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Army CIO/G-6 Support to Army Campaign Plan for Health Promotion, Risk Reduction and

Suicide Prevention (ACPHP)

12 Jan 10

Mr. Steve RidingsArmy CIO/G-6

Army Net-Centric Data Strategy Center of Excellence

https://www.intelink.gov/wiki/Suicide_Mitigation_COI

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Suicide Mitigation Overview

• Suicide rates among Army personnel have risen substantially since the beginning of the current conflicts in Iraq and Afghanistan, despite major surveillance and intervention efforts introduced by the Army to prevent suicides over this period.

• In October 2008, a memorandum of agreement between the National Institute of Mental Health (NIMH) and the Army was signed, which authorized NIMH to lead an interdisciplinary team of four research institutions to carry out the largest study of suicide and mental health among military personnel ever undertaken. Called the Study to Assess Risk and Resilience in Service Members (STARRS) , it is being supported with $50 million in funding from the U.S. Army.

• In December 2008, the Army Science Board presented the findings of its preliminary study on suicides in the Army. One of the findings of the report was that the data sources required to analyze the problem are disparate and not integrated. The current information environment does not support the identification and analysis of factors that impact Army suicide rates.

• In Spring 2009, General Peter W. Chiarelli, the Vice Chief of Staff of the Army (VCSA), established a Council of Colonels designated as the Army Suicide Prevention Task Force (ASPTF) to manage a wide range of tasks intended to reduce the rate of suicide in the Army.

• The Suicide Mitigation Data Management Working Group (SMDMWG) was then formed with the Functional Data Managers of ten data sources selected from the thirty-five data sources initially identified by the Army Science Board as potential data sources of interest.

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Background: Army Campaign Plan for Health Promotion, Risk Reduction and Suicide Prevention (ACPHP)

SOURCE: BG McGuire Presentation to 2009 Senior Leader’s Conference, 5 May 09

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Hierarchy of the Suicide Mitigation Community

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Suicide Mitigation Data Management Working Group

Vision

To enable the analysis of high quality data pertaining to U.S. Army suicides from many disparate sources; improving prevention and mitigation efforts by exposing, correlating, and integrating these data to provide a composite picture, enabling surveillance and decision-making that will positively impact social behaviors across the Army.

Approach• The SMDMWG consists of representatives from the Office of the Vice Chief of Staff, the

CIO/G-6, US Army Public Health Command (Provisional), NIMH, and the Functional Data Managers of each of the data sources identified as desired/required by USAPHC (Prov) and NIMH STARRS.

• The SMDMWG meets every other week to address the project tasks as assigned by the ASPTF through a Task Action Plan (TAP). This TAP is managed using a detailed Synchronization Matrix, exploiting the spiral model development process to combine elements of design and prototyping-in-stages to produce results.

• The initial SMDMWG addressed requirements for TAP 9.1.0 by establishing the USAPHC (Prov) ABHIDE system with data from ten data sources. This was Spiral 1 of the effort.

• The current plan addresses requirements for TAP 9.1.5, and is organized into Spiral 1.5 and Spiral 2. To support these spirals, the data sources are vetted and sorted into three Priority Sets.

• USAPHC (Prov) and the NIMH STARRS team have agreed to work together to evaluate potential data sources and to process data from the sources according to the same Priority Sets.

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Suicide Mitigation Spirals

• Spiral 1 – USAPHC (Prov) (completed July 09)– Initial Suicide Mitigation effort to collect data from ten data sources for the Army

Behavioral Health Integrated Data Environment (ABHIDE), to support USAPHC (Prov) epidemiologist studies.

– This data was gathered for deceased soldiers only.

• Spiral 1.5 – NIMH STARRS (started July 09)– All efforts required to provide National Institutes of Mental Health (NIMH)

STARRS team with data to support their Historical (Component 1) Study, includes living and deceased soldiers.

• Spiral 2 – USAPHC (Prov) (started July 09)– Creation of net centric data services to automate exchange of data with ABHIDE. – Additions to ABHIDE

• New data sources• New data elements for existing sources from Spiral 1• Data for living soldiers with suicide ideations and attempts

• Future Spirals – NIMH STARRS 5 year Prospective (Component 2) Study, includes living and

deceased soldiers

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Suicide Mitigation Data Extracts

Extract # Title User Extract Method Population Notes

1 Spiral 1 – Completed Suicides to USAPHC ABHIDE

USAPHC Manual All completed suicides since 2001 (Deceased soldiers only)

Refreshes bi-weekly until Extract #2 begins

Data elements based on Spiral 1 requirements.

