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Annex B (Synchronization Matrix – Army Campaign Plan for Health Promotion, Risk Reduction and Suicide Prevention)

VERSION 10 Working Document: As of 10 July 2009

Policy (Programs) Bin / # Task Po 1 (T) Develop and publish Annex D of the ACPHP to encourage Commanders to implement, as appropriate, critical

tasks for health promotion, risk reduction, and suicide prevention-related programs. (O) Annex D distributed to Commanders.

Po 1.1.0 (T) Revise DA PAM 600-24 (Suicide Prevention and Psychological Autopsies) to reflect a blueprint document to provide a "how to" guide for Army Health Promotion, Risk Reduction, Related Suicide Prevention Councils, Committees and Task Forces. (O) A revised DA PAM 600-24 (Health Promotion, Risk Reduction, Related Suicide Prevention Councils, Committees and Task Forces) to provide comprehensive guidance to the Army.

Po 1.1.1 (T) Identify and implement measures of effectiveness to assess the impact of program changes identified in the Army Suicide Prevention Program (ASPP). (O) List of measures to evaluate the effectiveness of the ASPP.

Po 1.1.1.1 (T) Identify and implement measures of effectiveness to assess the impact of program changes identified in the Army Campaign Plan for Health Promotion, Risk Reduction and Suicide Prevention (ACPHP). (O) List of measures to evaluate the effectiveness of the ACPHP.

Po 1.1.2 (T) In DA PAM 600-24 designate responsible office(s) to utilize the results of the psychological autopsy to examine investigative findings, determine trends, pull data points, and capture and distribute lessons learned to shape future solutions (when completed). (O) Maximum utilization of the data included in the psychological autopsy.

Po 1.1.3 (T) Revise regulatory guidance to emphasize support for Compo 2 & 3 Commanders to help liaison with local law enforcement, coroners, and medical examiners for purposes of documenting determination of death and collecting epidemiological data regarding off-post suspected suicides of Reserve Component Soldiers. (O) Improved access to local documents by the Reserve Components.

Po 1.1.4 (T) Establish standard policy and regulatory requirements for reporting suicide related events that are consistent across all Army Components. Current Reserve Component systems for reporting non-active duty deaths are not consistent with Active Duty reporting procedures. (O) Consistent reporting procedures across all components.

Po 1.1.7 (T) Provide annual Army-wide guidance and recommended activities for observance of Suicide Prevention Week (AC) and Month (RC). (O) Increased suicide prevention awareness.

Po 1.1.8 (T) Revise the composition, roles and responsibilities of Suicide Prevention Task Force (SPTF) to be compliant with the initiatives and guidance identified in the Army Suicide Prevention Program. (O) Clearly identified roles and responsibilities of the SPTF for all Army components.

Po 1.1.9 (T) Implement within the Army Commands (ACOMs) HQ ARNG, HQ USAR and Direct-Reporting Units (DRUs) a command level Suicide Prevention Action Plan (SPAP) which is nested with the Army Suicide Prevention Program (ASPP). (O) Proper training and oversight of ASPP activities in ACOMs and DRUs.



Policy (Programs) Bin / # Task Po 1.1.10 (T) Establish policy to adopt standard nomenclature [Diagnostic and Statistical Manual of Mental Disorders (current

edition) vs International Classification of Diseases (current edition)] as the standard for behavioral health diagnoses and definitions. (O) Standardized terminology in all informing documents.

Po 1.1.11 (T) Establish common terminology, definitions and consistent use for all terms involved in investigating and reporting suicides, suicide attempts, ideations and acts of self harm. (O) Enhanced data accuracy, integrity and reporting.

Po 1.1.12 (T) Establish a policy requiring suicide prevention training at the lowest appropriate level before and after authorized absences while deployed (ex. mid-tour leave R&R). (O) Soldiers going on and returning from leave are more aware of the stressors involved with transition phases; at-risk Soldiers are identified early.

