# Presentation: 898790

## Warrior Care and Transition OfficeCarey Symposium30 October 2008

*“**A total transformation of the way we care for Soldiers and their Families”*

- BG Gary H. Cheek, Director, Warrior Care and Transition Office

**Notes:**
During World War II, Wakeman General Hospital, Camp Atterbury, Indiana was the largest Convalescent Hospital in the U. S. Army.

Valley Forge General Hospital opened in 1943, the Valley Forge General Hospital was the nation’s largest military hospital by the end of World War II. Able to treat more than 3,000 patients in its more than 100 separate buildings, the hospital specialized in the treatment of eye injuries, and conducted pioneering work in the fields of plastic surgery and eye surgery. 

This somewhat busy slide shows the history of deployable hospital medical force structure requirements over the past nearly 20 years.  The Pre-Medical Force 2000 structure contained 162 hospitals of seven different designs.  Over the succeeding years, a series of studies, redesigns, changes in assumptions, and changes in the basic National Military Strategy have led to the most recent Medical Reengineering Initiative Force of 32 CSHs required, 26 resourced, leaving a risk margin of 6 hospitals.  

## Purpose	

**Purpose**

- Provide a strategic overview of how the US Army cares for our wounded, ill and injured Soldiers
- Where we were
- Where we are
- Where we’re going

## 18 February 2007
Inpatient care – Best in the world

But for 4,400 outpatient Soldiers....
-Substandard Facilities
-Minimal supervision
-Limited Family support
-No feedback mechanisms
-Poor coordination across the continuum of physical and mental healthcare

***18 February 2007***
- Inpatient care – Best in the world
***But for 4,400 outpatient Soldiers....***
- -Substandard Facilities
- -Minimal supervision
- -Limited Family support
- -No feedback mechanisms
- -Poor coordination across the continuum of physical and mental healthcare

***Today***
- Inpatient care – Best in the world
***36 Warrior Transition Units with 11,354 Soldiers in outpatient care***
- Best facilities
- Military leadership and structure
- Centralized Family support
- -Multiple feedback mechanisms
- -Synchronization and coordination of physical and mental healthcare

**Army Care for Wounded, Ill and Injured Soldiers****Where We Were...Where We Are**

## Army Care for our Wounded, Ill and Injured SoldiersWhat We’ve Done in the Past 90 Days

- Empowered our senior commanders and established a “triad of leadership” to direct this program at installation level.  Commanders at all levels are deeply involved in our Warrior Transition program.
- Revised our WTU entry criteria to focus on those Soldiers who were wounded, ill or injured in theater and/or have complex medical conditions that require intensive case management.
- Created a predictive model to project future WTU population based on deployments, redeployments, mobilization and demobilization.
- Directed installations to maintain cadre manning at 100% of ratio requirements for current WTU population.
- Corrected discrepancies in cadre special duty pay to ensure all eligible receive the pay.
- Improved our administrative processes to expedite orders for Soldiers and cadre.

**Notes:**
We did all this while deploying XX brigades and YY,YYY Soldiers for combat operations in Iraq and Afghanistan and continuing transformation of our combat formations.

## Missions of the Warrior Transition Unit                                                     and Warrior in Transition

**Missions of the Warrior Transition Unit                                                     ****and Warrior in Transition**

**Warrior Ethos: **
- I will always place the mission first.
- I will never accept defeat.
- I will never quit.
- I will never leave a fallen comrade.
**Warrior Transition Unit Mission:  **
- Provide command and control, primary care and case management for Warriors in Transition to establish conditions for healing and promote the timely return to the force or transition to civilian life.
**Warrior in Transition Mission: **
- I am a Warrior in Transition. My job is to heal as I transition back to duty or continue serving the nation as a Veteran in my community. This is not a status, but a mission. I will succeed in this mission because
- I AM A WARRIOR AND I AM ARMY STRONG.

**Notes:**
WTU Mission Essential Task List:

 Provide command and control
 Provide quality primary care and case management services
 Synchronize clinical care, disposition and transition 
 Provide administrative and support and services for Warriors, Families and Cadre 
 Promote readiness to return to the force or transition to a productive civilian life
 Warrior In Transition Mission:  

