As a continuation of last week's blog about readiness assessments, we now attempt to answer questions about the civilian providers' role within these assessments. For example, do civilian providers need to make a readiness determination? What does it mean if a civilian provider does make a readiness determination? What if a civilian provider doesn’t want to provide readiness feedback?!
These are all great questions! The biggest expectation of providers in the community is that they conduct good, ethical, effective care for service members. There is no expectation that network providers would be making decisions on readiness. However, there are times when a service member may get flagged in the system, necessitating a readiness assessment. These flags may be due to a pending large-scale training exercise, a deployment, or the service member themselves endorsing behavioral health symptoms at their yearly physical. At these times, a military provider should reach out to the service member, and let them know that they are flagged, requiring a behavioral health evaluation to determine their individual readiness status (no duty limitations vs duty limitations). If this is the case, the service member and the evaluator will likely want to hear from you, the network behavioral health provider, to hear your perspective as it relates to the client’s case (such as the service member’s stability, prognosis, and ongoing treatment needs). You may be wondering what this process looks like and if it is ethical and/or legal for you to communicate your patient’s healthcare status. Before discussing a step by step plan, it is important to discuss HIPAA compliance. There is a military clause under HIPAA that permits communications on certain topics with a service member’s command team. It does not necessitate disclosure and its incredibly important to verify to whom the information is disclosed, in order to protect the patient. Please check out the resources below to learn more about this clause. Now, here are some definitive steps on how to respond when someone wants to hear from you about your service member patient.
1. Talk to the service member. What event initiated this request? Is there a pending training exercise? Is there an upcoming deployment? Is the assessment due to a profile that was initiated after a yearly physical? The implications are different depending on what is the cause of this recent request for information.
2. How does the service member feel about this initiating event? It is good to know the concerns for the service member, their motivations, and thoughts. While this is not the only consideration to be used in determining readiness, it is important to know.
a. If it’s a field exercise, do they want to go? Do they feel ready to go? Do they have the coping skills to be effective during this exercise? Do they have the resources they need? Do we expect their symptoms to worsen if they are in an extended training event? How long will this event be? How do they see themselves coping?
b. If it’s a pending deployment, the same questions above apply. This time though, think about a longer timeline (e.g., 3-9 months) and how it impacts all of the above questions.
c. If they have a profile that was initiated after a physical, what does the service member think of the profile? Do they want it? Do they want to stay in the military? Do they think they cannot sustain and want out? Are they bothered by the thought of having a profile?
3. Who is the information going to? Do they want it to go to a medical provider, a nurse, a case manager or do they want it to go to command, or all of the above?
4. What information does the patient want released? What information does the patient not want to be released? How do they want it released? Do they want to be present in the room during conversations when you release information or do they want a copy of what is being released?
5. What potential repercussions does the service member anticipate from the release of this information? Patients do not always have an accurate read on this! Sometimes they do, and sometimes they do not because this is a complex process. Communicating with military providers can really help service members achieve their military goals. Occasionally, service members are kept on duty limitations because it is unclear the status of their treatment progress from their network provider; consistent communication can help alleviate any treatment questions. Finally, it could be beneficial to consult someone familiar with the military system if there are any outstanding questions. Find a military specialist to contact.
6. Finally, how do YOU as the provider feel about releasing information? If you are not comfortable, releasing the bare minimum required, a treatment summary or just your notes is sufficient and a step in the right direction for establishing what the next steps for your patient will be. Also, there are many people you can consult with, generally speaking, to help you gain more comfort in working with military personnel.
7. When you are ready to release information, ensure that you have a signed release from the service member!
Once a Network Provider has been able to communicate the current status of their patient in terms of diagnosis, stability, and risk, a provider within the DoD will then most likely meet with that patient and help determine that service members’ readiness, ie, the need for any duty limitations. This is a complex evaluation that considers a variety of issues and information, as well as regulations and policies.
Again, providing ethical, effective care is the most important consideration when working with military members. We are lucky to have providers in the community helping our military personnel every day! If someone from the military ever reaches out about one of your patients, following these guidelines is an effective way to steer you and your patient in the right direction.
Health.mil: Military Command Exception
Look for upcoming webinar through the CDP-P on Wednesday, July 9th.
Title: Assessing Readiness for Service Members Receiving Private-Sector Behavioral Health Care: Insights from a Recent RAND Report
Presenters: Jessica Sousa, MPH, MSW and Kimberly Hepner, Ph.D.
For Questions about this blog please reach out to: cdp-tpr-ggg@usuhs.edu
Click here for Part 1: "What is Readiness and Why is it So Important?"
Click here for Part 2: "Overview of Military Readiness Assessments"
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Amanda McCabe, Psy.D., is a Military Behavioral Health Psychologist with the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In this capacity, she develops and delivers training on a variety of evidence-based therapies. Prior to the CDP, Dr. McCabe served as a clinical psychologist in the Army from 2013 to 2024.