1. CIOR Summer Symposium Copenhagen – July 31, 2012 Post-Deployment and Re-Integration The Medical Aspects Affecting United States Army Reserve Soldiers Ambassador (Dr.) Stan Flemming United States Army Reserve

2. The United States Army Reserve Key Milestones Act of Congress – April 1908 ▫Established the first Army Reserves consisting of ONLY reserve medical officers The Army Appropriations Act of 1920 ▫Established the non-medical Army Reserves (Much like the Army Reserves of today) WWI - Nearly 200,000 members of the Army Reserve served in WWI. WWII - Over 200,000 of the 900,000 soldiers were Reserve soldiers. ▫62% of the Battalion level commanders were Reserve soldiers. ▫84% of Company commanders were Reserve soldiers. ▫30% of Platoon Leaders were Reserve soldiers ▫Nearly 50% of all soldiers Killed in Action were Reserve Soldiers. Korean War - Nearly 250,000 members of the Army Reserve served in the Korean War ▫Nearly 400 units were Reserve Vietnam War – About 10,000 members of the Army Reserve served in the Vietnam War ▫President Chose to use a Draft instead of calling up the Reserves. Persian Gulf War – Nearly 85,000 members of the Army Reserve served in the Persian Gulf War ▫Provided major support for medical operations, special operations, and logistical support. Global War on Terrorism/The Long War – Since 9/11, the Army Reserve has mobilized more than 200,000 Army Reserve Soldiers

3. The United States Army Reserve The Growing Role of the Army Reserve – Challenges and Opportunities In Theater As of 1 May 2012 MSC 37 KIAs 131 Non-Battle Deaths (NBDs) 72 Other Deaths (Pending) 0 Total Deaths (KIAs + NBDs+Others)203 WIAs 1,466 (47,167) MISSING /CAPTURED 0

4. The United States Army Reserve The Growing Role of the Army Reserve – Challenges and Opportunities Strategic Reserve vs. Operational Reserve : Following September 11, 2001: ▫Reserves transitioned from a Strategic Reserve to an Operational Reserve - Provides operational capabilities and strategic depth to meet U.S. defense requirements across the full spectrum of conflict to achieve a rapid force closure. -Participate in a full range of missions according to their services' force-generation plans. - Provides for an agile, flexible organizational structure that provides cohesive functional force packages when and where they are needed to achieve mission success. - Allows for flexibility with down-sizing the Active Force while sustaining current and future mission obligations in support of the national defense. - Reorganized structure to meet requirements of Force XXI (Future Army).

6. The United States Army Reserve The Growing Role of the Army Reserve – Challenges and Opportunities Stressors of Downsizing the Force & Increasing Deployments: ▫Increased demand for an integrated force ▫In 1991:  35% of the all Army forces comprised of Reserve component ▫In 2012:  54% to 70% of the all Army forces comprised of Reserve component depending on Theater of Operation  Nearly 47% of all combat service support assets are in the Army Reserve  Nearly 70% of all field medical support assets are in the Army Reserve ▫Increased frequency of deployments for Reserve component soldiers

7. The United States Army Reserve The Growing Role of the Army Reserve – Challenges and Opportunities Stressors of Downsizing the Force & Increasing Deployments: Increase in personnel deployment frequency ▫1950-1989: 10 major deployments ▫1990- Present: Over 30 major deployments  Contributing factors:  Increased geo-political considerations/requirements  The compression of time regarding number of deployments  Decreased size of force  Increased requirement to move combat power faster than ever before.  No change in the operational Global footprint of current missions  Increased Optempo of the Army  Result: Increasing pressure on the force  Structurally  Individually