List of soldiers provided to data sources by USAPHC

2 Spiral 2 – Suicide Completions, Attempts, Ideations to USAPHC ABHIDE

USAPHC Data Services or Manual

Data Services to be implemented where possible in the Spiral 2 timeframe.

All completed suicides, attempts, and ideations (Living and Deceased soldiers) since 2001

Refreshes on bi-weekly.

Replaces Extract #1.

Revises data elements based on Spiral 2 requirements.

Data sources who are creating data services will continue with Extract #1 until the data services are available.

List of soldiers provided to data sources by USAPHC

3 Spiral 1.5 – Historical Study

NIMH STARRS

Manual - All completed suicides, attempts, ideations from January 2004 to June 2009

- All soldiers who served on active duty at any time from January 2004 through June 2009

One time only extract, no refreshes.

USAPHC will de-identify data before it is sent to NIMH.

List of soldiers provided to data sources by USAPHC

4 Future Spiral – Prospective Study Initial Extract

NIMH STARRS

Manual All soldiers on active duty as of study start date (TBD)

USAPHC will de-identify data before it is sent to NIMH.

List of soldiers provided to data sources by USAPHC

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Spiral 1 – Army Behavioral Health Integrated Data Environment

• An initial pilot database was designed by CIO/G-6 & USAPHC (Prov) as a prototype suicide registry to support USAPHC (Prov) behavioral analysis and to potentially support the VCSA Suicide Report. The prototype was completed in March 2009.

• The pilot database was populated by the Armed Forces Health Surveillance Center (AFHSC) with data collected from various sources. The database, and the extract, transform, and load environment to populate the database, was later named the Army Behavioral Health Integrated Data Environment (ABHIDE).

• The ASPTF developed a Task Action Plan (9.1.0) that required an integrated database to expand upon the prototype suicide registry. The ABHIDE met the initial requirements, and was adopted as Spiral 1 (ABHIDE) for this mitigation effort. ABHIDE entered production in July 2009.

• ABHIDE provides the USAPHC (Prov) with the information management capabilities needed to integrate non-related/dispersed data into a single comprehensive suicide tracking and mitigation database. This database and its capabilities support enterprise-wide population-based surveillance reporting of Army suicide (deceased Soldiers only). The database will also support the mitigation efforts for future suicide events across all phases of Army service (living and deceased soldiers).

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Spiral 1 – ABHIDE Data Sources

Centralized Operations Police Suite (COPS)

Drug & Alcohol Management Information

System (DAMIS)

Medical Protection System (MEDPROS)

Integrated Total Army Personnel Database

(ITAPDB)

Military Health System Data Repository (MDR)

Clinical Data Mart (CDM)

Defense Casualty Information Processing

System (DCIPS)

CID Information Management System

(CIMS)

Army Central Registry (ACR)

Army Suicide Event Report (ASER)

A database driven, Web-enabled, secure intranet application to support processing the Army Military Police reports

The Army’s official repository for all current and historical Army Substance Abuse Program (ASAP)-related information

Medical readiness database that includes all medical and dental readiness requirements in accordance with Army regulations

Consolidated human resource database providing the Army and DOD with a single repository for personnel info for all components of the Army

Centralized data repository for MHS that captures, validates, and distributes defense health data to users worldwide

Tool to measure , analyze, and mange performance of direct patient care, wellness, prevention, and disease management to improve care delivery

Tracks causality data pertaining to service members and their families, manages mortuary information, repatriation data, and survivor case

management

A consolidated data system for criminal investigation reports, criminal intelligence applications, and record storage.

A victim-based registry documenting substantiated spouse and child abuse events involving Army service members

Standardized risk and protective factor information collected on suicide events

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Details of Spirals 1.5 and 2

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Spiral 1.5 – NIMH/STARRS

• Data Providers support the Army Suicide Mitigation Project and NIMH STARRS team by:

– Providing Data Dictionaries, related supporting information, and sample data extracts to NIMH for investigation

– Providing extract data for historic study and prospective study for NIMH via USAPHC (Prov)

– Providing the extracts to USAPHC (Prov) for verification of extracts and for de-identification of Personal Identifiable Information (PII)

– Developing Data Thread illustrations to depict decision points for data input, time periods necessary to obtain data, and other data sources that feed into the primary data source

– Assisting CIO/G-6 with formulation and approval of Data Use Agreements

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Spiral 1.5 – NIMH STARRS Data Requirements

2 We recognize that not all data elements will be available for all years for all Soldiers. In particular, some Army data systems may only have come online in recent years, and/or may only capture partial data for some Soldiers (e.g., for Guard and Reserve component Soldiers only when they are activated).