## Warrior Transition Unit

** **

**Ft. Drum**
- 487

**Ft. Dix**
- 229

**Ft. Eustis**
- 172

**Ft.  Carson **
- 607

**Ft.  Riley **
- 377

**Ft.  Leonard Wood **
- 157

**Ft.  Lewis**
- 585

**Ft. Stewart**
- 488

**Ft. Benning**
- 293

**Ft. Jackson**
- 99

**Ft.  Knox**
- 310

**Ft. Gordon**
- 359

**Ft.  Campbell**
- 630

**Ft.  Sam Houston **
- 603

**Ft.  Polk **
- 249

**Ft. Sill **
- 109

**Ft.  Hood **
- 1142

**Ft.  Bliss **
- 314

**PR**
- 74

- Ft.  Richardson
- 119

**Schofield Barracks**
- 277

**West Point **
- 95

**CA**
- 195

**AR**
- 206

**AL**
- 91

**UT**
- 128

**MA**
- 164

**WI**
- 235

**FL**
- 143

** ****Balboa**
- 62

**Ft.  Wainwright**
- 99

**WRAMC **
- 605

**Ft Huachuca **
- 50

**Ft.  Leavenworth **
- 19

**Ft. Belvoir**
- 70

**Ft. Lee**
- 73

**VA**
- 189

**Ft Meade **
- 74

**Redstone Arsenal**
- 15

**Ft Rucker**
- 13

**Landstuhl  **203

**Heidelberg **  32

**Bavaria  **161

- Current WT Population
- (assigned or attached to a WTU)
**11,305 **Soldiers (as of 14 OCT)
- AC/NG/USAR/Total 7576/2342/1386/11305

**Ft. Bragg**
- 690

**Warrior Transition Unit**

**Ft.  Irwin**
- 60

## WTU Structure

**WTU**

**1:****10**

**PCM**

**NCM**

**TRIAD**

**1:****40**

**1:36 (1:18)**
**1:20**

**SQD LDR**

**1:200**

**PLT SGT**

**CO CDR**

**1 / CO**

**1SG**

**1 / CO**

**CO XO**

**1 / CO**

**1:200**

**SR NCM**

**1:100**

**1:200**

**TNG SP**

**HR SP**

**1:60**

**SUP TECH**

**BN CDR**

**1 / BN**

**BN XO**

**1 / BN**

**1 / BN**

**CSM**

**S1**

**1 / BN**

**FRSA**

**1 / BN**

**SR HR ASST**

**SEE HR SP**

**SR FIN MGR**

**S4**

**1 / BN**

**1 / BN**

**INFO SYS**
** ****MGT SP**

**1 / BN**

**WTU Structure**

**(2 – ****4**** per PLT)**

**(2 – 5 per CO)**

**(max of 10 per CO)**

**(2 – ****6**** per BN)**

**WTB**

**1:200**

**MED SPT ASST**

**OPS SP**

**1:500**

**BN SURG**

**1/BN**

-  = new position

**Changes      in ****RED**

- SMSA = SUP, MED SPT ASST

**1 / BN**

**ATTORNEY**

**1 / BN**

**PARALEGAL**

## Army Care for Wounded, Ill and Injured SoldiersWarrior Transition Unit Population

**NON EVAC**

**EVAC**

**Army Care for Wounded, Ill and Injured Soldiers****Warrior Transition Unit Population**

**MEB and medical    **
**non-deployables move to WTUs**

**Revised entry criteria**

**AC Soldiers: 92% of Growth**

## WT Population by Medical Condition

**Orthopedic ****	****	****     ****(44%)****	**** 37%**
**Internal Med****	****	****	**** 16%**
**Mental Health (non PTSD)****	**** 10%**
**Gen Surg & Other Surg****	****	****  4%**
**Neurological****	****	****      ****(5%)****	****  8%**
**PTSD****	****	****	****      ****(2%)  ****10%**
**TBI (Mild, Moderate, Severe) ****(1%)****   6%**
**Eye & ENT****	****	****	****  4%**
**Cardio****	****	****	****	****  2%**
**Amputation (Upper & Lower)****	****  1%**
**Endocrine****	****`****	****	****  1% **
**Dental****	****	****	****	**** 0.8%**
**Burns****	****	****	****	**** 0.6%**

**(Historical)**  **Current**

**WT Population by Medical Condition**

**CURRENT**

## Army Care for Wounded, Ill and Injured SoldiersReturn to Duty

**MONTH OF SOLDIER DISPOSITION**

**PERCENT OF WT SOLDIERS RETURNED TO TH EFORCE**

**NUMBER OF WT SOLDIERS **

- ESTABLISHMENT OF WTU

**WTU POPULATION MONTHLY DISPOSITION**
**RETURNED TO THE FORCE** vs. **MEDICALLY SEPARATED**

**DECREASE IN THE “PERCENT RETURNED TO THE FORCE“AFTER WTU ESTABLISHED IS ASSOCIATED WITH AN INCREASE IN THE PERCENT OF WT POPULATION THAT ARE IN THE MEB / PEB PROCESSES**

- MAJOR EFFORT TO MOVE MEB INTO WTU

**AS OF 2 OCT 08**
**UPDATED WEEKLY**

**65%**

**43%**

**Army Care for Wounded, Ill and Injured Soldiers****Return to Duty**

**Notes:**
MEDICAL / 08 SEP 2008 / DR CARINO / 681-1873

34% OF DISPOSITIONED WARRIORS IN TRANSITION HAVE BEEN MEDICALLY SEPARATED.  FIVE PERCENT WERE SEPARATED DUE TO ADMINISTRATIVE OR ADVERSE ACTIONS.

