Targeted Care Pilot Program puts people first when it comes to mental, behavioral health resources

Story by Jean Graves

Medical Readiness Command, West

FORT JOHNSON, La. — Bayne-Jones Army Community Hospital was selected to participate in the Defense Health Agency Targeted Care Pilot program to connect service members with behavioral health resources and improve access to care for specialty mental health services. During a recent DHA site visit July 19-20, the behavioral health staff, program, and pilot were evaluated at the Joint Readiness Training Center and Fort Johnson, Louisiana.

J.C. Sarver, program manager for outpatient behavioral health from the DHA clinical management team, spent two days with the installation director of psychological health along with the military and civilian behavioral health staff at BJACH.

Sarver said his team is responsible for the execution and implementation of DHA behavioral health policies. He spent some time discussing the goals of the Targeted Care pilot with public affairs to help educate the community.

Q: What is your primary job at DHA and why are you here this week?

A: My role as the outpatient behavioral health program manager is to guide, define and create policy that impacts outpatient services. This includes embedded, multi-disciplinary and primary care behavioral health, as well as intensive outpatient programs. My colleagues and I work with the behavioral health clinical community to identify and make recommendations based on best practices.

Q: What is the role of the installation director of psychological health?

A: The IDPH’s role at the installation level is to integrate all mental health and prevention resources to better serve Soldiers and their Families. Lt. Col. Alexander Ragan is the IDPH here, he is responsible for the psychological health of the installation and charged with coordinating the spectrum of care across the installation. Having a person like Ragan in this role gives senior commanders a better understanding of the mental health resources available for their unit personnel, as well as for transitioning individuals and patients to the resources that best suit their situation or needs. This puts people first and directs them to the right care at the appropriate time. Empirical data suggests the earlier and sooner a person gets the help they need, the better the outcome. Ragan helps integrate all the resources on Fort Johnson and works diligently to communicate the availability of specific services to those who will benefit from them the most.

Q: What exactly is the Targeted Care pilot?

A: Targeted Care matches individuals seeking care to the appropriate support. Examples of support include making an appointment with a specialty behavioral health care provider or a primary care behavioral health consultant, or connecting them to non-medical support such as Military and Family Life Counselors, chaplains, Military OneSource, etc.
Targeted Care is essentially a workflow process within outpatient behavioral health. The Air Force created the Targeted Care concept, and it was successful, now we are trying to implement their success at Army and Navy medical treatment facilities. All MTFs in this pilot program volunteered to participate following a DHA-sponsored behavioral health summit in December 2022. The summit included all service branches, components of military and family programs, and chaplains, TRICARE, and other DHA entities including senior executives.

Targeted Care is about getting active-duty service members and their Families the right care at the right time by incorporating outside agencies into our system of behavioral healthcare. Integrating these external resources allow us to more appropriately and efficiently provide a system of care tailored to the needs of everyone.

Q: Why is Targeted Care important?

A: Typical behavioral healthcare for most individuals is four to six visits. By vectoring people to appropriate non-clinical behavioral healthcare, we have created opportunities for patients to be seen in a more evidence-based and therapeutic way. What this means is that they can now be seen every two weeks versus every four weeks. Through this program we are better able to match a beneficiary’s stress or distress level with the appropriate resources and provide them with the best care for their needs.

Q: What is vectoring?

A: Vectoring is a preliminary assessment to match an individual’s needs with the right resource. Individuals can call or visit a specialty behavioral health clinic, and a behavioral health specialist will ask them to complete a vector assessment questionnaire that will evaluate the person from a risk and safety perspective. This helps determine if the person is in crises. If they are not, the technician will identify their presenting conditions and, along with a provider, determine if they are appropriate for other counseling or non-counseling resources, or if they need specialty behavioral health services. If the assessment shows an external resource is most appropriate, a warm hand off will be conducted. The technician will make a connection to the right resource and facilitate an appointment for the individual.

Q: Why is it important to evaluate the Targeted Care Pilot Program?

A: Seeing and understanding the challenges and barriers that are faced at the MTF level and consolidating best practices is important. This visit to BJACH and Fort Johnson gives me the opportunity to talk to the behavioral health specialists who are on the frontline when it comes to targeted care. They are helping to shape what Target Care should look like for DHA. One of the reasons I wanted to come to Fort Johnson was because of the great job they are doing with the vector assessment tool. We will never refuse patient care. If an individual refuses to be vectored, they can still be seen in the specialty behavioral health clinic. However, vectoring can help a person get the right kind of help sooner if they take advantage of the vector assessment process.

Q: Why is Targeted Care important?

A: Targeted Care allows providers to more efficiently use existing behavioral health resources to meet current demands. Through coordination and consolidation of installation resources, access to care will improve and wait times for initial and follow-up visits will decrease. The result is increased readiness. On average, there are six to 12 walk-ins daily at the specialty care clinic. By vectoring people to other appropriate resources more efficiently, the behavioral health staff will have more time to focus on individuals who truly need medical intervention.

Q: What is the goal of the Targeted Care program?

A: Ultimately, we want our patients to have the tools necessary to successfully deal with whatever is causing the person to seek out behavioral health resources. The end state goal of the Targeted Care Program is a tool to inform and educate individuals about what behavioral health resources are available on the installation for their specific needs, what the scope of care is for each external resource and to refer individuals appropriately along that continuum. This will enable us to optimize specialty behavioral health clinics.

Q: How would you rate your evaluation of the Targeted Care Pilot Program here?

A: During my interactions with the staff and the various behavioral health services here at Fort Johnson, I’ve gained valuable feedback that will help us improve the implementation and sustainment instructions for the program after we conclude the pilots at all the Army and Navy installations. So far, Fort Johnson is one of our best pilot programs, and the lessons learned here will benefit other MTFs moving forward.