1. Current and Relevant Trends in Caring for the Behavioral Health Needs of the Connecticut National Guard
Michael Dutko MA, LPC, LADC
Susan Tobenkin LCSW

2. Mission
No soldier should ever feel alone. Our primary goal is to serve and advocate for service members of the Connecticut National Guard by providing support, case management resources, and referrals.
We also aim to improve unit readiness and the psychological health of the Connecticut National Guard through outreach, education, and resource development.
Every attempt will be made to ensure service members and their families are receiving the support they require. An important goal of the CTNH BH Team is helping service members develop life skills by enhancing protective factors that directly build resilience. Along with striving to eliminate stigmas associated with seeking help. 
The CTNG Behavioral Health Team will promote suicide prevention/postvention and awareness.
CT National Guard Behavioral Health Team

3. Behavioral Health Team
MAJ Javier Alvarado, LCSW State Behavioral Health Science Officer C: (860) Fax: (860) Susan Tobenkin LCSW, SCSA Behavioral Health Specialist C: (860) Fax: (860) Michael Dutko MA, LPC, LADC C: (860) Fax: (860) James G. Fox, LCSW C: (860) Fax: (860)
1LT Luigina Facchini
Admin. Support
O: C: Fax: (860)
SGT Harry Murray
O: C: Fax: (860)
Air Guard Director of Psychological Health
Mrs. Linda U. McEwen
Cell: , Office

4. The Connecticut National Guard
Current Strength CT National Guardsmen
Male / Female – 3,035 / 554
Average Age of CTARNG Soldier – 29
Age:
17 – 25: 1,487
26 – 35: 1,130
36 – 50: 789
51 > 183
Combat
Over 500 to deploy 2017
Over 5,000 SM’s deployed since 11 Sep 2001
Multiple Deployments (2-4)
Common issues
BH Issues / Adjustment
Financial stressors / Employment
Relationship - Family / Marital / Significant Others
Substance Use
Active Army vs. National Guard
The Connecticut National Guard

5. CTNG Deaths By Suicide AGE RANK SUICIDE DATE 23 SPC 8/12/14 26 1LT
6/4/14
PFC
5/2/13 22
4/20/13 21
12/25/12 29
SGT
7/14/12 18
PV1
12/8/11 27
7/21/11
SSG
7/1/11 47
SFC
5/18/11

6. Suicide Factors and Prevention
Mitigation Strategies:
Master Resilience Training
Emphasis on Yellow Ribbon Programs / DCS
RSP and Unit Leader Resilience Training Packages
RSP Resilience Training Program
Enhanced Accession Criteria / BH screening
Emphasis on Service Member and Family Sponsorship
Leader Stress Management Control Training
Review ARNG accession criteria / screening process
Collaborate employment with GSD-EDU, ESGR, USAR
Substance Abuse Prevention, Outreach & Treatment
Suicides General Factors:
Male
Age: (18-24 years old)
White
Single
PFC or SPC
5 Years of Service
More Likely M-day
Non-prior service
Not in-training
Combat MOS
Roughly two-thirds never deployed & one-third deployed

7. Behavioral Health Big 3 SUICIDE PREVENTION
Training (Suicide Prevention-Postvention-Intervention and Response) - Flank suicide prevention efforts – also address overall wellbeing - initiatives that focus on sleep, physical fitness etc.
BHT RESPONSE
Work with Command to prioritize early identification & intervention (maintain 100% assessment at PHA's for force fitness) - Emphasis on mobile and rapid crisis response by BH Team and COC. Promote command consultation & collaboration.
RESOURCE DEVELOPMENT:
Ongoing community outreach/partnership, development of CHPC, Fresh Check, CTSAB, In order to monitor and track the needs of Soldiers – Improve electronic data collection (Metrics – Enhance Outcome Data).

8. Periodic Health Assessments (PHA)
Required of every Service Member and is a preventative screening tool designed to improve reporting and visibility of Individual Medical Readiness for all soldiers
Soldier Readiness Process (SRP)
Consists of several different examinations, evaluations, and interviews to determine overall medical and deployment readiness
Post Deployment Health Assessment (PDHA)
Occurs upon redeployment and Behavioral Health Team will assess needs of Service Members to address integration issues and connect to providers in the community and provide appropriate support.
Tag Policy 24
SM’s who arrested or convicted of a crime will meet with CTNG Behavioral Health for an assessment. Goal is to provide support and identify needed resources.