Po 1.1.14 (T) Implement within the Army Service Component Command (ASCC) a theater-level Suicide Prevention Action Plan (SPAP) which is nested with the Army Suicide Prevention Program (ASPP). (O) Proper training and oversight of ASCC ASPP activities.

Po 1.1.15 (T) Establish guidelines for the interpretation of confidentiality laws to improve information and data disclosure from medical to non-medical entities for risk management purposes. (O) Access to information by non-medical entities for improved Soldier care.

Po 1.2.0 (T) Publish Rapid Revision of AR 600-63 (Army Health Promotion) to reflect changes in the Army Suicide Prevention Program. (O) Updated 600-63.

Po 1.2.1 (T) Revise AR 600-63 to identify the Army G1 as lead office for data collection to regulate, validate and approve suicide event related databases. Presently there are multiple agencies developing their own database solutions. (O) Improved efficiency and streamlining of data tracking.

Po 1.2.2 (T) Revise AR 600-63 to establish HQDA G1 as the primary source for official Army suicide rates. (O) A single source authority identified for suicide rate reporting.

Po 1.2.3 (T) Mandate in AR 600-63 that all SPTFs implement an integrated Family member suicide prevention program. (O) Coordinated suicide prevention efforts for Family members.

Po 1.2.3.1 (T) Revise AR 600-63 to provide suicide prevention program policy for non-installation based commands and geographically-dispersed Soldiers. Currently, AR 600-63 is installation based and focuses on services and resources found on an installation which Reserve Components, recruiters and other geographically dispersed populations cannot access. (O) Program guidance is in place for non-installation-based commands and geographically-dispersed Soldiers.



Policy (Programs) Bin / # Task Po 1.2.4 (T) Provide / clarify policy / guidance – from DA through subordinate commands to installations / Garrisons / State

JFHQ / HQ USARC / DRUs / MSCs – to standardize CHPCs, and other forums promoting inter-disciplinary teams (CDRs, MTFs, FAP, ASAP, DES, CID, RRP, Chaplaincy, Suicide Prevention, DPTMs, etc.); formalize charters; share / disseminate information; and provide integral, multi-disciplinary products and services to support and reduce risks affecting organizations, Soldiers, Civilians, and Families. (O) Health Promotion and Risk Reduction Programs (related programs) provide an integral and comprehensive picture of risks / risk trends and provide fully integrated Soldier, Civilian, and Family support and promote community wellness.

Po 1.2.5 (T) Require the publication of a formal charter signed by Senior CDR / Garrison CDR / State JFHQ CDR/ HQ USARC / DRUs / MSCs CDRs for all Health Promotion, Risk Reduction, and Suicide Prevention-related programs. At a minimum charters must clearly outline: (1) organization and membership; (2) mission; (3) scope and objectives (integration with other councils / committees); (4) meeting schedule; (5) standard products / services; (6) metrics, assessment, and reporting protocols; and (7) marketing/outreach plan. (O) Health Promotion councils, Installation Prevention Teams, and Suicide Prevention task forces are formally structured, functional, coordinated, and provide conspicuous, effective products and services.

Po 1.2.6 (T) Establish policies and procedures to facilitate long-term assistance to Families, unit members and co-workers who experience loss due to suicide; care provided via external service outreach programs. (O) Enduring assistance to survivors.

Po 1.2.7 (T) Review and revise the procedures for direct referral of all Army Component Soldiers to behavioral health when suicide risk factors are identified via PDHA / PDHRA / PHA or other standard screening methods. Current policy mandates a referral to the primary care provider as the initial step to behavioral health. (O) Increased efficiency of the Soldier referral process.

Po 1.2.8 (T) Establish standardized policies and procedures for ensuring Soldiers identified with suicide risk symptoms / behaviors are managed in a consistent manner across all Army components. Standardize procedures for unit actions include unit watch, weapons profile, etc. (O) Standard templates for procedures applied Army wide.

Po 1.2.9 (T) Immediately review and assess PDHA / PDHRA questions and update as required. (O) Improved identification of suicide risk factors.