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Spiral 2 – ABHIDE New Data Sources and Data Services

• Data Providers support the Army Suicide Mitigation Project by assisting the CIO/G-6 task force and USAPHC (Prov) with:

– the identification and extraction of additional data elements for the ABHIDE population to foster USAPHC (Prov) epidemiological study

– the identification and extraction of data elements for ABHIDE from new data sources identified by NIMH STARRS to foster USAPHC (Prov) epidemiological study

– the identification and extraction of living soldiers' attempts/ ideations for ABHIDE population

– the establishment of standardized and periodic feeds of data for the data sources

– the creation of web/data services to automate information flow to ABHIDE

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Implements ADSL Data Services

NIPR APC

SOA STACK

Security

ESB: Messaging

DataAbstraction

ESM

Data StoreData StoreADS 1 Infrastructure

Data StoreData StoreADS 2 Infrastructure

ADS 4 Infrastructure

Data StoreData StoreADS 6 Infrastructure

ADS 6WS

Data StoreData StoreADS 5 Infrastructure

ADS 5WS

Data StoreData Store ADS 4WS

ADS 1WS

ADS 2WS

ADS 3WS

PROXY

Preliminary Architecture

ABHIDEABHIDE

WebServiceClient

Data StoreData StoreADS 3 Infrastructure

Data StoreData StoreADS 7 Infrastructure

Data StoreData StoreADS 8 Infrastructure

Secure EMail

Data Source Automated Integration with ABHIDE

Implements Manual Data Extracts

USAPHC(Prov)

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Backup

Suicide Mitigation: Overview Data Process Flow – Slide 1 of 2D

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Determine Funding Impacts

* Define Data Element

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Get Stakeholder

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Identify Legal, PII, PHI Constraints

Get Stakeholder

Buy-In

Obtain IRB and IA

Certification

Determine Funding Impacts

Create & Deploy Data Service

Create & Deploy Data Service

Create SORN -Draft, Publish, & Satisfy Comments

Identify Business

Needs

Create & Deploy Data

Service

Pilot And Feedback

Identify Business

Needs

* Develop Data

Models

** Identify Data

Providers

* LoadManual

Extracts

* CreateManual

Extracts

Notes: * See next slide for detailed process ** See ADS process for details

Scope Problem /

ID Strategy

Establish Legal

Working Group

Suicide Mitigation: Detailed Process Flow - Data Elements, Requirements, Models, Extracts Slide 2 of 2

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Create LDMsFinalize Data

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sign-off

Agree to Provide

Data

Load Full Extract

Develop / Test Extract Script; Verify Output

Create/Send Sample Data

Send Full Data Extract

Receive Updated Data

DictionaryIdentify Requested

Data Elements

Create PDMs

Map Data Provider to Business Needs

Clarify Data Elements

Extend Existing Database as

Needed

Test Load Process with Sample Data; Confirm sample to Data Elements List

Update Data Dictionary

for Consumer

Key:

Provide Data

Dictionary

De-Identify Data (if required)

Create Uniform Data Elements

List

Define MediumFor Data Exchange

Define Data Element Requirements Process

Develop Data Models Process

Create/Load Manual Data Extracts Process

Select Required

Data Elements

Receive & Review

Data Dictionary

Create Standardized

Data Dictionary in a

Project Database

Data Provider

Coordinator

Modeler

Generate Uniform Data

ElementsSpreadsheet

per Data Provider

Consumer

Create/Send Sample Extract*

Generate Official

Selection Spreadsheet

Confirm via signoff

Specify Data Elements in Data Use

Agreement

Key

Review Data

Dictionary

Add Basic PII/HIPAA Indicators

Verify All “De-

Identified” Data

Elements & Indicate

Those That Cannot Be

Sent

Coordinate Meetings to Clarify Data Elements

Load Sample Extract

Identify & Resolve

Discrepancies

Create/Send Full Extract

Resolve Discrepancies

Confirm via signoff

Update Official Selection

Spreadsheet

ITERATE

Suicide Mitigation: Supplemental Process Flow – Define Data Elements to be included in Data Extracts, Develop Data Dictionaries

* Updated sample extracts as required.

Map Data Provider to Business

Needs