THE DECREASE FROM AUG 07 TO PRESENT IN THE PERCENTAGE OF DISPOSITIONED WARRIORS RETURNED TO DUTY IS PRIMARILY DUE TO A SIGNIFICANT INCREASE IN THE NUMBER OF SOLDIERS ENTERING THE PROGRAM FOR MEDICAL EVALUATION BOARD PROCESSING.

IN THE LAST FOUR MONTHS, THE NUMBER OF MEDICALLY SEPARATED WARRIORS IN TRANSITION INCREASED AS SOLDIERS COMPLETED MEB REQUIREMENTS.

DO NOT BRIEF:

HISTORICALLY ONLY 10% OF ALL SOLDIERS IN THE MEDICAL EVALUATION BOARD (MEB) PROCESS ACTUALLY RETURN TO DUTY OR REFRAD. 

PERCENT OF WT SOLDIERS RETURNED TO THE FORCE = [NUMBER OF SOLDIERS RETURNED TO THE FORCE / (NUMBER OF SOLDIERS RETURNED TO THE FORCE + NUMBER OF SOLDIER MEDICALLY SEPARATED)].

ACRONYMS:   MEB = MEDICAL EVALUATION BOARD;  PEB = PHYSICAL EVALUATION BOARD; WTU = WARRIOR TRANSITION UNIT; MODS = MEDICAL OPERATIONAL DATA SYSTEM

Dr. Carino reviewed the FY05, FY06, and FY07 data and between 7 to 8 percent the Soldiers are medically separated for PTSD as the primary.  The bottom line is that 92% remains on active duty; but, those remain on active duty may be under active treatment. 

## Comprehensive Transition Plan

**Comprehensive Transition Plan**

_**Components**_
- Ft Lewis:        Initial Assessment
-    Enhanced Reintegration Action Plan (ERAP)
- Alaska: 	      Track Plan
- Ft Benning:    Leader Book
- Ft Campbell:  Database
- Hawaii:          Cdr Tracking Tool

- RTD

## Programs for the Families of Wounded Warriors

**Soldier Family Assistance Center Services**
-   SFACs at all WTUs
-   Military Entitlements and Benefits
-   Information and Referral
-   Social Services (substance abuse, financial counseling, stress management)
-   Education services
-   Child and Youth (on-site child care and School Liaison services)
-   Transition/Employment (job search, career counseling, referral to Dept of Labor)

**Programs for the Families ****of Wounded Warriors**

## Army – VA IntegrationBest Practices

**Army – VA Integration****Best Practices**

- VA and Army enrolling RC soldiers into VA Health Care at 12 de-mobilization sites
- VA assigned Veteran Benefits Administration (VBA) Advisors and Veterans Health Administration (VHA) Liaisons at WTUs across the Army
- VA and Army are working to ensure adequate space and support are available for newly detailed VA employees
- Provided VA unlimited access to DoD medical records / databases
- Senior Advisor Exchange between VA and Army
- VHA and VBA active participation in Comprehensive Transition Plan
- In the future, vocational rehab counselors will visit all WTUs to ensure Soldiers get career counseling

## Army Partnering with the VA to provide Medical Care 

**Army Partnering with the VA ****to provide Medical Care **

**Army Rehab Unit/VA Facilities**
- Amputees
- Spinal cord injuries
- Poly-Trauma / TBI
- Mental Health component built-in
- Joint VA/DoD staffing
- Results:
- 558 inpatients
- 189 outpatients
- 156 RTD (28%)
**Seamless Transition Center**
- OEF/OIF outreach
- Initial counseling and assessment
- Community-based resource center
- Soldier, Veteran and Family resource center

**Notes:**
Here are some of the areas we are partnering in to support soldiers.

## Army Care for our Wounded, Ill and Injured SoldiersWhere We’re Going

- CSA Guidance:
- Right size our population.
- Improve our administrative and medical board processes.
- Maneuver medical assets to key installations to increase access to care.
- Increase access to mental health care.
- Measure key indicators of performance.
- Help Soldiers manage expectations.

