit Change

❑National Defense Authorization Act Fiscal Year 2016

❑DoD Connector Program/Partnering For Readiness (P4R)

❑Qualifying Life Events (QLE) and TRICARE Plan options

“Medically Ready Force…Ready Medical Force” 12

TRICARE’s Benefit Change: A Continuum of Interventions and Increased Access to Behavioral Health

∎ Final Rule, “TRICARE; Mental Health and Substance Use Disorder Treatment,” published in Federal Register on September 2, 2016 (81 FR 61068-61098)❑ Aligned TRICARE’s mental health (MH) and substance use disorder (SUD)

benefit with the principles of mental health parity

❑ Expanded covered MH and SUD treatment under TRICARE purchased care

❑ Streamlined requirements for institutional providers

❑ Eliminated many limits on care

∎ TRICARE manual changes published on June 13, 2017❑ Networks developed to increase access to new provider types

“Medically Ready Force…Ready Medical Force” 13

Plan Ahead: TRICARE Qualifying Life Events (QLE)

∎ TRICARE provides the opportunity to change plans between Prime and Select out

of cycle if a QLE occurs. Beneficiaries may change their TRICARE plan outside of the normal open season (mid-November to mid-December) if a QLE occurs. QLEs include:

https://tricare.mil/LifeEvents/QLE

“Medically Ready Force…Ready Medical Force” 14

Plan Ahead: Loss of TRICARE coverage if separating before retirement

∎TRICARE eligibility ends when the member leaves the service (unless retiring) leading to loss of TRICARE benefits for the member and their family

❑ Temporary health care coverage may be available and acts as a bridge between military health benefits and a new civilian health plan

▪ Transitional Assistance Management Program

▻80 days of premium-free transitional health care benefits after regular TRICARE benefits end

▹ https://tricare.mil/Plans/SpecialPrograms/TAMP

▪ Continued Health Care Benefit Program

▻Gives temporary health coverage for 18-36 months when eligibility for TRICARE ends

▹ https://tricare.mil/Plans/SpecialPrograms/CHCBP

❑ Reservists (and their eligible family members) who are deactivating but remaining in the reserve force may be eligible for TRICARE Reserve Select

“Medically Ready Force…Ready Medical Force” 15

Congressional Requirement: Program for Children at Risk of Mental Health Conditions with Parental Deployment

∎ NDAA 2016, HAC-D Report 114-557 directs SECDEF develop by Fiscal Year (FY) 2017 a program to:❑ Identify children at risk for mental health (MH) conditions related to parental

deployment

❑ Develop tools, education, and guidance for providers and parents

∎ Program Development ❑ Model Adaptation for the DoD Environment

❑ Model Selection and a platform for partnering

“Medically Ready Force…Ready Medical Force” 16

Model Adaptation: Continuum of Interventions in DoD and Community Settings

“Medically Ready Force…Ready Medical Force” 17

Child

Family

Military & Civilian

Community

Culture

INTERVENTIONS Indicated

PreventionSelective

Prevention

Case Identification

Universal Prevention

Standard Treatment: Known Disorders

PositiveDevelopment

Compliance with Long-term Treatment

and After Care

INTERVENTION SETTINGS

Home Acute Inpatient PsychCare/ SUDRF

School

NeighborhoodAgency / Child & Youth Programs

Primary Care Clinic/Embedded

BH/HS OutpatientMental Health/

OBOT

Psychiatric Residential

Treatment Facility

Intensive Outpatient Treatment

Partial Hospital/Opioid Treatment

Program

Adapted from Weisz , Sandler, et al. (2005)

Health Promotion

Institute of Medicine

DoD Connector Program: Prevention and Treatment Programs for Children of Deployers

“Medically Ready Force…Ready Medical Force” 18

INSTITUTE OF MEDICINE, Intervention Spectrum for Psychological Disorders

PREVENTIONSelective - Resources target at-risk children Indicated - Resources target children with current symptoms▪ Child and Family Behavioral Health System (CAFBHS)▪ Child & Youth Military Family Life Counselors/DoD Child & Youth Programs ▪ DoDEA Student Education Services▪ Family Advocacy Program/New Parent Support Program▪ Family Readiness Programs▪ Families Over Coming Under Stress ▪ Military OneSource▪ USCG Work-Life Programs▪ Yellow Ribbon Program

TREATMENT Treatment and Continued Care -Resources for MH/SUD disorders▪ CAFBHS ▪ Services’ military treatment facilities ▪ TRICARE (purchased care):