8. The United States Army Reserve The Growing Role of the Army Reserve – Challenges and Opportunities Stressors affecting unit and individual soldier readiness & sustainability: ▫Affects on Individual Soldier s:  The human mind and body is not designed to function with repeated combat deployments without substantial time to recover.  It takes 24 to 36 months to fully recover from a one-year combat deployment - (According to recent studies)  Repeated deployments and down-sizing the force makes it difficult to achieve ideal dwell time between deployments.  Affects psychological functioning of the individual soldier.  Affects psychological functioning of soldier family members.  Affects psycho-social functioning of soldiers with peers, family, friends, and community  Goal:  1 year deployment with 2 years home station post-deployment.  Achieve goal for 70% of the force by 2011 (Goal not met) ▫Affects on Units:  Troop withdrawals in Iraq and Afghanistan will leave ~ 50,000 troops deployed to the war zone (Most of them in Afghanistan. )  The Army will continue to maintain unit deployments around the world  The Horn of Africa  The Philippines  Kosovo  Korea  Japan The plan requires an active force of at least 547,000 soldiers and ready access to the reserves ▫Active Army: 547,000 ▫National Guard: 358,000 ▫Army Reserve: 205,000 * These numbers do not reflect the new required down-sizing of the 2012 force

10. The United States Army Reserve Post-Deployment and Re-Integration Tools for the Military Leader ▫Mental Health Self-Assessment (MHSA) Program ▫Pre-Deployment Health Assessment ▫Post-Deployment Health Assessment ▫Family Readiness Groups ▫Family Assistant Program

11. The United States Army Reserve Post-Deployment and Re-Integration Tools for the Military Leader ▫Mental Health Self-Assessment (MHSA) Program ▫Pre-Deployment Health Assessment ▫Post-Deployment Health Assessment ▫Family Readiness Groups ▫Family Assistant Program

12. Post-Deployment and Re-Integration The United States Army Reserve Post-Deployment and Re-Integration The Medical Aspects Affecting United States Army Reserve Soldiers ▫Mental Health Self-Assessment (MHSA) Program  A voluntary program,  Anonymity is maintained  Offered to Military Families and Service Members  A self-directed mental health and alcohol screening and referral program  Available to military Families and service members affected by deployments and mobilizations.  Available online program available 24/7 in both English and Spanish.  Also available at special events held at military bases and Reserve units  * An additional assessment available for parents concerned about depression in adolescent children. ▫Purpose or Goal:  Enable an individual to screen his or her situation with regard to some of the more common mental health issues.  Does not Rather provide a diagnosis.  Assists in identifying any presence of symptoms consistent with a condition or concern that would benefit from further evaluation or treatment.  Provides guidance as to where one might seek assistance.

13. The United States Army Reserve Post-Deployment and Re-Integration Tools for the Military Leader ▫Mental Health Self-Assessment (MHSA) Program ▫Pre-Deployment Health Assessment ▫Post-Deployment Health Assessment ▫Family Readiness Groups ▫Family Assistant Program

14. The United States Army Reserve Prevention and Response Pre-Deployment Health Assessments (Pre- DHA) Provide counter-measures against potential health and environmental hazards Optimize protection for our troops A comprehensive health surveillance tool for servicemember affected by deployment Early intervention can reduce long-term negative health affects associated with deployments Improve the quality of life Completed within 30 days of deployment

15. The United States Army Reserve Prevention and Response Pre-Deployment Health Assessments (Pre- DHA) Completed within 30 days of deployment A tool to assist Commanders and soldiers with the opportunity to identify potential medical concerns prior to deployment Ensures issues are identified that may affect Soldier performance during deployment Provides a conduit to care for Soldiers if a referral is required. Provides a counter-measure against potential health and environmental hazards Optimize protection for our troops A comprehensive health surveillance tool for identifying servicemembers affected by deployment Early intervention can reduce long-term negative health affects associated with deployments Improve the quality of life

