Interview with Ranilo Laygo, Ph.D., Chief of the Fusion Cell at Tripler Army Medical Center.
In a current pilot program, behavioral health providers and Commanders more effectively achieve their common goals of supporting Service Members’ behavioral health and Unit Readiness through what has been called Fusion Cell. With a growing awareness to the stressors Service Members face related to deployment, this significant collaboration may be a necessary step to improving the identification and intervention of our at-risk Service Members. Here is an interview with Dr. Laygo to tell us more about how the role of the Fusion Cell and how it stands to improve our support to deployed Service Members.
Q: What is a Fusion Cell?
A: A Fusion Cell (FC) can be defined as the co-location of specialized personnel (e.g., subject matter experts, analysts, etc.) representing various agencies and disciplines that share resources and synthesize information to identify Soldiers at-risk for behavioral health (BH) issues.
Q: What is the purpose of the Fusion Cell?
A: The FC’s mission is, "To transform data from disparate sources into “actionable intelligence” and appropriately communicate this intelligence to Commanders, Unit Health Care Providers, and Military Treatment Facility (MTF) personnel to provide early Soldier intervention that optimizes Unit Readiness."
The FC accomplishes this mission by aggregating Soldier data from existing sources that lie across different operational boundaries (e.g., Command, MTF, and Garrison) and transforming it into useable and timely actionable intelligence. This intelligence is shared with Commanders, Unit Health Care Providers, and MTF personnel who use it to identify their at-risk Soldiers. Once a Soldier is identified, Command and/or behavioral health (BH) personnel can intervene in a timely manner and offer the appropriate BH care services, if needed.
The actionable intelligence mentioned above is shared in two ways: First, FC produces a number of reports for Commanders, Unit Healthcare Providers, and MTF personnel. The content and timing of these reports vary depending upon the recipient’s role in supporting the Soldier’s BH. Second, the FC Intervention Team Coordinator conducts monthly, Battalion-level Collaboration Meetings with Battalion and Company Commanders, Unit Healthcare Providers and MTF personnel. At these meetings, participants discuss, plan for, track, and coordinate an optimal intervention for their at-risk Soldiers.
Q: What stage of development is the Fusion Cell currently in?
A: As a Medical Command (MEDCOM) pilot program, FC was tasked with providing services to Soldiers assigned to 25th Infantry Division, 8th Theater Sustainment Command, 516th Signal Brigade, 500th Military Intelligence Brigade, Tripler Army Medical Center’s (TAMC) Troop Command and United States Army Pacific (USARPAC) HHBN. FC is currently engaged with all Units.
Q: What role does the Fusion Cell play in addressing the behavioral health issues of deployed service members?
A: FC supports deployed Soldiers in two ways. First, deployed Soldiers’ BH concerns are addressed during monthly FC Collaboration Meetings with Rear-Detachment. In some cases, the Unit’s Behavioral Health Officer (BHO) joins the Collaboration Meeting from theater via teleconference. There is also an open dialogue regarding Soldiers en route or newly returned from theater for BH and/or family reasons in order to create a care plan and determine support needs.
Second, FC supports Soldiers during the redeployment process. To assist with the BH screening of redeploying Soldiers, FC sends the deployed BHO or Brigade Surgeon a data base containing risk information on the Soldiers in their Unit. The data base includes information on nine indicators, augmenting the information the BHO or Brigade Surgeon has from Commanders.The additional FC data allows for a more thorough screening of Soldiers down range.
FC also creates reports on Soldiers at-risk for BH issues and delivers them to Reverse Soldier Readiness Process (R-SRP) Providers prior to the Soldier’s arrival. These reports contain information on nine different risk factors the Soldier may have experienced in the past several years (e.g., BH admissions, Open FAP case, prescriptions for psychotropic medications, etc.). These reports give the R-SRP Providers a comprehensive picture of the risk factors present for the Soldier which allows for more effective treatment planning.
Q: Suicide among service members has recently been called the military’s “most insidious enemy” by Time Magazine. How is the Fusion Cell supporting the Army to effectively attend to this issue?
A: The sharp rise in the Army’s suicide rates between the years of 2005 and 2009 was one of the reasons why FC was created. FC addresses this important issue in several ways. Research has shown that an accumulation of stressors often precedes adverse events such suicide. This is why the data aggregation described above is so important. By aggregating Soldier risk data across several sources and summarizing it in a usable fashion, FC gives Commanders and Providers a more comprehensive assessment of a Soldier’s total, accumulated risk. Armed with this data, Commanders and Providers can identify at-risk Soldiers earlier and intervene before more serious adverse events occur. On the treatment side, FC immediately notifies the appropriate BHOs and Nurse Case Managers if an adverse event occurs involving suicide-related behavior (e.g., suicidal ideation). This notification allows Providers to follow up immediately with the Soldier and/or their Command if necessary. Finally, long-term goals of FC is to identity reliable predictors of adverse events and use them to develop mathematical models that predict which Soldiers are at-risk for negative outcomes.
Q: From your findings, are there recommendations that you can offer to behavioral health providers?
A: FC refrains from making general recommendations to BH care providers. Instead, we provide them with as much data as possible so they can make better-informed decisions about Soldiers care.
Q: What is the future of Fusion Cell?
A: Short-term goals include expanding services to cover Active Duty Soldiers in Japan and Korea, effectively becoming the FC for the Pacific Regional Medical Command, and partnering with the Embedded Behavioral Health teams being stood up at Schofield Barracks. The long term goal is to replicate FC throughout the remaining regions in the Enterprise. End interview.
In closing, it appears that Fusion Cell is creating a much needed partnership between Commanders and BH providers to improve the care of Service Members. The efforts of Fusion Cell, in combining information from multiple sources, identifying the specific stressors and at-risk Service Members, and enabling Commanders and Medical personnel to be more aware of these issues, may also be serving to reduce the stigma that Service Members face in obtaining BH treatment. While this is a pilot program in the Pacific, we look forward to how this might be expanded in other areas to further inform BH treatment and recommendations.