9. Screening Tools: Behavioral Health Questionnaire (BHQ)
Utilized during the course of the PHA to help capture, assess, and screen unit support, trauma indicators, areas of concern, deployment history, and resource needs
Behavioral Health Assessments
Along with the BHQ these face to face interviews of 100 percent of the force are used as the springboard for discussions about personal details that help to assess the mental state of the individual SM’s
Patient Health Questionnaire (PHQ)
offers clinicians concise, self-administered screening and diagnostic tools for mental health disorders
Columbia Suicide Severity Rating Scale (C-SSRS)
Is a rating scale created by researchers at Columbia University to evaluate an individual's degree of suicidal ideation
Screening Tools:

10. Why Use the Columbia Suicide Severity Rating Scale:
One page quick screen
Three page in-depth assessment completed in minutes
Best Practice: Predictive and Easy to use by all community GATE Keepers, not just BH Professionals.
Intensity of Ideation and use of deterrents compared
Thresholds indicate NEXT STEPS
Reduces false positives and catches missed risk than other measures
NO COST
Why Use the Columbia Suicide Severity Rating Scale:

11. TOTAL CSSRS: 15,229

12. Preventative Maintenance Checks and Connecticut National Guard
Suicide Prevention
ASIST
Designed to teach leaders at all levels to identify those who may be at risk of suicide or suicide ideation. This gives Soldiers the opportunity to speak to someone trained in mentoring and fostering an environment of understanding.
PMCS
Focused on individual SM’s and building camaraderie through conversation. Primary goal is to proactively address the needs of our CTNG SM’s – “Take Action Before They Arise”. The program depends on leadership buy in and ongoing unit level implementation. PMCS is meant to be executed during downtime at drill.
BH Coin
Over the years many of our soldiers have gone above and beyond to care for each other ensuring their wellbeing. The coin is presented to soldiers, and distinguished community partners who serve and advocate for the needs of SM’s and their families.
PMCS
Preventative Maintenance Checks and
Services of
Service Members
2.0
Connecticut National Guard

13. Suicide Intervention Family Brochure
Brochure developed through collaborative efforts with the CT Suicide Advisory Board. Understanding is that SM’s spend 2 days a month with the Guard Family but spend a majority of their time with loved ones.
BH 24 hour Help Line
Unit Briefings
CCIRs

14. Suicide Postvention Postvention training
Teaches about memorial services , military and civilian resources and support, and how to provide an integrated response to a suicide death. Using nationally designated best practice protocols, didactic learning, discussion and interactive case scenarios, participants learn important steps for reducing risk of contagion and promote healing
Commander Talking Points
In the event that we experience a suicide, we want to ensure that we implement an integrated response to a suicide death that promotes healing and prevents further at risk behavior through a focused and direct message on safety and safe messaging.

15. COMMUNUITY RESOURCES WORK AND LIVE IN OUR COMMUNITIES
REQUIRE SERVICES CLOSE TO HOME/VA VET CNTR/CLINICIANS
Increase coordination of services.
Reduce redundancies
Partnerships Include:
Veteran’s Administration (VA)
Vet Center
Military informed Community Providers
CT Military Support Program (MSP)
CT Suicide Advisory Board
CTNG BH TEAM – FINAL RECOMMENDATIONS

16. Partnerships with Community Providers
Community Health Promotion Council (CHPC)
The Committee is comprised of NG, VA and Vet Center representatives, created to promote various internal/external programs that provide assistance to SM's and their families
Jordan Porco Foundation Fresh Check Events
Fresh Check Day is the signature program of The Jordan Porco Foundation (JPF). Fresh Check Day aims to create an approachable atmosphere where Service Members are encouraged to engage in dialogue about mental health, build a bridge between Service Members and the mental health resources and programs that exist in the CT National Guard, in the community, and on a national level.
CT Suicide Advisory Board
Zero Standard Learning Collaborative and Initiative
The Zero Suicide continuous quality improvement approach is founded in the belief that suicide deaths for individuals under care within health and behavioral health systems are preventable
Partnerships with Community Providers

17. Case Example Mitigation Strategies: SM’s Risk Factors:
Referred by peer
BH Assessment completed
Positive C-SSRS
Referred to and coordinated Inpatient Treatment
Collaboration with Treatment facility while SM was inpatient
Collaboration with Discharge Planning
Follow up services coordinated in community
BHT Case management
Communication with Unit
Goal of return to duty
SM’s Risk Factors:
Male
Age: 25
White
Single
SGT
5 Years of Service
M-day
Combat MOS
Deployed x1

18. Conclusion: Bottom Line, Up Front (BLUF)
The Way Forward
Leadership support of BH mission
Rapid and mobile response
Screening/Assessment
Community Resource Development
Case management
Data
Conclusion: Bottom Line, Up Front (BLUF)
Collaboration Communication Comradery Community Cohesion

19. “As a service member, you need to be open and honest when you share, and you need to listen when others share with you. You need to know that you’re never alone, that there is another way out- that is, a way to deal with your pain constructively, and even ways to fix it.” ~ SPC McDonald, (OIF Veteran, Ret.)

20. Questions?