Staff Voices: Q & A on the Army’s Embedded Behavioral Health (EBH) program

Staff Voices: Q & A on the Army’s Embedded Behavioral Health (EBH) program

Here in the Pacific Region, I am aware of what appears to be taking place across the Army, a great commitment and rapid transition toward building Embedded Behavioral Health (EBH) teams.  I noticed Service Members were no longer blindly picking and choosing a mental health provider. Instead, there are now teams including psychologists, social workers, psychiatrists, and case managers assigned to a specific battalion, creating a more accessible pathway toward treatment.

Since we have seen the benefits of earlier embedded models, such as the Behavioral Health Consultant in Primary Care, it makes sense that perhaps the collaborative EBH team efforts may improve patient care as well as provider resiliency, with the responsibility to both the Service Member and Command. Since embedding providers appears to be a growing trend, I reached out to interview the expert in the field, CDR Beaulieu, to share her experience and knowledge on the efforts of the Army’s EBH.

Dr. Laura Cho-Stutler: Please introduce yourself and describe your role with Embedded Behavioral Health (EBH).

CDR Kay Beaulieu: I am CDR Kay Beaulieu, a psychologist in the Public Health Service.  I was the first team leader of the first Embedded Behavioral Health team in the Army at Ft. Carson.  My current role is the Clinical Director of Embedded Behavioral Health for the Army. My duties include: updating the EBH Operations Manual, working with AMEDD C&S for training about EBH, teaching classes for EBH Team Leaders, tracking monthly outcome measures, keeping the EBH Document site updated, and being available to answer questions about EBH from Team Leaders, Department Chiefs, MEDCOM, CDP…

LC-S: How did EBH begin and what are the goals of the program?

KB: By 2008 there had been conflicts in two theaters of operation resulting in a significant increase in demands for behavioral health care, particularly from Soldiers assigned to operational units.  In response to this increased demand, Evans Army Community Hospital at Fort Carson came under intense scrutiny following a rash of violent crimes, including 8 homicides perpetrated by Soldiers from units that had experienced heavy combat in theater.  National Public Radio and the Washington Post ran numerous negative stories regarding behavioral health care at Fort Carson which prompted the visit of several Senators and/or their aids to the post.  An Epidemiologic Consultation (EPICON) was generated which resulted in several recommendations regarding a model of care.

Evans Army Community Hospital’s Department of Behavioral Health developed a model of care that focused on the following goals which are the goals of EBH:

  1. Improving access to care
  2. Increasing the mission readiness of operational units/Brigade Combat Teams
  3. Identifying Soldiers with BH challenges as early as possible
  4. Increasing and improving communication between behavioral health professionals and operational unit leaders, and
  5. Serving as a clinical platform for quality care delivery

LC-S: How is it different from traditional outpatient behavioral health care in military settings?

KB: We are located within walking distance of the Soldiers’ place of duty. We are composed of teams of 13 people to include LCSWs, psychologists, psychiatrists or psychiatric nurse practitioners, a case manager, an LPN, two psych assistants and two front desk personnel. When fully staffed there is one Behavioral Health provider point of contact (POC), for each battalion in a combat brigade. Having one POC per battalion establishes relationships between the infantry leaders and the providers which helps decrease stigma. Once EBH has been established, the number of Soldiers able to deploy increases because Soldiers who will not be able to deploy are identified earlier in the deployment cycle.

LC-S:  What is the range of roles or "a day in the life" of an Embedded Behavioral Health provider?

KB: Every workday morning, EBH clinic personnel meet for 10 – 30 minutes to discuss events of interest that occurred since the last meeting to include Soldiers who were hospitalized, arrested or subject of a Serious Incident Report (SIR).  This is also when team and department information is disseminated.

For the rest of the day, the provider will see Soldiers for individual and/or group therapy.  The providers will also talk with 1SGs or company or battalion commanders either by phone or in person.  One day a week the provider will cover triage which means they will see Soldiers who come in for urgent issues or are discharged from a psychiatric inpatient facility either on or off post.

