WARRIOR TRANSITION PROGRAM Mr David Burns Warrior Transition Office Office of the Surgeon General Army Medical Command 28 July 2008 Unclassified

Warrior in Transition Mission: “I am a Warrior in Transition. My job is to heal as I transition back to duty or become a productive, responsible citizen in society. This is not a status but a mission. I will succeed in this mission because I am Warrior. “ Army Strong!

Warrior Transition Background June 2003: Mobilized Reserve Component Soldiers Injured Soldiers returning and medevaced from Afghanistan (OEF) and Iraq (OIF) in greater numbers Soldiers who reported to MOB stations who were not medically deployable were kept at MOB stations to either fix and deploy or refer to Physical Disability Evaluation System (PDES) Soldiers demobing were able to stay on Active Duty for treatment of “In Line of Duty” conditions (medical conditions aggravated or incurred while mobilized) First Nurse Case Managers were mobilized to manage Reserve population June 2003- March 2004 Formal MHO structure, operations, organization and dedicated Command and Control established on Installations Each MHO Soldier assigned to a Nurse Case Manager Developed MHO Program operational standards

Warrior Transition Background March - April 2007 Congress asks Army to evaluate structure, care, systems, and process for all “Warriors in Transition” regardless of Compo or GWOT affiliation. Development of Warrior Transition Unit Staffing Ratios set for PCM, CM, PLT SGT, PEBLO, BH, etc. Same standard set for all Soldiers Ombudsman Program established at MTFs Significant changes made in the Army Physical Disability Evaluation System (PDES) Greater emphasis placed on training of the Cadre

Mission Essential Task List The WTU will… Provide Command and Control Provide Administrative Support Provide high quality, expert primary care and case management Provide coordination and synchronization of care, treatment and services through the Triad of care with the multidisciplinary team: Primary Care Manager, Case Manager, and Squad Leader Promote readiness of Soldier and family to transition back to the force or civilian life

WTU An Army Brigade, Battalion, or Company which provides command and control, administrative support, primary care and case management, coordination and synchronization of care, treatment and services through the Triad of care: Primary Care Manager, Nurse Case Manager, and Squad Leader, to promote readiness of Soldier and family to transition back to the force or civilian life.

Warrior Transition Unit Ft. Drum 566 Ft. Dix 259 Ft. Eustis 192 Ft. Carson 774 Ft. Riley 450 Ft. Leonard Wood 155 Ft. Lewis 761 Ft. Stewart 597 Ft. Benning 347 Ft. Jackson 83 Ft. Knox 330 Ft. Gordon 433 Ft. Campbell 762 Ft. Sam Houston 616 Ft. Polk 331 Ft. Sill 143 Ft. Hood 1332 Ft. Bliss 343 PR 88 Ft. Richardson 148 TAMC 261 West Point 63 CA 220 AR 233 AL 105 UT 137 MA 160 WI 217 FL 149 WTU CO - 20 WTU BDE - 1 CBHCO - 9 WTU BN - 14 POC: Dr. Michael J. Carino, OTSG, 7 July 2008 Ft. Irwin & Balboa 164 Ft. Wainwright 82 WRAMC 653 Ft Huachuca 51 Ft. Leavenworth 18 Ft. Belvoir 61 Ft. Lee 66 VA 197 Ft Meade 58 Redstone Arsenal 13 Ft Rucker 19 Landstuhl 230 Heidelberg 44 Bavaria 229 Current WT Population (assigned or attached to a WTU) is 12,879 Soldiers Ft. Bragg 718 Warrior Transition Unit Green balls on: Drum WRAMC Knox Bragg Gordon Benning Lvn Hood FSH TAMC Richardson Lewis Landstuhl/Hiedl/Wurzburg 7 7