▪ Outpatient Therapy ▪ Office-Based Opioid Treatment ▪ Intensive Outpatient Program ▪ Partial Hospitalization ▪ Opioid Treatment Program ▪ Residential Treatment Center ▪ Acute Inpatient Psychiatric Facilities▪ SUD Rehabilitation Facilities

Universal - Resources target all▪ AfterDeployment▪ Military Kids Connect ▪ Military OneSource ▪ NDSP-Non-DoDDS Schools▪ PlanMyDeployment ▪ PlanMyMove ▪ Real Warriors

Needs Identification▪ By Providers to Exceptional

Family Member Programs for Assignment/Support Purposes

CONNECTORPROGRAM

Adapted from Weisz , Sandler, et al. (2005)

CONNECTOR PROGRAM PLATFORM: PARTNERING FOR READINESS

PLANNING COMMUNICATION WITH

PARTNERS

PREPARING THE WORKFORCE TO SUPPORT

OUR PEOPLE

DEVELOPING RESOURCES FOR PROVIDERS AND

PARENTS

PARTNERING FOR READINESS

(P4R)

“Medically Ready Force…Ready Medical Force” 19

SHAPING PROCESSES TO SHARE

AND DELIVER SERVICES

PARTNERS: DoD Connector Program/P4R

∎ Building partnerships is a cornerstone for behavioral health prevention and intervention to support military families; more partners are anticipated.

❑ Defense Health Agency (DHA)

❑ DoD Education Activity (DoDEA)

❑ Defense Suicide Prevention Office (DSPO)

❑ Military Community & Family Policy (MC&FP)

❑ MC&FP’s Office of Special Needs and Services’ Exceptional Family Member Programs (EFMP)

❑ Military Family Readiness Council (MFRC)

❑ National Guard-National Guard Bureau (NG-NGB) and Air National Guard (ANG)

❑ Headquarters, Department of the Army (HQDA), Assistant Chief of Staff for Installation Management (ACISM), Child and Youth Programs

❑ Substance Abuse Mental Health Services Administration (SAMHSA)

❑ U.S. Coast Guard (USCG)

“Medically Ready Force…Ready Medical Force” 20

DoD Connector Program: 2017 and 2018 Milestones

∎ 2017

❑ JUL: Military OneSource webisode, “TRICARE Benefits: MH and SUD”

❑ AUG: SAMHSA and P4R conference, Resource Awareness and Sharing

❑ SEP: Articles on child suicide prevention, Health.mil and Exceptional Advocate

❑ DEC: Military Family Readiness Council (MFRC), recommendation to SECDEF

∎ 2018

❑ MAR: MFRC panelists include MH subject matter experts

❑ MAR & JUN: TRICARE behavioral health consultants meetings with P4R member panelists

❑ APR: SAMHSA KSOC-TV webisode, “Addressing the Mental Health Needs of Military Children”

❑ MAY: SAMHSA National Mental Health Awareness Day webisode, “Partnering for Health and Hope Following Trauma”

❑ MAY: Military OneSource Call Center tour for P4R members

❑ JUN & SEP: Child and Adolescent Suicide Prevention Month; DSPO, DoDEA, and DHA

❑ SEP 2018: Suicide Prevention Month

❑ OCT 2018: Prevention of Child and Adolescent Bullying and Cyberbullying

“Medically Ready Force…Ready Medical Force” 21

DoD Connector Program: 2019 and 2020 Milestones

∎ 2019❑ MAY: SAMHSA’s National Children’s Mental Health Awareness Day, “Suicide Prevention: Strategies That Work”

❑ OCT: Mental Health Services in the overseas areas

❑ MONTHLY: P4R TCONS, Hosted by Dr. Kelly Blasko, Military Kids Connect, “Universal Messaging and Programming”

∎ 2020 ❑ MONTHLY: P4R TCONS, Hosted by Dr. Kelly Blasko, Military Kids Connect, “Universal Messaging and

Programming”

❑ MAR: J-7, Clinical Communities Speaker Series: “Children and Youth: Advanced Practices for the Pediatric Health Care Provider”

❑ MAR: SAMHSA webinar: “Increasing Behavioral Health Resources for Military and Veteran Children and Families”

❑ MAY: P4R partners present to SAMHSA’s weeklong webcasts; topics:

▪ Prevention of Prescription and Opioid Drug Misuse

▪ Prevention of Underage Drinking and Alcohol Misuse

▪ Prevention of Illicit Drug Use and Youth Marijuana Use

▪ Prevention of Youth Tobacco Use (E-cigarettes and Vaping);

▪ Prevention of Suicide

❑ JUL: Military Child Education Coalition (MCEC) Pre-Conference Session: “P4R Partners and Military Families”

“Medically Ready Force…Ready Medical Force” 22

Contact Information

Dr. Kelly A. Blasko

Counseling Psychologist

Lead: mHealth Clinical Integration

Connected Health

Kelly.a.blasko2.civ@mail.mil

(c) 253-341-2415

“Medically Ready Force…Ready Medical Force” 23

Supporting Military and Family Where They Serve

Webinar

March 12, 2020

Ms. Erika R. Slaton

Associate Director, Outreach and Engagement

Military Community Support Programs

Military Community & Family Policy

Office of the Deputy Assistant Secretary of Defense

• Discover the range of support provided through Military OneSource

• Understand what non-medical counseling resources are available through MC&FP

• Learn how to access Military OneSource state-based points of contact

• Explore online tools and resources

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Objectives

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Range of Support

Military OneSource offers:• Face-to-face, online, by

phone and video sessions • Short-term, up to 12

sessions, per issue• Available to children and

teens with some guidelines• Can address issues such as:

– Stress management– Marital and communication

issues– Adjustment and deployment

challenges– Parenting skills– Grief or loss

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Confidential Non-medical Counseling

Additional access to non-medical counseling:Military and family life counselors, or MFLCs, and child and youth behavioral MFLCs offer:• Face-to-face counseling and

presentations • Services in a variety of locations:

– Military and family support centers

– Child development centers– School and youth camps– Embedded in military units– Targeted “surge” locations– On-demand events

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Military and Family Life Counseling

Military OneSource provides personalized support designed for expectant parents and parents of children up to age five:• Sessions consist of a variety of

parenting topics, resources, tools and tips– Improving self-care– Developing a routine for your child– Discovering community and

branch-specific resources– Understanding developmental

milestones– Managing challenging behaviors– Single and dual military parents

• Unlimited sessions, available by phone and secure video

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New MilParent Specialty Consultation

State consultants support the total force with emphasis on dispersed military populations. Their role is to:• Provide outreach and education to

military and civilian sectors. • Develop and execute a state support

plan. • Connect active duty, National Guard

and reserve members and families to Federal, state, and local resources and non-profit organizations.

• Integrate community resources into the Military OneSource network of resources available through a 24/7 call center and website.

Request support at: https://supportrequest.militaryonesource.mil/

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State-Based Outreach and Support

MilitaryOneSource.mil provides a 24/7 connection to resources.

Health and Wellness pages feature:

• Articles on healthy living, mental health and health care

• Specific content for wounded warriors and caregivers

• Links to self-care mobile apps and resilience tools

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Online Tools and Resources

Order and download products that cover a range of topics:

• Relationships

• Health and wellness

• Deployment

• Parenting

• Special needs

• Casualty assistance

• Education

• Non-medical counseling

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Educational Materials and Products

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Service members and families have access to Military OneSource as they transition to civilian life:• Supports the Joint Action Plan

required by Executive Order 13822• Ensures that service members and

their families have access to Military OneSource’s suite of services

• Includes Coast Guard members and their families

• Enables Military OneSource outreach to service members who opt-in for contact during the DoD Transition Assistance Program

• Communicates the availability of peer support and non-medical counseling resources

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Military OneSource 365-Day Expansion

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Here’s just a sample of what individuals tell us:• Deployment groups at the school were

very much appreciated. The three MFLCs not only have the skills, but have the heart in working with military kids and their parents.

• Thank you so very much for the great MFLC support during the recent crisis [ in our schools]. I certainly appreciate the flexibility of the MFLC Program to allow [MFLC] to go to school and be available for the kids.

• This is my third time using [Military OneSource] and you have kept my marriage and family together through deployments and everything else.

• Every time I call [Military OneSource], I learn about more resources available. I always wish I knew sooner!

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What They’re Saying

SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.

www.samhsa.gov

1-877-SAMHSA-7 (1-877-726-4727) ● 1-800-487-4889 (TDD)

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Erika R. Slaton

Associate Director, Outreach and Engagement

Military Community Support Programs

erika.r.slaton.civ@mail.mil

Increasing Behavioral Health Resources for Military and Veteran Children and Families

March 12, 2020

Melissa Comeau

Director

Military and Veteran Caregiver Network

American Red Cross

Military caregivers consistently experience worse health outcomes, greater strains in family relationships, and more workplace problems than non-caregivers.

