Washington – More than 700,000 children have had one or more parent deployed to the Iraq or Afghanistan theaters of operation, and recent studies indicate that those children suffer significant rates of behavioral and stress disorders, according to a recent White House report.
Now, the Army is attempting to bring behavioral programs closer to children by expanding its in-school programs, eventually including schools outside of military bases, officials said at a recent webinar held by DCoE.
“When you treat a child in a school, you know more about that child than what you would ever learn in a clinic,” said Michael Faran, MD, PhD, director of Army Medicine’s Child, Adolescent and Family Behavioral Health Office. “That is because you work with the teachers and other people who have daily contact with these individuals and with their families. This is a very provider- and patient-friendly environment.”
The toll that multiple deployments takes on the mental health of children has been an ongoing concern of the military and military families. The recent White House report cited a 2010 study that found an 11% increase in outpatient visits for behavioral health issues among a group of 3- to 8-year-old children of military parents and an increase of 18% in behavioral disorders and 19% in stress disorders when a parent was deployed.
The Army’s strategy is to offer comprehensive behavioral health services in key installation locations, such as schools, that are more accessible to families. “The purpose of this is to get behavioral health into the communities where families live,” said Faran.
Currently, the Army has school-behavioral health programs in 36 schools on seven installations and is “rapidly expanding” these programs to more areas, Faran said. In addition, the Army would like to expand these programs to schools off-post, since 60% to 70% of military children attend schools off post, he said.
School-Based Behavioral Health
One benefit of school-based behavioral health programs is that the “no-show rate” for appointments is much lower than clinic-based appointments, Faran explained.
“We are averaging now between 1% and 5% of no shows,” he said. “This is in contrast to clinic-based no-shows that run around 10% to 20% in the military treatment facilities and usually around 13% to 15% in civilian communities. What that means is that people come for services when it is located in a convenient place, like schools.”
Parents also report less time away from work when they attend the child’s appointment at school versus when the appointment is in a clinic away from school, Faran said. Seeing a counselor in a school setting also can decrease the stigma of mental health care, he said.
Staffing at the school-based programs includes psychiatrists, psychologists, social workers, administrative staff and sometimes nurse practitioners. The school programs emphasize behavioral health prevention, intervention, training and education on deployment issues for parents as well as school staff. The program is not only for students, but also families, since the program also offers family therapy at the schools.
An advisory panel, usually led by the principal, is established at each school where a behavioral health program is based, according to Faran, and the council determines how the program will be developed at the particular location. In addition, a triage team of health and school professionals at the school meets on a weekly basis to discuss the specific children and adolescents who are receiving behavioral health care and to develop treatment plans for them.
“We, as providers,when we go into a school, our goal is to become a part of that school so that we are true partners with the other professionals in the school in taking care of students,” said Faran.
The Army also has a five-day academy to train health professionals and school administrators on school behavioral health. “It is run by a team of people who have worked closely with other experts around the country in developing this curriculum,” Faran said. “We now believe we have a very good training program for teaching people school behavioral health.”
Academic Performance at Issue
Barbara Thompson, director of the Office of Family Policy/Children and Youth Military Community and Family Policy, said that the Military Family Life Counselor (MFLC) counseling program has also played an important role in helping children and their families. These licensed clinicians are nonmedical personnel deployed to Guard and Reserve events, installations and schools on and off military bases.
“What is great about it is that they go to where families and children are located. They don’t wait for families and children to go to them,” said Thompson. “That has provided a very convenient way for families to receive confidential, anonymous coaching to work out their issues. The great thing about them being licensed clinicians is that they know the red flags, and, as soon as it becomes a medical issue or a therapeutic issue, they know how to refer children and families to a higher level of intervention.”
Officials also said there is a need to know more about the academic performance of military children. Kathleen Facon, chief of Educational Partnerships for DoD Educational Activity, said that military children attend schools in more than 600 public school districts in 47 states and the District of Columbia. Currently academic achievement data is not collected on military children, so little is known about their performance and how it might be affected by parental deployment.
DOD has asked the Department of Education to collect and report data on the performance of military children as part of the reauthorization of the Elementary and Secondary Education Act, an act that establishes standards for schools nationally.
In 2008, the U.S. Food and Drug Administration issued an alert about increased risk for suicidal ideation and behavior for patients taking anti-epileptic drugs (AEDs).
In the year since the release of a RAND report critical of follow-up within the Military Health System (MHS) for patients with post-traumatic stress disorder (PTSD) and depression, the DoD has released results of several new programs to improve screening, increase the number of therapeutic visits and track mental health measures.