Assessing Readiness in Service Members Who Receive Private-Sector Behavioral Health Care

Table of Contents

• Assessing Readiness in Service Members Who Receive Private-Sector Behavioral Health Care 1
• About This Report 3
• RAND National Security Research Division 3
• Acknowledgments 4
• Summary 5
• Research Approach 6
• Key Findings 6
• The Military Health System Has Increased Its Reliance on Private- Sector Providers to Deliver Outpatient Behavioral Health Care to Service Members 6
• Readiness Assessments Are Not Adequately Captured in the Medical Record but One-Third of Service Members Initiating Private-Sector Care Received Concurrent Direct Behavioral Health Care 7
• Staff Member Approaches to Readiness Assessment for Service Members Receiving Private-Sector Behavioral Health Care Varied Substantially 8
• Staff Recommended Improving Access to Documentation of Private- Sector Behavioral Health Care 8
• Recommendations 9
• Recommendation 1. Ensure Adequate Staff to Provide Military Behavioral Health Care to Service Members and Readiness Assessment for Those Seen in Private-Sector Care 9
• Recommendation 2. Clarify Minimum Requirements for Tracking and Monitoring the Readiness of Service Members Who Receive Private- Sector Behavioral Health Care 10
• Recommendation 3. Identify Mechanisms to Improve Private- Sector Behavioral Health Providers Information-Sharing to Inform Readiness Assessment and Command Communication 11
• Conclusions 11
• Contents 13
• Figures and Tables 15
• Figures 15
• Tables 16
• Introduction 17
• Readiness Assessment in the U.S. Military 18
• Readiness Assessment for Service Members Who Receive Military Behavioral Health Care 21
• Readiness Assessment for Service Members Who Receive Private-Sector Behavioral Health Care 23
• Policy Guidance on Readiness Assessment for Service Members Who Receive Private-Sector Care 24
• Contributions of This Research 25
• Organization of This Report 26
• Methods 27
• Administrative Data 27
• Eligibility Criteria for Analyses 28
• Administrative Data Analyses 28
• Staff Interviews 31
• Interview Sample 31
• Interview Guides 33
• Data Collection 35
• Qualitative Data Analysis 35
• Participant Characteristics 37
• Summary 37
• Trends in Receipt of Private-Sector Behavioral Health Care for Service Members 39
• Trends in Outpatient Behavioral Health Care 39
• Outpatient Visits 40
• Virtual Behavioral Health 41
• Receipt of Private-Sector Behavioral Health Care by Care Setting 43
• Receipt of Private-Sector Behavioral Health Care by Visit Type 44
• Receipt of Private-Sector Behavioral Health Care by Primary Diagnosis 45
• Trends in Inpatient Intensive Outpatient Emergency and Residential Behavioral Health Care 46
• Inpatient Stays 47
• Intensive Outpatient Program Partial Hospitalization and Emergency Care 48
• Variation in Private-Sector Behavioral Health Care by Service Branch and Military Treatment Facilities 49
• Summary 52
• Understanding Patterns of Behavioral Health Care for Service Members Seen in the Private Sector 57
• Patterns of Private-Sector Behavioral Health Care 57
• Outpatient Private-Sector Behavioral Health Care 58
• Inpatient Intensive Outpatient and Emergency Department Private- Sector Behavioral Health Care 60
• Concurrent Outpatient Direct Behavioral Health Care 61
• Challenges with Quantifying Additional Direct-Care Utilization Required for Service Members Seen in Private-Sector Behavioral Health Care 64
• Summary 65
• Staff Approaches to Conducting Behavioral Health Readiness Assessment and Command Communication 67
• Administrator Perspectives on Policy Guidance 68
• Assessing Readiness of Service Members Receiving Private- Sector Behavioral Health Care 69
• Assessing Readiness 70
• Tracking 76
• Sources of Information Used in Assessing Readiness 78
• Staff Involved in Assessing Readiness 79
• Documentation of Time Spent Conducting Readiness Assessments 80
• Summary of Common Military Treatment Facility Approaches 82
• Approach to Command Communication 83
• Passive Versus Active Communication 83
• Timing 84
• Summary 85
• Staff-Identified Challenges and Recommendations for Improving Readiness Assessment and Command Communication 87
• Challenges Conducting Readiness Assessment and Command Communication 87
• Lack of Information on Service Member Clinical Status or Private- Sector Treatment 87
• Inadequate Staffing to Track and Monitor Readiness 90
• Consequences of Inadequate Readiness Assessments 91
• Service Member Barriers to Accessing Behavioral Health Care 93
• Inadequate Private-Sector Provider Competency in Assessing Readiness 94
• Staff Recommendations 95
• Improve Military Treatment Facility Access to Information About Service Member Clinical Status and Documentation of Treatment Received in Private-Sector Behavioral Care 95
• Increase Military Treatment Facility Staffing for Managing Private- Sector Behavioral Health Care 97
• Educate Private-Sector Behavioral Health Providers to Enhance Their Role in Assessing Readiness 98
• Increase Military Treatment Facility Capacity to Provide Behavioral Health Care 99
• No Recommended Improvements 99
• Standardize Policies or Practices for Assessing Readiness 100
• Other Recommendations 100
• Other Considerations 100
• Summary 101
• Summary and Recommendations 103
• Strengths and Limitations 103
• Key Findings 105
• The Military Health System Has Increased Its Reliance on Private- Sector Providers to Deliver Outpatient Behavioral Health Care to Service Members 105
• Readiness Assessments Are Not Adequately Captured in the Medical Record but One-Third of Service Members Initiating Private-Sector Care Received Concurrent Direct Behavioral Health Care 106
• Staff Member Approaches to Readiness Assessment for Service Members Receiving Private-Sector Behavioral Health Care Varied Substantially 106
• Staff Recommended Improving Access to Documentation of Private- Sector Behavioral Health Care 107
• Recommendations 108
• Recommendation 1. Ensure Adequate Staff to Provide Military Behavioral Health Care to Service Members and Readiness Assessment for Those Seen in Private-Sector Care 109
• Recommendation 2. Clarify Minimum Requirements for Tracking and Monitoring the Readiness of Service Members Who Receive Private- Sector Behavioral Health Care 111
• Recommendation 3. Identify Mechanisms to Improve Private- Sector Behavioral Health Providers Information-Sharing to Inform Readiness Assessment and Command Communication 112
• Staff Interview Protocols 115
• Interview GuideAdministrators 115
• Introductory Language 115
• Introductory Language 116
• Interview GuideProviders 119
• Abbreviations 123
• References 125