In early 2010, two U.S. Public Health Service (USPHS) Commissioned Corps social work officers and one U.S. Army social work officer increased access to emergency behavioral health care services at Fort Bragg by serving in what’s comparable to a 9-to-5 setting in the Emergency Department (E.D.) of the installations’ Womack Army Medical Center (WAMC). But a few months into their assignment, the USPHS officers recognized a growing need to have social workers available at all hours of the day.
Lacking adequate clinical staff is not an option.
“A lot of crises occur on weekends and after work hours,” pointed out LCDR William Bolduc, Social Work Supervisor, E.D. Social Work Initiative, WAMC.
What resulted is a 24-hour, 7-day a week program that embeds Licensed Clinical Social Workers (LCSW) in the E.D. at all hours of the day at one of the largest Military Treatment Facilities (MTF) in the nation. The E.D. Social Work Initiative, as the program is formally called, was designed to provide continuous onsite behavioral health, substance abuse, sexual assault and domestic abuse screenings at WAMC. The initiative was modeled after a program at Fort Hood in Texas; WAMC is the second MTF to provide continuous onsite emergency behavioral health services.
The USPHS officers involved are assigned to Fort Bragg as part of the ongoing agreement between the Department of Defense (DoD) and the Commissioned Corps to increase behavioral health services available to military service members, their family members and veterans.
“This geographic area of North Carolina is in high-demand and short supply of behavioral health providers and social workers,” said COL Brian T. Canfield, Commander, WAMC. “Having clinical social workers readily available to enable soldiers that have rotated back or were evacuated from deployment work through their systemic rehab challenges, here on Fort Bragg, is an important capability within Womack.”
Prior to the E.D. Social Work Initiative, service members with emergency behavioral health needs or victims of domestic violence could present to the E.D.; however, the on-call psychologist and social worker were off-site and would have to be called in, delaying access to care. Since the initiative began, patients needing behavioral health and social work services have immediate on-site access, decreasing patient stays in the E.D., resulting in a 100% increase in immediate access to specialty behavioral health care.
LCDR Bolduc, along with USPHS Commissioned Corps officer LCDR Tricia Booker and their civilian counterparts, provide social work interventions at WAMC, with the majority of the work coming in the form of behavioral health assessments that determine the best course of action – in-patient hospitalization, long-term outpatient treatment or a command interest profile, a tool for enhancing the safety of personnel in the unit when a soldier presents with suicidal or homicidal ideation. Since launching the 24/7 E.D. Social Work Initiative, nearly 2,000 patients have been screened for behavioral health and domestic violence intervention.
LCDR William Bolduc, one of the coordinators in charge of the 24/7 E.D. Social Work Initiative.
Currently, a total of four USPHS social work officers, two Army social work officers, two civilian social workers and two social work assistants work as part of the E.D. Social Work Initiative. Additionally, USPHS officers supervise social work interns from Fayetteville State University’s Master’s in Social Work program.
“Often times, someone will enter the E.D. presenting a problem such as heart palpitations but really what they’re dealing with is anxiety or a panic attack,” LCDR Bolduc said. “We see a soldier’s mother or spouse, especially when the soldier is deployed, and the family member may be overwhelmed and not know where to go. We put them in contact with appropriate resources so the soldier can stay focused on his or her mission overseas.”
“We’re a complement to the Army mission. Because we’re uniformed, we bring credibility and can relate to soldiers and their families in a way that some of our civilian counterparts can’t,” Bolduc continued.
LCDR Booker noted that the E.D. Social Work Initiative’s reach extends far beyond the walls of WAMC. The social workers provide referrals to Army Community Services, support programs and financial management programs available at Fort Bragg.
LCDR Tricia Booker, a PHS officer and social worker supporting the 24/7 E.D. Social Work Initiative.
“I worked for the U.S. Air Force prior to coming to Fort Bragg and every day I learn something new,” LCDR Booker said. “I really appreciate what the men and women in the Army do every day – all the deployments and what their families go through, plus the after effects. You really see it first hand and it makes you appreciate the sacrifices they make for our country.”
Undoubtedly, the program has increased access to care. Yet, it’s difficult to point to hard data or a dollar figure that can demonstrate the success of the E.D. Social Work Initiative. But as COL Canfield points out, the success of the program cannot be solely measured through statistics.
“In no uncertain terms, they have instrumentally contributed to our ability to take care of our soldiers and families – with exclamation points,” said Col Canfield. “On a 24-hour basis, it’s not uncommon that we see anywhere from three-to-seven behavioral health related issues, ranging from attempted suicide, alcohol over-consumption, either accidental or intentional drug overdose, a multitude of things. In some cases, that USPHS officer who is working on shift in the E.D. presents an additional capability to us that were it not present, would have added to the wait time for the patient to be treated and perhaps resulted in the soldier being transferred and admitted to an in-patient facility.”