Po 1.2.10 (T) Establish policy facilitating command referred behavioral health assessment for Soldiers undergoing significant disciplinary action (e.g. courts martial, chapter separations, etc.) when there are multiple risk factors identified. (O) Comprehensive intervention for at-risk Soldiers.

Po 1.2.11 (T) Publish guidance directing the term "mental" health be replaced with "behavioral" health as policies, regulations, training and other informing documents are revised / updated. (O) Reduced stigma associated with the use of the word "mental".



Policy (Programs) Bin / # Task Po 1.2.12 (T) Evaluate DoDSER and Army policy authorizing/implementing psychological autopsies (AR 600-63, DA Pam 600-

24) to determine if DoDSER should elicit additional information, currently secured only by a psychological autopsy, to standardize, improve, and facilitate maximal capture of information regarding suicide-related events. If indicated, recommend that DoD amend DoDSER to capture the additional information. (O) A report evaluating the need for additional information, and, if indicated, recommended amendment of DoDSER.

Po 1.2.13 (T) Develop and distribute policy guidance to optimize outreach to collateral contacts (spouse, family members, friends) to encourage participation in Soldier's treatment. (O) Provide a thorough biopsychosocial assessment of Soldiers to validate presence and severity of symptoms.

Po 1.2.14 (T) Establish a policy to convene quarterly Suicide Prevention Review Boards in deployed theaters at the Corps / Division TF / JTF Level HQ, and report findings to HQDA. (O) Army's ability to review trends, implement changes and manage suicide prevention efforts in deployed theaters is improved.

Po 1.2.15 (T) Develop and distribute policy guidance to direct the conservative use of psychiatric medications for conditions that are generally expected to resolve within 6 months (i.e., Adjustment Disorders; grief reactions) and for which psychotherapy may be a more appropriate option. (O) Appropriate use of psychiatric medications.

Po 1.2.16 (T) Develop policy directing the adoption of written credentialing criteria for the granting of specialty practice privileges within behavioral health (e.g., neuropsychological assessment within psychology privileging). (O) Clear and consistent application of specialty criteria for specialized practice in psychology, social work and psychiatry.

Po 1.2.16.1 (T) Assess and develop a centralized Army-wide credentialing / privileging process to ensure consistency, facilitate provider movement and provision of care across MTFs, regions and theaters. (O) Decreased redundancy of effort and expedited service delivery by specialty medical care across MEDCOM.

Po 1.2.17 (T) Establish policy and distribute guidance to ensure treatment protocols fully utilize opportunities for individual and family psychotherapy. Current programs generally address medical issues and fail to address psychological, social and spiritual components. (O) Comprehensive approach leads to improved resolution of symptoms, increased coping and enhanced recovery.

Po 1.2.18 (T) Review treatment protocols and establish policy to facilitate return to duty or MEB ICW DCoE. This is accomplished by appropriate utilization of neuropsychological / psychological assessment to validate complaints and symptoms and quantify deficits prior to and again after developing a plan of treatment. (O) Improved assessment to better inform treatment plans and assist in determination of return to duty / MEB status.

Po 1.2.19 (T) Establish policy to develop comprehensive treatment plans which fully utilize multi-disciplinary approach in the treatment of behavioral health issues to best address brain-behavior relationships (Rehabilitation, Psychologists, Physical Therapy, Occupational Therapy, etc). (O) Programs establish best practices enabling Soldiers to receive state of the art care.



Policy (Programs) Bin / # Task Po 1.3.0 (T) Update AR 600-85 (Army Substance Abuse Program) by Rapid Revision to reflect changes in Health Promotion,

Risk Reduction and Suicide Prevention. (O) Updated AR 600-85. Po 1.3.1 (T) Provide access to and mandate that Reserve Components comply with the reporting requirements for drug and

alcohol related events reported through DAMIS. (O) Improved tracking of risk factors across all components. Po 1.3.2 (T) Review and validate the 21 high-risk factors established by the Risk Reduction Program in AR 600-85 Table 12-1.

Staff across ARSTAF to address additions, deletions and redefinition of terms. (O) Ensure a comprehensive risk reduction product.

