1. 1 Apart from the war itself, we have no higher priority! For Official Use Only 12-11-08/1530JAM X Supporting Projects Programs Expand Access to Care Improve Quality of Care Support Transition Improve Screening & Surveillance Build Resilience Conduct Research Build a strong culture of Leadership & Advocacy Seven Strategic Goals Provide strong, visible leadership and necessary resources Create / disseminate / maintain excellent standards of care If best practices are unavailable, conduct pilot or demonstration projects to better inform quality standards Monitor and revise access, quality, and program implementation to ensure standards and consistent quality Build a system where each can expect and receive the same level of service and quality of Service, regardless of Service, Component, status, or geographic location TBI/PH Requirements Background Five Guiding Principles TBI/PH Program Requirements Task Force Documents Emerging Requirements Enduring Programs

2. 2 Apart from the war itself, we have no higher priority! For Official Use Only 12-11-08/1530JAM X Strategic Framework Mission: To create and sustain a TBI/PH continuum of care of the highest quality. PH Programs MH staffing model Staff MH personnel requirements Coordinated PH telemedicine system Establish and monitor MH access standards TBI Programs Staff TBI personnel requirements PH Programs Behavioral Health clinical practice guidelines Comprehensive PH training curriculum TBI Programs TBI clinical practice guidelines Comprehensive TBI training curriculum Coordinated TBI telemedicine system TBI definitions and coding guidelines PH Programs Resilience outreach Anti-stigma education Core PH curricula in all levels of leadership Core curriculum to train providers on responding to distressed service/family members MH providers integrated into primary care settings TBI Programs Leadership, Community, Family Education & Awareness PH Programs Surveillance systems Assess/ track prevalence and management of PH Capability to disseminate surveillance data within DoD/VA TBI Programs Surveillance systems Assess/track prevalence and management of TBI Capability to disseminate surveillance data within DoD/VA PH Programs Center of Excellence Outpatient programs with advanced diagnostics and reintegration services TBI Programs Case Management and Care coordination Center of Excellence Outpatient programs with advanced diagnostics & reintegration services PH Programs Epidemiological Studies Families/Caregivers Projects Neurobiology/ Genetics Etc. TBI Programs Treatment and Intervention Prevention Measures in Screening, Detection, and Diagnosis Etc. Intent/Outcome Timely access to comprehensive healthcare by providing staffing in areas to include outreach and prevention services, traditional MH care treatment, behavioral health in primary care, and inpatient care. Intent/Outcome World-class treatment for MH conditions, including PTSD and TBI through evidence-based practices, training in clinical practice guidelines, and providing the tools necessary for state-of- the-art care. Intent/Outcome Build mental strength through the warfighter’s daily framework by optimizing the ability of the individual, family, community, and unit/ organization to thrive and be productive despite adversity, trauma, and stress. Intent/Outcome Improve quality and effectiveness of treatment through transition, coordination, and management of care across the DoD, VA and civilian support networks as patients transition between providers and duty status. Intent/Outcome Promote the use of consistent/effective assessment practices and accelerated development of electronic tracking, monitoring and management of PH and TBI conditions. Intent/Outcome Establish a strong foundation of medical and cross-functional research, continuously improving program vision and capabilities. Leadership & Advocacy Access to Care Quality of Care Resilience Screening & Surveillance Transition of Care Research & Development

3. 3 Apart from the war itself, we have no higher priority! For Official Use Only 12-11-08/1530JAM X SOC Accomplishments Leadership and Advocacy DECEMBER 2008MAY 2007 No concentrated focus on PH/TBI issues DCoE established to provide leadership and expert guidance Conducted strategic summits to inform policies and programs National Center of Excellence, to be completed 2009

4. 4 Apart from the war itself, we have no higher priority! For Official Use Only 12-11-08/1530JAM X SOC Accomplishments Quality of Care DECEMBER 2008MAY 2007 TBI specific ICD-9 codes do not exist Submitted proposed revisions to ICD-9 codes for publication in 2009 (will enable better tracking; clinical management) No Clinical Practice Guidelines for mild TBI Published clinical guidance for management of mild TBI in deployed / non-deployed activities Decentralized and non-standard PTSD and TBI training Trained over 1,100 DoD/ network providers on evidence-based treatment for PTSD; and over 1,600 providers in evidence-based TBI

5. 5 Apart from the war itself, we have no higher priority! For Official Use Only 12-11-08/1530JAM X SOC Accomplishments Access to Care DECEMBER 2008MAY 2007 Access standard for initial MH appointment: 30 days Standard updated to a 7 days; increasing compliance at MTFs Psychological health staffing not standardized Interim staffing model developed 233 MH providers hired (full implementation validation underway) Negotiated agreement with DHHS to provide 200 Public Health Officers for MTFs No Psychological Health Telemedicine capability Initiated multiple telemedicine pilot programs to provide MH services to personnel and families, regardless of geographic location

6. 6 Apart from the war itself, we have no higher priority! For Official Use Only 12-11-08/1530JAM X SOC Accomplishments Transition of Care DECEMBER 2008MAY 2007 Case management and care coordinators for Wounded, Ill, and Injured Service members with TBI / MH conditions are not readily available Enhanced DVBIC Care Coordination for TBI Funded Case Managers / Care Coordinators for SMs with TBI/MH conditions

7. 7 Apart from the war itself, we have no higher priority! For Official Use Only 12-11-08/1530JAM X SOC Accomplishments Screening and Surveillance DECEMBER 2008MAY 2007 Inadequate process to assess or document deployment TBI concerns Added TBI questions to Post- Deployment Health Assessment and Reassessment forms No method for assessing or evaluating changes in neuro- cognitive function Implemented NCAT across the enterprise; over 140,000 to date No common definition of TBIPublished DoD TBI definition / reporting policy

8. 8 Apart from the war itself, we have no higher priority! For Official Use Only 12-11-08/1530JAM X SOC Accomplishments Resilience DECEMBER 2008MAY 2007 Aversion to seeking care for MH conditions Launched pro-resilience campaign Limited training for line leadershipCreated Service awareness and understanding, including leadership education and training Lack of child and adolescent PH programs Sponsored Sesame Street production for children of returning ill and injured

9. 9 Apart from the war itself, we have no higher priority! For Official Use Only 12-11-08/1530JAM X SOC Accomplishments Research DECEMBER 2008MAY 2007 Lack of evidence-based practices for resilience; gender- and ethnic- specific PTSD/TBI issues Funded numerous research programs to provide more understanding, and foundation for evidence-based practices