Military Connected Children and Families:
Common Concerns and Shared Work
Martha Blue-Banning, Ph.D
Beach Center
Paul Ban, Ph. D.
Medical Command Joint Base Lewis Mc Cord
Joanne Cashman, Ed.D
IDEA Partnership
Let’s Find Out Who Is Here…
1.
2.
3.
4.
5.
6.
7.
8.
9.
Family member
Student
Educator
Service Provider
Military Family
member
Military-Active Duty
Military- Reserves
Military – Guard
Other
0%
0%
0%
0%
0%
0%
0%
0%
0%
1
2
3
4
5
6
7
8
9
In what primary setting do you interact
with military connected children?
1.
2.
3.
4.
5.
6.
7.
8.
Public School
DODEA School
Private School
Home School
Family Setting
Medical Setting
FMWR
Other…
0%
0%
0%
0%
0%
0%
0%
0%
1
2
3
4
5
6
7
8
Families as Systems
• Individuals cannot be understood in isolation
from one another.
• Families are systems of interconnected and
interdependent individuals, none of whom
can be understood in isolation from the
system.
http://www.genopro.com/genogram/family-systems-theory/
Sisyphus from Greek mythology –
has to continually start over
5
SYNTHESIS OF SIX MILITARY-RELATED REPORTS
ON NEEDS OF MILITARY FAMILIES
1.
2.
3.
4.
5.
6.
Strengthening Our Military Families: Meeting America’s Commitments (Presidential Report)
National Leadership Summit on Military Families: Final Report
Military Family Needs Assessment
Exceptional Family Member Program: Focus Groups Final Report
What Transitioning Military Families with Children who have Special Needs Currently Experience Phase I
What Transitioning Military Families with Children who have Special Needs Currently Experience Phase II
Beach Center on Disability, 2012
Beach
Beach Center on Disability, 2012
Family Support Framework
Cultural Competence
Family Strengths/Needs
• Emotional Well-Being
• Material Well-Being
• Health
• Family Interaction
• Parenting
• Disability-Related
Supports
Types of Resources
•
•
•
Information
Instrumental
Emotional
Provided via activities/
routines in natural settings
and via practices based on
an evidence-based practice
approach whereby the best
available research on “what
works” is integrated with
family and professional
wisdom and values.
Legislation, Policies, and Administrative Infrastructures
Sources of Resources
• Family members
• Friends
• Community resources
• Educational resources
• One-to-one peer support
• Parent groups/
organizations
• Community human
services
• Early intervention
services
• Disability specialists
Beach Center on
Disability, 2012
1
Beach
BeachCenter
Centeron
onDisability,
Disability,2012
2012
Family Support Framework
Cultural Competence
Family Strengths/Needs
• Emotional Well-Being
• Material Well-Being
• Health
• Family Interaction
• Parenting
• Disability-Related
Supports
Types of Resources
•
•
•
Information
Instrumental
Emotional
Provided via activities/
routines in natural settings
and via practices based on
an evidence-based practice
approach whereby the best
available research on “what
works” is integrated with
family and professional
wisdom and values.
Sources of Resources
• Family members
• Friends
• Community resources
• Educational resources
• One-to-one peer
support
• Parent groups/
organizations
• Community human
services
• Early intervention
services
• Disability specialists
Legislation, Policies, and Administrative Infrastructures
1
FAMILY SUPPORT
Jan. 26, 2011—Collaboration is at the heart of
the government’s new military family support
directive and is the key to supporting service
members and their families in the months and
years ahead, a Defense Department official said
today.
http://www.defense.gov/news/newsarticle.aspx?id=62593
Perceptions
In Europe, years ago, castles and homes were built
with a small enclosed room used for making bread.
Today, after generations of making bread in these
rooms, it is unnecessary to add yeast to the bread
dough. The yeast culture simply lives in the air and
leavens any dough that happens to be placed there.
Source: Janet Vohs in Cognitive Coping, Families, and Disability. Baltimore, MD: Paul H. Brookes Publishing
Perceptions
When sailors and explorers thought the world was
flat, they coped with that fact. That knowledge
structured everything about how sailors thought and
behaved. When word got out that the world was round,
this news caused a shift in behavior and in people’s
perceptions of what was possible. The world did not
change, but what was thought to be true about it
changed and people went about sailing their boats very
differently based on the fact that the world was round.
Source: Janet Vohs in Cognitive Coping, Families, and Disability. Baltimore, MD: Paul H. Brookes Publishing
To what extent do you agree that collaboration is at the heart of
support to military families in the months and years ahead
1.
2.
3.
4.
5.