WARRIOR TRANSITION POPULATION Method for Entry into WTU Current WT Population (10,866) by EVAC (BI, NBI, Disease) and NON-EVAC POC: Dr. Michael J. Carino, OTSG 17 March 2008 Evacuation Information verified using TRANSCOM Patient Movement Reports Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB) information verified using the Medical Evaluation Board Internal Tracking Tool (MEBITT) MEB/PEB numbers only reflect the number of Soldiers who were referred to the WTU for completion of their Board Process; Other Categories on the Pie Chart may include additional WT Soldiers in the MEB/PEB process who Entered the WTU for other reasons. Non Evac WT population may also be GWOT related, i.e. due to GWOT Mobilization, GWOT Demobilization, and AC medical conditions that are GWOT related but the Soldier wasn’t evacuated Out of Theater. View "Header and Footer" November 22, 2018

Staffing Ratios for Warrior Transition Units 1 Company for every 200 WT 1 Co Cdr and 1SG for every Company 1 XO for each company of at least 150 WT 1 PSG for every 36 WT 1 Squad Leader for every 12 WT 1 Nurse Case Manager for every 18 WT (MEDCEN) 1 Nurse Case Manager for every 36 WT (MEDDAC) 1 Human Resource Sergeant for every 200 WT 1 Social Worker (family therapist qualified) for every 100 WT (1 to 50 at WRAMC and BAMC) 3 Human Resource Specialists for every 200 WT 1 Finance Sergeant for every 200 WT

Staffing Ratios for Warrior Transition Units (cont.) 1 Supply Sergeant for every 200 WT 1 Supply Specialist for every 200 WT 1 Patient Administration Sergeant/Specialist for every 200 WT MEB Physician for every 200 Soldiers in MEB/PEB process 1 Primary Care Manager for every 200 WT 1 Training Specialist for every 200 WT 1 Occupational Therapist for every WT Brigade or Battalion 1 Occupational Therapy Technician/ Recreation Specialist for every 200 WT 1 PEBLO for every 30 Soldiers in MEB/PEB process Ombudsmen (Contract) are “earned” as follows: o >35 WTs – 200 WTs = 1 Ombudsman o 201 WTs – 400 WTs = 2 Ombudsmen o 401 WTs – 600 WTs = 3 Ombudsmen

Benefits of CBHCO Soldier returns to family, friends and community – helps the healing process Reintegration support while healing Continuity of civilian medical providers helps make medical transition seamless once Soldier is back on Reserve status Reduces stress and financial hardship of Soldier and family Unofficial Trial of duty while at CBHCO Opportunity for establishing link with VA during healing process Reserve Soldiers taking care of Reserve Soldiers Congressional and public grass roots support Social Worker assigned to each CBHCO to improve behavioral health capability

Community Based Health Care Organizations HQ Locations Alaska Wisconsin Washington Montana North Dakota Minnesota Maine VT Oregon Massachusetts South Dakota NH Idaho New York Wyoming Rhode Island Michigan Pennsylvania Connecticut Nevada Nebraska Iowa NJ Ohio Illinois California Indiana West Virginia Delaware Utah Colorado Kansas Missouri Kentucky North Carolina Maryland New Mexico Oklahoma Arkansas Tennessee Arizona Hawaii SC Virginia Texas MS Georgia Louisiana Florida Alabama CBHCO Locations Puerto Rico

Triad The Triad: PCM, Case Manager, and PLT SGT/SQD LDR collects Soldier data and information; analyzes data and information to produce a plan of care, treatment, and service specific to each Soldier’s needs. Primary Care Manager (Physician) Provides primary oversight and continuity of health care and ensures the level of care provided is of the highest quality. The relationship developed between patients and their PCM is the basis for successful prevention-oriented, coordinated health care. Patients reap benefits from consistent health care and improved overall health.

Triad cont’d Case Manager: Licensed healthcare professionals (registered nurses) that assess, plan, implement, coordinate, monitor, and evaluate options and services to meet Soldier’s health needs. Responsible for implementation of the Comprehensive Transition Plan (CTP) Squad Leader: NCO responsible for all that the squad does or fails to do. He is a tactical leader and, as such, leads by example. The squad leader works as part of the Triad providing for the care of the Warrior and his or her Family. Maintains accountability of his soldiers and equipment. Ensures the WT keeps all scheduled medical appointments. Inspects the condition of Soldiers' billeting, clothing, and equipment.