Po 1.3.3 (T) Implement common terminology and definitions for suicide gestures and attempts - established by OTSG - to facilitate established mechanisms supporting installations in meeting the requirement to report suicide gestures and attempts in accordance with AR 600-85 12-3(b) for every battalion and separate company (by UIC). (O) Common terminology improves the accuracy of reporting suicide gestures and attempts.

Po 1.3.4 (T) Assess, identify and synchronize all surveys, tools and surveillance methods used across the Army to identify high-risk behaviors including suicide (i.e. URI / R-URI / PDHA / PDHRA). (O) Surveys are consolidated using an enterprise approach and the Army has a common operating picture of high-risk behaviors.

Po 1.3.5 (T) Clarify policy establishing procedures for the Alcohol Drug Control Officer (ADCO) to access information (abstracts) derived from the Centralized Operations Police Suite (COPS) on a recurring basis. (O) Maximize information sharing related to high-risk behaviors.

Po 1.3.6 (T) Revise the Risk Reduction reporting process in AR 600-85 (ASAP) to create a quarterly "rolling" data report (versus only by calendar quarter) on a monthly basis for use by commanders. (O) Provides relevant and timely risk factor data for units.

Po 1.3.7 (T) Re-evaluate whether Soldiers enrolled in ASAP Level I should not be deployed or PCS'ed. Mitigating factors should be a consideration in this determination. (O) Resilient Soldiers on deployment or change of station.

Po 1.3.8 (T) Conduct a pilot / demonstration to determine effectiveness of allowing Soldiers to self refer to the Army Substance Abuse Program (ASAP) education and / or treatment without commander notification. Revise the policy, if necessary, to require a Soldier's commander to be notified only upon enrollment into ASAP. Currently, it is required that commanders are notified whenever a voluntary assessment is made even if it does not result in enrollment into the program. (O) Increase willingness of Soldiers to be evaluated and reduce stigma.

Po 1.3.10 (T) Establish policies requiring losing Social Work Services (Family Advocacy Program cases) and ASAP to effectively notify gaining activities of enrolled at-risk (e.g., previous suicide attempts) Soldiers transferring to their locations during any changes of station (TDY / PCS / TCS / REFRAD). (O) Improved continuity of care.



Policy (Programs) Bin / # Task Po 1.3.11 (T) Reinforce the policy in AR 600-85 (The Army Substance Abuse Program) para 4-5a(1) which states that each

Soldier has an equal chance of being selected for a urinalysis test each time random testing is conducted. Emphasize Army Substance Abuse Program staff / personnel do not have the authority to exclude or eliminate Soldiers from urinalysis tests who continue to test positive. (O) Random drug testing not only supports medico-legal actions but ensures no Soldier drops below command visibility.

Po 1.3.12 (T) Amend the limits of 100% testing in AR 600-85, chapter 4, to allow commanders flexibility to conduct 100% urinalysis testing (unit sweep), incorporating "smart testing" methods. This expansion of unit sweep testing would be in addition to, and complimentary of, a good, truly random testing program. Smart testing is random testing conducted in such a manner that it is unpredictable by the testing population. This randomness must expand beyond random selection of Soldiers, but must include randomness of frequency (how often the commander tests) and periodicity (when during the month / week / day the commander tests). Unpredictability is the primary factor deterring Soldiers from using drugs. The absolute minimum rate of testing is one random sample per active duty Soldier per year (i.e., 100 Soldiers in the unit equals 100 random samples submitted per year; this is in addition to the 100% unit sweeps). (O) Commanders will be able to augment their random testing program with 100% unit sweeps incorporating smart testing techniques.

Po 1.4.1 (T) Rapidly revise AR 40-66 para. 8-9, which governs use of AHLTA, to require entry of ASAP notes and forms into AHLTA at the time the notes and forms are generated. Rapidly revise AR 600-85, which governs ASAP, to cross-reference the revised policy in AR 40-66, to advertise the requirement. (O) Behavioral health care providers access critical Soldier-care information, gleaned by their ASAP counterparts, at the same time ASAP learns the information, enhancing behavioral health care to at-risk Soldiers.