**Notes:**
Right size our population to ensure we focus on our combat wounded Soldiers and those ill and injured Soldiers that require the complex case management a WTU provides.
Improve our administrative and medical board processes while protecting the best interests of our Soldiers.
Maneuver medical assets to the installations where shortages in specialty care or board physicians are limiting performance.
Increase access to mental health care and foster initiatives and partnerships for treatment of post traumatic stress and traumatic brain injuries.  Aggressively hire additional qualified providers.
Measure key indicators of performance and identify points of friction that inhibit our ability to move soldiers equitably through the process.

## Warrior Care and Transition OfficeCarey Symposium30 October 2008

*“**A total transformation of the way we care for Soldiers and their Families”*

- BG Gary H. Cheek, Director, Warrior Care and Transition Office

**Notes:**
During World War II, Wakeman General Hospital, Camp Atterbury, Indiana was the largest Convalescent Hospital in the U. S. Army.

Valley Forge General Hospital opened in 1943, the Valley Forge General Hospital was the nation’s largest military hospital by the end of World War II. Able to treat more than 3,000 patients in its more than 100 separate buildings, the hospital specialized in the treatment of eye injuries, and conducted pioneering work in the fields of plastic surgery and eye surgery. 

This somewhat busy slide shows the history of deployable hospital medical force structure requirements over the past nearly 20 years.  The Pre-Medical Force 2000 structure contained 162 hospitals of seven different designs.  Over the succeeding years, a series of studies, redesigns, changes in assumptions, and changes in the basic National Military Strategy have led to the most recent Medical Reengineering Initiative Force of 32 CSHs required, 26 resourced, leaving a risk margin of 6 hospitals.  

## BACK UPSLIDES

- BACK UPSLIDES

## Army Care for our Wounded, Ill and Injured SoldiersChallenges We Are Addressing

- Although improving, we continue to face shortfalls in medical providers both at WTUs and Medical Treatment Facilities(MTF).  Currently, realigning assets regionally to meet critical requirements and fully empowering MTF Commanders to use TRICARE Network . Utilizing retiree recalls, mobilizations, and civilian hires to meet near term and future requirements.
- Increased mental health requirements have stressed our ability to provide adequate care.  Multiple actions ongoing:  New mental health programs, installation initiatives, and hiring actions.  Created the Director of Comprehensive Soldier Fitness (BG Rhonda Cornum) to elevate mental wellness to the level of physical wellness.
- We continue to improve our Physical Disability Evaluation System, but are approaching diminishing returns.  GEN (Retired) Fred Franks is conducting an external review of our processes for potential improvements, however, we do not believe it is possible to satisfy Soldier expectations under the current statute.

**Notes:**
We did all this while deploying XX brigades and YY,YYY Soldiers for combat operations in Iraq and Afghanistan and continuing transformation of our combat formations.

## Programs for the Families of Wounded Warriors

**Support for Wounded Soldiers and their Families**
-   Triad of Leadership, Triad of Care
-   Army Family Covenant, Army Community Covenant
-   Army OneSource link from Military OneSource is single portal gateway at _[www.militaryonesource.com](http://www.militaryonesource.com/)_
-   Army Wounded Warriors (AW2)-74 AW2 Advocates, 51 locations (VA Polytrauma Centers, VA Facilities, Military Installations, Satellite Offices throughout the United States) at _[www.aw2.army.mil](http://www.aw2.army.mil/)_
-   Wounded Soldier and Family Hotline and Ombudsman Program
-   Transportation, temporary housing and other support as necessary
-   On-line donations management at _[www.giftstoarmy.mil](http://www.giftstoarmy.mil/)_
-   Veteran Affairs support on-site and with reach back capability
-   Virtual SFAC for the geographically dispersed at _[www.armyonesource.com](http://www.armyonesource.com/)_
-   Disabled American Veterans/American Legions/Other Volunteer Support Organizations
-   My benefits web site produces personalized survivor and retirement benefit reports for active duty Soldiers and Family Members at_[ myarmybenefits.us.army.mil](http://www.myarmybenefits.us.army.mil/)_

**Programs for the Families ****of Wounded Warriors**

## www.giftstoarmy.army.mil

**www.giftstoarmy.army.mil**

**www.myarmylifetoo.com**

**www.americasupportsyou.mil**

**www.aw2.army.mil**

**www.militaryonesource.com**

## WARRIOR TRANSITION POPULATION: Length of Stay by Medical 

**WARRIOR TRANSITION POPULATION:** Length of Stay by Medical
- Condition as Sole Condition Recorded or as a Co-Morbidity

- All WT Soldiers (Current and Complete) October 2001—10 March 2008

**Average Length of Stay (days)**

## MEB PROCESSING TIME: Active MEB Cases (cases forwarded to PEB have been excluded)

- POC: Dr. Michael J. Carino, OTSG   8 September 2008

**Average Days in MEB Process**