Strongly Disagree, collaboration
is not the answer
Disagree, collaboration might
help but is not the answer
Neutral, collaboration could help
but I’m not sure
Agree, collaboration might help
us make better use what is
already available
Strongly Agree, collaboration
across the military, the families
and schools and the
communities is critical
0%
1
0%
0%
2
3
0%
0%
4
5
To what extent have you experienced effective
collaboration in your work or your services?
1.
2.
3.
4.
5.
Never, I have not experienced an
example of good collaboration
Rarely, I have experienced very
few examples of good
collaboration
Sometimes, once in a while I
have experienced things coming
together
Often, more often than not
things come together for me
Always, I expect and experience
good collaboration
0%
1
0%
0%
2
3
0%
0%
4
5
School-wide Integrated Framework
for Transformation
http://www.swiftschools.org
Child and Family Behavioral Health
Council for Exceptional Children
Paul Ban, Ph.D.
Child, Adolescent and Family Behavioral Health Office
United States Army Medical Command
05 April 2013
UNCLASSIFIED
DISCLAIMER
The opinions or assertions contained
herein are the private views of the authors
and are not to be construed as official or
reflecting the views of the Department of
the Army or the Department of Defense.
Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil
UNCLASSIFIED
Slide 2 of 20
05 April 2013
Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil
UNCLASSIFIED
Slide 3 of 20
05 April 2013
BEHAVIORAL HEALTH SYSTEM OF CARE
Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil
UNCLASSIFIED
Slide 4 of 20
05 April 2013
GOALS POPULATION BASED
MEDICAL/BEHAVIORAL PROGRAMS
• Child/Student Level, e.g., decreased absences, increased
grades, fewer behavior problems
• Family Level, e.g., increased cohesion and functioning,
decreased family violence, Soldier Readiness
• Community/School Level, e.g., decreased aggressive
incidents, improved climate, better overall performance
• System Level - Develop Resiliency and Unit Readiness
The Army Family is the deployable Unit!
Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil
UNCLASSIFIED
Slide 5 of 20
05 April 2013
To What Extent Do You Agree…
‘The military family is the deployable unit’
1.
2.
3.
4.
5.
Disagree
Somewhat disagree
Neutral
Agree
Strongly agree
0%
1
0%
0%
2
3
0%
0%
4
5
OUTREACH & PREVENTION
“Definitions of Promotion and Prevention Interventions,” National Research Council and Institute of Medicine of
the National Academics (2009). In: Preventing Mental, Emotional, and Behavioral Disorders Among Young People:
Progress and Possibilities.
Mental health promotion interventions (Definition): Usually targeted to the general public or a whole population.
Interventions aim to enhance individuals’ ability to achieve developmentally appropriate tasks (competence) and a
positive sense of self esteem, mastery, well-being, and social inclusion, and strengthen their ability to cope with
adversity.
Universal preventive interventions (Definition): Targeted to the general public or a whole population that has not
been identified on the basis of individual risk. The intervention is desirable for everyone in that group. Universal
interventions have advantages when their costs per individual are low, the intervention is effective and acceptable
to the population, and there is a low risk from the intervention.
Selective preventive interventions (Definition): Targeted to individuals or a population subgroup whose risk of
developing mental disorders is significantly higher than average. The risk may be imminent or it may be a lifetime
risk. Risk groups may be identified on the basis of biological, psychological, or social risk factors that are known to
be associated with the onset of a mental, emotional, or behavioral disorder. Selective interventions are most
appropriate if their cost is moderate and if the risk of negative effects is minimal or nonexistent.
Indicated preventive interventions (Definition): Targeted to high-risk individuals who are identified as having
minimal but detectable signs or symptoms foreshadowing mental, emotional, or behavioral disorder, or biological
markers indicating predisposition for such a disorder, but who do not meet diagnostic levels at the current time.
Indicated interventions might be reasonable even if intervention costs are high and even if the intervention entails
some risk.
Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil
UNCLASSIFIED
Slide 7 of 20
05 April 2013
CHILD AND FAMILY ASSISTANCE CENTERS
(CAFAC)
Integrate and provide direct Behavioral Health Support for Army Children and their Families
-- Provides range of direct care
-- A convenient “gateway” for Children & Families (C & F)
-- Manages the Child & Family System of Care for the Military Treatment
Facility
-- Serves as principal interface for other agencies providing services
(Installation Mngt. Command, local community)
CAFAC
Manages
Interface
Embedded C & F Beh.
Health Services (in
housing areas, Primary
Care, Medical Homes,
units, Child Devlpt.