WTU ASSIGNMENT/ATTACHMENT CRITERIA Each Army MTF will maintain a warrior transition unit (WTU). Units will vary in size from small detachments to brigades, depending on patient population. A Warrior in Transition is any Soldier who requires significant medical intervention in order to heal and return to duty or to make a successful transition to veteran status. Assignment or attachment to a WTU will not be performed solely to facilitate the early requisitioning of replacement personnel or for purely compassionate reasons. Service members that do not meet the criteria of AR 40-400 will not be attached or assigned to a WTU. All Service members who present to the MTF for medical evaluation or treatment from off-installation locations and who will be present more than 24 hours will be required to report to the WTU for accountability and control purposes. For those Soldiers who are on medical TDY orders, the orders will specify that the Soldier is under the command and control of the WTU while at the MTF. All Service members in a TDRL status will report to the WTU upon arrival at the MTF.

WTU Assignment Criteria for Active Component Requires a temporary profile of more than 6 months duration. Treatment plan requires the Soldier to spend most of his/her time receiving and/or traveling to and from medical treatment. Requires an MEB and therefore requires a permanent profile with duty limitations that preclude the Soldier from contributing to the parent unit’s mission. Profile limitations preclude deployment (AR 40-501, chapter 5) within the next 60 days and the unit is scheduled to deploy within 60 days. Unit has no rear detachment. Rear detachment capabilities are insufficient to accommodate the Soldier’s physical limitations. Limitations prevent the Soldier from contributing to the rear detachment’s mission.

WTU Assignment Criteria for Reserve Component Soldier was mobilized on 10 USC 12302 orders in support of named operations and diverted from his/her normal mobilization mission or demobilization processing in order to receive medical treatment. Soldier is in need of medical evaluation, treatment, and disposition including definitive health care for an illness, injury, or disease incurred in the line of duty and/or for aggravation of a pre-existing medical condition incurred in the line of duty. The MTF commander must determine if a Soldier is not expected to RTD within 60 days from the time of injury or illness or if the Soldier could RTD within 60 days, but will have fewer than 120 days beyond the expected RTD date left on 10 USC 12302 partial mobilization order. In such a case, the Soldier will be converted from partial mobilization orders to medical retention processing (MRP) 12301(h) orders, subject to the Soldier’s consent in accordance with current personnel policy guidance (PPG). (2) As a general rule, a mobilized RC Soldier will remain on partial mobilization orders until the MTF commander determines that the Soldier will not be able to perform military duties in that status, or that the Soldier will not have sufficient days left on AD after the medical condition improves to permit RTD.

Data Systems in Support of WTU Warrior Transition Web Reporting Web-based data system used to track and monitor WT Soldiers Data input by CM (clinical info) and Admin Support Staff Demographics, general diagnostic categories, MEB/PEB Status Location of Assignment; WTU or CBHCO Case Manager Armed Forces Health Longitudinal Technology Application (AHLTA). Military Electronic Medical Record Joint Patient Tracking Application (JPTA) Web-based patient tracking and management tool that collects, manages, analyzes and reports data on patients arriving at medical treatment facilities (MTFs) from forward deployed locations

MANAGEMENT OF WOUNDED AND ILL FEDERAL RECOVERY COORDINATOR Oversight/Compliance Evacuation and Notification Evaluation Treatment Medical Evaluation Board MEB Physical Evaluation Board PEB Maintenance Support Rehab Transition COAD / COAR Separate / Retire Seamless Transition Clinical Management WTU Medical/Case Managers VA Case Management Veterans Health Admin (VHA) Benefits Management AW2 SFMS Life-time Tracking… SFAC Benefits & Services Veterans Benefits Admin (VBA) PEBLO Administration WTU Command & Control VA Out Reach Program