The Public Health Service Officer in the Department of Defense CDR Dennis Slate, PsyD Brooke Army Medical Center LCDR M. Victoria Ingram, PsyD, ABPP Womack Army Medical Center LCDR Rick Schobitz, PhD Brooke Army Medical Center * The comments expressed in this presentation reflect the opinion of the authors and not the Department of Defense, the medical treatment facilities above, or the U.S. Army

Objectives 1. Describe the clinical impact of officer credibility in the military behavioral health environment. 2. Describe the PHS/Army Psychology Internship and its role in recruiting and training psychologist to assist with the DoD mission. 3. Describe the efforts of PHS mental health officers in response to the shootings at Fort Hood. Essentially the FAQs regarding culture, training, and impact.

Press Release 2008 “U.S. Public Health Service (PHS) Commissioned Corps Officers to Augment Behavioral Health Services in Military Treatment Facilities (MTFs)” The Assistant Secretary of Defense (Health Affairs) and the Assistant Secretary for Health, Department of Health and Human Services (DHHS) sign a Memorandum of Agreement (MOA) to allow for the detailing through TRICARE Management Activity (TMA) of approximately 200 U.S. Public Health Service (PHS) behavioral health officers to Military Treatment Facilities (MTFs) within Continental United States (CONUS), Alaska and Hawaii.

Original Concept - Officers to be detailed to MTFs will come from both the ranks of the Commissioned Corps, as well as direct civilian accessions. It is anticipated that some of these civilian accessions will be former DoD uniformed providers. - Officers to be detailed in support of the Psychological Health mission will include psychiatrists, clinical psychologists, clinical social workers, and psychiatric nurses. Where possible, professionals who focus care in the area of Traumatic Brain Injury, including neurologists, nurses, speech pathologists, OT’s and PT’s may also be assigned.

Implementation June 2008 – First officer commissioned and assigned to DoD site (Fort Bragg, NC) under this initiative. May 2010 – Approximately 110 officers assigned to DoD across multiple sites. Officers from a variety of disciplines with a broad range of prior exposure/experience with the Department of Defense.

CULTURE & CREDIBILITY Military Customs and Courtesy Wear and Appearance of the Uniform Physical Fitness

CULTURE & CREDIBILITY The Enlisted Corps Differences Rank & Title Fraternization The Officer Company Grade vs. Field Grade Level of Responsibility Leadership

CULTURE & CREDIBILITY Deployment, Deployment Cycle and Support Awareness

CULTURE & ETHICS (& Law) Joint Ethics Regulation UCMJ Common Fallacies regarding inconsistencies with the “APA Ethical Principles and Code of Conduct”

CULTURE & ETHICS (& Law) Military specific behavioral health evaluations DoD 6490 – Command Directed Mental Health Eval Chapter MSE MSE for Drill Sergeant, Recruiter, other duty Sanity Board SERE, SFAS, MARSOC, etc Credentials AR Waivers

Requirements For All PHS Officers Detailed Thru the DoD- PHS PH/TBI Initiative  OBC required for all new accessions  In processing Supplemental instructions ̶ Administrative orientation with DoD Commissioned Corps liaison officer ̶ Supplemental instructions on military courtesy & protocol, uniform wear, & physical fitness  Orientation in providing PH & TBI care in military populations

Combined US Army/USPHS Psychology Postdoctoral Residency Brooke Army Medical Center Fort Sam Houston, TX

End State  Residents will be competent providers in the military health system and be prepared to provide services in garrison or when deployed  Residents will be competent Officers, prepared to lead, serve as clinic managers, oversee enlisted staff, and serve as consultants to Commanders

Rotations Training Sites  SAMMC, Fort Sam Houston – Warrior Clinic – Community Behavioral Health Service – Consultation & Liaison – Pain Clinic – Army Substance Abuse Program  External Rotation – Fort Hood, TX

Elements of Residency  Direct Patient Care  Management  Didactics  Weekly  VTC availability for remote rotation  Offer more specific military topics, in-depth knowledge about applying clinical skills to military population.  Organized thematically for enhanced skill development  Instruction from visiting experts in the field throughout year  Center for Deployment Psychology

Center for Deployment Psychology  Mission: Train mental health professionals to provide high quality deployment-related behavioral health services to military personnel and their families  Conduct courses at the Uniformed Services University, Bethesda, MD  Imbedded training personnel at MTF’s, including Brooke Army Medical Center

Fort Hood Response (PHS)  Social workers on site (3), Psychologists sent TDY from BAMC (2) and DECO (2)  Assigned to CRDAMC BH Operations Center and involved in direct clinical care  Services focused on families of deceased, “affected persons” (civilian and military) at SRC

Impact  Served in BH leadership planning and delivery of clinical services to families of deceased and “affected persons”  Completed Phase I of Fort Hood BH Operational Plan  PHS officers assisted with and participated in Phase II planning and completion (16-26 Feb 2010)

Questions? CDR Dennis Slate, PsyD Brooke Army Medical Center LCDR M. Victoria Ingram, PsyD, ABPP Womack Army Medical Center LCDR Rick Schobitz, PhD Brooke Army Medical Center