Probable Major Depressive Disorder

38 % post-9/11 and 18.9% pre-9/11

Experience Anxiety

43.1% post-9/11 and 28.7% pre-9/11

https://www.rand.org/pubs/research_reports/RR499z1.html

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What Behavioral Health Challenges Do Military and Veteran Caregivers Face?

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Military and Veteran Caregiver Network

Military and Veteran Caregiver Network

To provide our nation’s military and veteran caregivers from all eras with peer support programs and services

to reduce their isolation and increase their connectedness, engagement, hopefulness, knowledge and skills.

• Reduce caregiver isolation

• Increase caregiver connectedness

• Increase caregiver engagement, hopefulness and

wellbeing

• Increase caregiver knowledge & skills

• Create a network of partner organizations

• Train peer mentors, facilitators & moderators

• Provide one-on-one peer mentoring and peer support

groups (online and community-based)

GOALS OBJECTIVES

OUTCOMES

Connection Engagement Knowledge Skills Hope

MISSION

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The Role of Caregiver Peer Support

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Barriers Impacting Caregivers Searching for Behavioral Health Support

“I don’t know where to go”.

“The services are only for the

Veteran”.

“I don’t want to impact my Service Member’s career”.

“There are no programs for Pre 9/11”.

“I don’t have time”. “We don’t have

the money”.

“ I don’t have any respite”. “There are no

Childcare options”.

“I don’t know what to expect”.

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Searching for Resources

• SAMHSA

• Department of Veterans Affairs Caregiver Support Line 1-855-260-3274

• Hero Care Network

• Cohen Veterans Clinics

• Give An Hour

• Operation Family Caregiver

• Military One Source

• Psych Armor

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Resources Often Recommended by Peers

• https://findtreatment.samhsa.gov/

• https://www.caregiver.va.gov/

• https://www.cohenveteransnetwork.org/

• https://giveanhour.org/

• https://www.operationfamilycaregiver.org/

• https://www.militaryonesource.mil/

• https://psycharmor.org/

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Links to Resources

SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.

www.samhsa.gov

1-877-SAMHSA-7 (1-877-726-4727) ● 1-800-487-4889 (TDD)

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Thank You

Melissa.Comeau@redcross.org

https://www.redcross.org/caregivers

Other Key Resources

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Children’s Health Insurance Program101

Division of State Coverage Programs

Children and Adults Health Programs Group

Center for Medicaid and CHIP Services

Where to go for Information on CHIP for Families

• CHIP coverage by state at https://www.insurekidsnow.gov/coverage/index.html

• Frequently Asked Questions at https://www.insurekidsnow.gov/coverage/questions/index.html

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Outreach and Enrollment Resources

• Connecting Kids to Coverage National Campaign– Raises awareness about Medicaid and CHIP and provides outreach

guides and toolkits that can be used to help states, community organizations, schools, health care providers and others organize and conduct successful outreach activities

– Radio and television public service announcements

– Check out www.insurekidsnow.gov for resources!

– Outreach and Enrollment Fundamentals https://www.insurekidsnow.gov/downloads/library/misc/outreach-and-enrollment-fundamentals.pdf

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SAMHSA’s SMVF TA Center E-Newsletter – “Topics in the News”• https://signup.e2ma.net/signup/1820873/1777480/

Military Family Research Institute – Resources and Research• https://www.mfri.purdue.edu/resources-and-research/resources/

VA Special Report on Women Veterans, 2015• https://www.va.gov/vetdata/docs/SpecialReports/Women_Veterans_2015_Final.pdf

SAMHSA’s SMVF TA Center Webinar “Key Transitions: Supporting the

Behavioral Health of Women Veterans”• https://www.youtube.com/watch?v=5UBWzXDQzLA

Children’s Health Insurance Program (CHIP)• www.insurekidsnow.gov

Medicaid or CHIP Enrollment• www.healthcare.gov

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Additional Resources:

Questions?

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Contact SAMHSA’s SMVF TA Center

345 Delaware Avenue

Delmar, NY 12054

Phone: 518-439-7415, ext. 5272

Email: smvftacenter@prainc.com

SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.

www.samhsa.gov

1-877-SAMHSA-7 (1-877-726-4727) ● 1-800-487-4889 (TDD)

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Thank You!