Cntrs., Schools (SBH),
and others as desired
Interface
Civilian
Services in
the Local
Community
Installation
Management
Command
Services
(IMCOM)
Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil
UNCLASSIFIED
Slide 8 of 20
05 April 2013
CAFAC DEVELOPMENT:
PROBLEMS WITH THE PREVIOUS SYSTEM AT JOINT BASE LEWIS-McCHORD (JBLM)
• Difficult for providers and families to know where to get care
– Multiple points of entry
– Multiple phone numbers
• Overlap of services
• Duplication of effort
• Gaps/”white space” in services
• Lack of communication between disciplines
• Frequent changes in availability of services for adults
depending on the active duty mission.
Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil
UNCLASSIFIED
Slide 9 of 20
05 April 2013
In your experience,
which is the most frequent challenge…
1.
2.
3.
4.
5.
6.
7.
8.
Multiple points of entry
Multiple phone numbers
Overlap of services
Duplication of services
Gaps in services
Lack of communication between
services
Changes in availability of services
due to change in assignment
Other
12%
1
12%
2
12%
12%
12%
12%
3
4
5
6
12%
12%
7
8
CAFAC CLINICAL SERVICES
• Multidisciplinary Services
– Psychiatry, Nurse Practitioner, Psychologists, LCSWs,
Case Management
• Individual
• Family
• Couples/Marital
• Group
• Outreach & Prevention
Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil
UNCLASSIFIED
Slide 11 of 20
05 April 2013
EXAMPLES OF CAFAC OUTREACH & PREVENTION
•
Outreach efforts are tied to the Army’s deployment cycle
–
Community events:
•
•
•
•
•
•
–
Briefings:
•
•
•
–
Family Readiness Support Assistants training, units
Steering Committees
Community Speaking Engagements, Chaplain programs, Madigan staff
Partnerships:
•
•
•
–
Expectant/New Parents Health & Wellness Expo
Kids’ Fest, Military Family Nights
WA Military and Kids’ Summit (Tacoma)
Foster Care Partnership (Pierce County)
Parent University
WA State Children’s Justice Conference
Army Community Services: shared briefings
Collaboration with chaplains (Marriage & Family therapists workshops with chaplains)
Ongoing coordination with the installation during redeployment of 18,000 troops
Groups:
•
•
•
Relationship Workshops
Emotional Regulation
Trauma Focused Couples Therapy
Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil
UNCLASSIFIED
Slide 12 of 20
05 April 2013
SCHOOL BEHAVIORAL HEALTH (SBH) PROGRAMS
Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil
UNCLASSIFIED
Slide 13 of 20
05 April 2013
SBH CLINICAL SERVICES
• Partnership between Madigan Hospital, JBLM and Clover Park
School District
• Serves six post elementary schools; expanding “beyond the
gates”
• Embedded Behavioral Health:
– Licensed Child & Adolescent Psychiatrist
– Two Licensed Clinical Psychologists (Child and Adolescent
specialty; Pediatric Neuropsychologist)
– Six Licensed Clinical Social Workers
• One provider asset per school; works with existing resources
• Child Psychiatrist - mobilized
• Evidence Based Treatment
Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil
UNCLASSIFIED
Slide 14 of 20
05 April 2013
SBH CLINICAL SERVICES (2)
•
•
•
•
•
•
•
•
•
Psychiatric diagnosis / evaluation
Psychiatric medication evaluation and management
Psychiatric emergency evaluation
Individual and Family Therapy
Behavioral Health case management for SBH students
Psychoeducational and therapeutic groups
Prevention and wellness/resilience
“Curbside” consultation
Universal Emotional
Screening Pilot
Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil
UNCLASSIFIED
Slide 15 of 20
05 April 2013
To what extent does this model have the potential to
provide better service?
1. Little chance for change
2. May make some
improvement
3. Will have an positive impact
4. Will have a significant
positive impact
5. Will change the way things
are done for the better
0%
1
0%
0%
2
3
0%
0%
4
5
N
TIERED INTERVENTIO
SBH services capture
High-Risk students
(Tier 3)
Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil
UNCLASSIFIED
Slide 17 of 20
05 April 2013
TIERED
INTERVENTION(2)
…the “At-Risk” Students (Tier 2)
…and Promotes Prevention (Tier 1)
•
• Kids:
Groups:
– “Coping CAT” – Anxiety
– Social Skills
– Leadership-Positive Behavior
– Communication & Feelings
– “Buddy Lunches” & Mentoring Activities
(brigade basketball, Peer Mediators)
– Sibling Communication & Behavior
– Stress Management
– Anger Management
Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil
–
•
•
UNCLASSIFIED
Deployment Group (the effects of deployment
and reintegration)
– Understanding and Combating Bullies
– Transition Group (5th graders)
Parents:
– Parent-Child Play Group
– Common Sense Parenting; 1-2-3 Magic
– Parent Support Groups
Teachers/Providers:
– Child and Family Process Action Team; Health
and Resiliency Promotion Board
– “Copier Chat” – targeted information delivery
– Brown Bag Series – diagnostic and intervention
specific; “Ask a Doc”
– Health & Fitness – Walk/Run group; Crafting
– Participant in the WA State Autism Coalition
– Campaign of Kindness – “filling someone else’s
‘bucket’”
Slide 18 of 20
05 April 2013
CONTINUOUS FEEDBACK LOOP
Process Action Team
Advisory Group
Advisory Council
Consultation
•Shared Goals
•Sense of Community
Triage
•Increased Awareness/Education
•Support of School’s Needs
•Desire to Contribute (resources,
subject matter expertise, time, etc.)
