Return to Duty Practices of Army Behavioral Health Providers in Garrison

• Published in: Military medicine 2018-11, Vol.183 (11-12), p.e617-e623
• Main Authors: Crouch, Coleen, Curley, Justin M, Carreno, Jamie T, Wilk, Joshua E
• Format: Article
• Language: English
• Subjects: Armed forces; Clinical decision making; Decision making; Documentation; Focus groups; Military personnel; Military readiness; Public health; Surgeons General
• ISSN: 0026-4075; 1930-613X
• DOI: 10.1093/milmed/usy103

While combat readiness is a top priority for the U.S. Army, there is concern that behavioral health (BH) return to duty (RTD) practices may under-represent the number of soldiers available for deployment. Profiling, the official administrative process by which medical duty limitations are communicated to commanders, was recently found to be significantly under-reporting BH readiness levels in one Army Division. This is a safety issue in addition to a readiness problem, and underscores the importance of better understanding RTD practices in order to offer solutions. This study sought to categorize the information and tools used by Army BH providers in garrison to make decisions about duty limitations that can affect BH readiness. A qualitative approach was used for this study. Fourteen semi-structured interviews and three focus groups were conducted with a diverse convenience sample of Army BH providers in October 2015, resulting in input from 29 practitioners. Through thematic analysis, it was discovered that profile decisions are driven first by safety of the soldier and secondarily by the needs of the unit. To facilitate their clinical decision-making, providers consider an array of data including standardized scales, unit mission, consultation with unit leadership, meetings with other providers, and, when appropriate, discussion with the friends and family of the soldier. If the military is to address the concern of under-reporting behavioral health readiness levels in garrison, it is critical to develop more predictability in treatment planning and reporting, as well as access to necessary data to make these clinical decisions. The interviews and focus groups revealed that while the technical process for initiating a profile does not vary, there is great disparity about the amount and type of information that is taken into consideration when making profile decisions. Categorization of the information that supports RTD decisions can lead to a better understanding of the process and inform leadership about ways to improve the accuracy of BH readiness reporting.