16. The United States Army Reserve Prevention and Response Form Completion Roles and Responsibilities Health Care Provider A health care provider (nurse, medical technician, medic, or corpsman) must review the form immediately after its completion Positive response to specific questions requires referral to an independent practitioner (physician, physician assistant, nurse practitioner, advanced practice nurse, independent duty corpsman, independent duty medical technician, or Special Forces medical sergeant) Independent practitioner performs interview/exam and determines deployability Form Sign-off and Processing Provider documents the evaluation and assists service member with any needed referrals Deploying person and health care provider sign the form Original form is maintained in deploying person’s permanent medical record Copy is placed in the person’s deployment health record (DD 2766) Data is sent electronically according to Service-specific guidance to the Defense Medical Surveillance System at the Armed Forces Health Surveillance Center http://afhsc.army.milhttp://afhsc.army.mil Follow-up and Ongoing Care Additional information on the Pre-Deployment Health Assessment process is available at: www.PDHealth.mil Upon re-deployment, all personnel who completed a DD 2795 must complete a Post-Deployment Health Assessment Form (DD 2796) and receive a face-to-face interview with a credentialed health care provider as part of the Post-Deployment Health Assessment process

18. The United States Army Reserve Post-Deployment and Re-Integration Tools for the Military Leader ▫Mental Health Self-Assessment (MHSA) Program ▫Pre-Deployment Health Assessment ▫Post-Deployment Health Assessment ▫Family Readiness Groups ▫Family Assistant Program

19. Post-Deployment and Re-Integration The United States Army Reserve Post-Deployment and Re-Integration The Medical Aspects Affecting United States Army Reserve Soldiers Post Deployment Affects: ▫Significant increase in Post Traumatic Stress Disorder (PTSD) ▫Significant rise in depression ▫Significant rise in suicide among Reserve and Active soldiers ▫Significant rise in divorce among Reserve and Active soldiers ▫Noticeable increase in homicide cases (usually affecting a family member) ▫Noticeable increase in Traumatic Brain Injuries (TBI) Estimated Cases: ▫PTSD: > 211,819 (In Veterans Medical Facilities – Actual numbers in Active/Reserve are unknown) ▫Depression: 9,000 new cases every three months ▫Suicide: 20.2 per 100,000 soldiers (In 2002, the army suicide rate was just 9.8 per 100,000.) ▫Divorce: > 20% post deployment ▫Homicide: 17 per 100,000 (overall national rate of around 27 per 100,000.) ▫TBI: > 200,000

20. 1,75 7 220 POST TRAUMATIC STRESS DISORDER Number of Newly Identified Cases, Army Deployed (OIF/OND/OEF Soldiers) and Non Deployed We expect the number of new cases in CY12 to be related to the number of exposed troop the number of deployments, and the overall exposure to combat. First Quarter CY12 trend suggest that CY12 will show a significant decrease in diagnosed PTSD Source: Office of the Surgeon General \ 703.681.3136 Last updated: 7 April 2012 UNCLASSIFIED NUMBER OF ARMY SOLDIERS WITH IDENTIFIED PTSD  PTSD case defined as either two (2) outpatient encounters on different days with ICD9 diagnostic code Of 309.81; OR inpatient encounter with ICD9 diagnostic code of 309.81. Incidence date is earliest encounter with diagnosis of PTSD (309.81).  Deployment to OEF/OND/OIF lasting longer than 30 days, beginning prior to incident PTSD diagnosis. ( 7 April )

21. POST TRAUMATIC STRESS DISORDER Number of Newly Identified Cases, Army OIF/OEF Soldiers

22. The United States Army Reserve Why the Post-DHA and Re-Assessment Baseline Post-deployment assessment performed within 30 days of return to the United States/Home Station Provides Commanders and Soldiers the opportunity to identify potential medical concerns within 90-180 days after redeployment Creates a mechanism by which issues may be identified that could affect soldiers in their daily life as a result of deployment prior to departing from the DEMOB (De-Mobilization) station Provides a conduit for soldiers to obtain necessary care Medical research has demonstrated that health concerns, particularly those involving mental health, were more frequently identified several months following the return from a deployment versus immediately post- deployment