LC-S:  What are the benefits for Command and Service Members?

KB: For Command

  • Commanders have one point of contact for their behavioral health needs.  These needs can include evaluation for administrative discharge, command directed evaluations or having Soldiers who need to be seen on a same day basis because of some type of behavioral health crisis such as suicidal or homicidal thoughts or an event which triggers an urgent need for the Soldier to talk with someone.
  • Soldiers don’t have as far to go so they don’t miss as much work as they would if they had to go further for their appointment.
  • By having one POC command is able to get information about trends.  Some examples of trends include: a.) Several Soldiers report to the provider that a particular sergeant is identifying and bad-mouthing Soldiers who come to EBH; b.) Several Soldiers from the same company are hospitalized during the weekend thinking they will get an automatic honorable discharge from the Army; c.) Several Soldiers mention how great their company commander is.

For Soldiers

  • One of the benefits for Soldiers is they see the same provider (whenever possible) every time they come in.  The provider is aware of the tempo of their unit and has an understanding of significant events that have occurred in the unit while the unit was deployed or in garrison.  Soldiers receive multi-disciplinary care in one building.  A wide variety of services are located in the EBH building which is located in their footprint.  These services include individual and group therapy and psychotropic medication management.
  • If the Soldier needs to see someone on an urgent basis, every attempt is made to have the Soldier see their provider.  This continuity of care means the Soldier does not have to repeat their story over and over.  If the Soldier is of high interest, his/her situation will be known to all the providers on the team so if the Soldier has an urgent need to talk and their provider is not available, the other providers are aware of the Soldier’s treatment plan and background.

LC-S:  How does EBH improve Soldier readiness?

KB: By making dispositions (recommendations for administrative discharge or Medical Examination Board) earlier in the deployment cycle, when it is time to deploy there are fewer Soldiers who are not deployable because of a behavioral health reason.  A comparison of two brigades at Ft. Carson showed that a brigade with an EBH team prior to deployment had 10 Soldiers medically not ready to deploy for behavioral health reasons in comparison to 115 medically not ready to deploy for behavioral health reasons for a brigade that did not have an EBH team.

LC-S: How might this level of treatment impact the Soldier's families?

KB: The healthier the Soldier is, the healthier the family is.

LC-S:  How does EBH fit into BH care delivery at Ft Carson?

KB: EBH is part of behavioral health care delivery at Ft. Carson. In addition to EBHTs, BH care at Ft. Carson is comprised of strong connections with the Command, detailed orientated nurse case management, an intensive outpatient program, engaged Family Advocacy Program, and Child and Adolescent Family Assistant Center. We have a solid working relationship with Division BH assets and IMCOM Army Substance Abuse Program. Army Community Services assists as a force multiplier for the many needs that challenge our Soldiers. Ft. Carson is also unique in its "Connect Care" meetings that nurse case manage with our partners in the civilian community for inpatient psychiatric services.  EBH assists in this delivery of BH care and coordinating the care through the continuum of challenges for our Soldiers, their families and the myriad of biological, psychological and social problems threatening the readiness of our forces.

Thank you, CDR Beaulieu, for taking the time to answer my questions about the Embedded Behavioral Health (EBH) teams. This program not only helps to improve the access to care, the continuity of care and identify Soldiers with BH challenges, but also it appears to be reshaping the relationship between behavioral health providers, Soldiers, and Command. While providers have the ability to better understand their Service Members through the unique cultural history and challenges faced in each battalion, Service Members and Command can feel more comfortable with being involved in treatment knowing it is becoming a part of their routine toward a healthy mission readiness. I look forward to seeing the continuing evolution and success of EBH.

Dr. Laura Cho-Stutler is a Deployment Behavioral Health Psychologist at Tripler Army Medical Center, where she trains and supervises psychology interns and residents in providing services to active duty Service Members and their families.