Support of Military
Children and Families
Paul Ban Ph.D./ MCHO-CL-C (BHO) / (253) 968-4726 (DSN 782) / paul.ban@us.army.mil
UNCLASSIFIED
Slide 19 of 20
05 April 2013
JBLM COMMUNITY PROJECT
Facilitators
•ACS - Army Community Service
•CYSS - Child, Youth & School
Services
•CAFAC - Child, Adolescent and
Family Behavioral Health Office
•SBH - School Behavioral Health
•EFMP - Exceptional Family
Member Program
•JBLM Libraries
•Military OneSource
•USO
•FAP - Family Advocacy Program
•Madigan Army Medical Center
•Harborstone Credit Union
Slide 34 of
Slide 35 of
Real Opportunities for Collaboration
Are at the Intersection of People and Programs
• Common goals
• Common challenges
• Shared work
Nurturing Collaboration:
Content, Context, Contact and Communication
• Define the common interests
• Learn the individual
perspectives
• Identify the potential partners
• Do work together
• Build a relationship!
Where Are the Windows on Shared Work?
Ask:
• Who cares about this and why?
• What work in underway
separately?
• Where are the possibilities?
• What will we do together?
• What will we do in support of
each other?
• How will we each inform and
build support in our own
networks?
A New Framework
for Stakeholder Engagement
Leading
by
Convening
Ensuring Relevant
Participation
How Have We Organized to Collaborate ?
• National CoP
• State CoPs
• National Organizations
• Federally Funded Technical Assistance Centers
• Practice Groups on Issues (including one PG that specifically
connects our CoPs, the PG on Military Families)
The National Community of Practice (CoP) on
School Behavioral Health
• Co-led by the IDEA Partnership at NASDSE (funded by Office of Special
Education Programs) and the Center for School Mental Health at the
University of Maryland (funded by Health Resources and Services
Administration).
• The focus of this Community is to collaboratively work to create a shared
agenda across education, mental health and families.
• The National Community now affiliates cross-stakeholder teams that have
created 15 state CoPs modeled on the national exemplar.
• The Community affiliates 22 national organizations and 9 technical
assistance centers and coalesces them around the issues they share.
• Together the states, organizations and TA centers lead 12 issue-based
Practice Groups that develop the content and design the interaction for of
the National Conference on Advancing School Mental Health.
States in the Community
•
•
•
•
•
•
•
Hawaii
Missouri
North Carolina
South Dakota
Illinois
Montana
Ohio
• Utah
• Maryland
• New Hampshire
Pennsylvania
• West Virginia
Minnesota
• New Mexico
• South Carolina
Practice Groups
• Building a Collaborative Culture
• Learning the Language/Promoting Effective Ways for
Interdisciplinary Collaboration
• Connecting School Mental Health with Juvenile Justice and Dropout
Prevention
• Psychiatry and Schools
• Connecting School Mental Health and Positive Behavior Supports
• Quality and Evidence-Based Practice
• Education: An Essential Component of Systems of Care
• School Mental Health for Military Families
• Families in Partnership with Schools and Communities
• School Mental Health for Culturally Diverse
• Youth Improving School Mental Health for Youth with Disabilities
• Youth Involvement and Leadership
Beyond This Session…
• Share your views with each other and the CoP
• Become a member of the Military Families Practice
Group
• Become a leader in the Military Families Practice Group
• Suggest how the Practice Group can inform and build
support across our various networks
• Help us to create the opportunities to keep bringing
people together…in person and online.
• … and so much more!
o Go to www.sharedwork.org,
o Click on the Behavioral Health CoP on the front page.
o View public pages in Behavioral Health …or join the CoP !
Lets find out…
How likely are you to stay connected
and invite others to connect after this session?
1.
2.
3.
4.
5.
Unlikely
Somewhat unlikely
Undecided
Somewhat likely
Very likely
0%
1
0%
0%
2
3
0%
0%
4
5
Thanks very much for including us today…
We look forward to working
with you in the future!
Presenter Contact Information
Martha Blue-Banning
mbb@ku.edu
Paul Ban
paul.k.ban.civ@mail.mil
Joanne Cashman
joanne.cashman@nasdse.org