23. Overview of DHAP Cycle

24. Post-Deployment Health Reassessment (PDHRA) AR TOTAL UNSCREENED SOLDIERS PREVIOUS WEEK’s COMPLIANCE % CURRENT AR COMPLIANCE % (Goal is 85%) 5,59650.74%50.72% *The above data represents DoD PDHRA Compliance based on the PDHA date. **The AR currently has the most opportunity for improvement in screening Soldiers within the DoD mandated window of 90-180 days post deployment. *** Minimum Compliance Standards are 85% for DoD and the Army. Aggregate 90-180 Day DoD Compliance Metrics for the Army Reserve Soldiers Currently Green (0-89) Entering Window1,901 Soldiers Soldiers Currently Amber (90-180) In the Window1,239 Soldiers Soldiers Currently Red (181+) Out of the Window2,456 Soldiers Total Unscreened Soldiers5,596 Soldiers As of: 18 JUN 12

25. Post-Deployment Health Reassessment (PDHRA) AR TOTAL REQUIREDPREVIOUS WEEK’s COMPLETION % CURRENT AR COMPLETION % (Goal is 100%) 68,49496.43%96.41% Only 50.72% of the screening assessments have been done within the mandated 90-180 window. **The above data represents Tier I (MEDPROS PDHRA Report)** **The below data represents Tier I & II (MEDPROS PDHRA Aggregate Report)** Army Aggregate Completion & Referral Metrics for AR * Minimum Compliance Standards are 85% for DoD and the Army. Soldiers Screened Soldier Referrals Behavioral Health Referrals Physical Health Referrals CY129,3584,402 (47.03%) 2,134 (22.80%) 4,289 (45.83%) Total Since Inception 109,66743,866 (40.00%) 14,799 (13.49%) 28,607 (26.09%) As of: 18 JUN 12

26. The DHAP demonstrates that the Army cares about its Soldiers and is a key component of Soldier medical readiness The DHAP program success requires Surgeons support and Commanders’ involvement at all levels. DHAP is a Commanders’ program Unit on-site events and Yellow Ribbon Program are the preferred modality for completion of the PDHRA screenings versus the call-center scheduled events are due to limited visibility of results. Success is greater with assisting Soldiers in getting access to care after completing the PDHRA assessment at the Yellow Ribbon Program Event 6 or unit on-site events

27. Benefits (CDRs & Leaders) Helps unit readiness by identifying and providing treatment for Soldiers’ physical and mental health concerns…reduces risk and increases deployability. Helps individual Soldier readiness by identifying Soldiers who need intervention and getting them expedited into the health care system Leverages the Soldier medical readiness system as a conduit to additional services. Provides Soldiers with quick access to health care resources. Demonstrates a commitment to the well-being of Soldiers and families.

28. The United States Army Reserve Post-Deployment and Re-Integration Tools for the Military Leader ▫Mental Health Self-Assessment (MHSA) Program ▫Pre-Deployment Health Assessment ▫Post-Deployment Health Assessment ▫Family Readiness Groups ▫Family Assistant Program

29. Post-Deployment and Re-Integration The United States Army Reserve Post-Deployment and Re-Integration Additional Support for Post-Deployed Soldiers Family Readiness Groups (FRG) ▫An organization of family members, volunteers, soldiers and civilian employees belonging to an Army command. ▫Provide support, assistance and a network of information among its members, the unit and community agencies. ▫FRGs consist of all assigned and attached soldiers, their spouses, children, extended families, fiancés, boyfriends or girlfriends and retirees. Even interested community members are welcome as well. ▫Gives a sense of belonging to the unit and the Army community—the Army family. ▫Assists members with accessing needed Army resources and share moral support during any unit deployments. ▫Keeps families informed of important information and events within the command. Family Advocacy Program (FAP) ▫Dedicated to the prevention, prompt reporting, intervention, and treatment of spouse and child abuse. ▫Assists commanders, soldiers and their families access services regarding crisis intervention, educational training for prevention of spouse and child abuse, workshops focusing on prevention of domestic violence, parent information and referral assistance. ▫Assures access to trained victim advocates who provide support, information, and referral resources to victims of family violence and sexual assault.

30. THANK YOU Amb. (Dr.) Stan Flemming stanflemming@hotmail.com