Po 1.5.1 (T) Review, rapidly revise, or rescind AR 40-216, 10 AUG 84 (Neuropsychiatry and Mental Health) ICW AR 600-63, DA PAM 600-24 and the Army Suicide Prevention Program to reflect current Army organization and structure. (O) Updated AR 40-216.

Po 1.6.1 (T) Revise AR 220-1 (Unit Status Report) to include monthly reporting for mandatory referrals for all drug positives and serious alcohol related misconduct and subsequent processing for separation. (O) Improved collective reporting will assist commanders in identifying and applying risk mitigation to high risk areas.

Po 1.7.1 (T) Resolve conflict between DODD 6490.1 (para 4.2.3.2) and DODI 6490.4 (para 6.1.3) regarding the recipient of the memorandum command directing a Soldier for a behavioral health assessment. Direct memorandum be sent to the behavioral health professional conducting the evaluation rather than the chair of mental health department. (O) Increase the promptness and efficiency of the evaluation of potentially at-risk Soldiers.



Policy (Programs) Bin / # Task Po 1.7.2 (T) Recommend revision of DODD 6490.4 para 6.3.2.1 which permits command directed referrals to change language

to "suspected behavioral health issues." Current policy requires the commanding officer to believe that a service member is suffering from "severe mental disorder"; severe is undefined. This policy limits the ability of the commander to intervene and refer for minor problems facilitating early resolution of problems and rapid return to duty. (O) Early identification and resolution of Soldier behavioral health issues and return to duty.

Po 1.7.3 (T) Recommend revision of DODD 6490.4 requirement to permit command referrals for behavioral health consultation for other than administrative separation proceedings. (O) Commanders can conduct behavioral health referrals for both administrative separations and other behavioral health issues as appropriate.

Po 1.7.4 (T) For command directed behavioral health evaluations revise DODD 6490.1 para 4.8.2 to have the personality disorder discharge be co-signed by a senior behavioral health clinician rather than the care provider's commanding officer. Commanding Officers of Behavioral Health Provider may not be qualified to diagnose mental illness. (O) Ensures that diagnosis is validated by credentialed behavioral health provider.

Po 1.7.5 (T) Align Army policy with requirements of DODD 6490.1 para 4.6.3.2 regarding recommendation for administrative separation for more than one episode of dangerous behavior. Non-compliance could result in increase in suicidal events. Compliance could result in larger number of administrative separations and facilitate stigma. Ensure consistency with HIPAA. (O) Policy that is compliant with current DODD regulations and reduction of high risk behavior in the Army.

Po 1.7.6 (T) Review and revise MEDCOM Policy Memo 09-012, 13MAR09, Subject: MEDCOM Procedures for CH 5-13, Personality Disorder Separations, to eliminate the need for second level review by OTSG / MEDCOM. (O) Soldiers and unit personnel will receive timely separation evaluations to reduce risk, enhance safety and ensure mission readiness.

Po 1.7.7 (T) Review and revise MEDCOM Policy Memo 09-012, 13MAR09, Subject: MEDCOM Procedures for CH 5-13, Personality Disorder Separations, to eliminate the need (a) to distinguish between Soldiers who have deployed or are currently deployed to an imminent danger pay area and those who have not deployed (b) to distinguish between Soldiers who have served for 24 months and those who have not and (c) to apply AR 635-200 Active Duty Enlisted Administrative Separations chapter 5-17 when it appears 5-13 governs. (O) Clarification will enhance separation procedures.

Po 1.8.1 (T) Revise AR 600-8-4 to require the LOD investigating officer consider results of the CID investigation / toxicology reports before final LOD determination when applicable. (O) A more complete and accurate determination.



Policy (Programs) Bin / # Task Po 1.8.2 (T) Amend Suicide Prevention Training to include information on Survivor Benefit Plan (SBP) and Dependent

Indemnity Compensation (DIC). Instruction to inform Family members of active duty Soldiers that DIC benefits will not be automatically received, in order to avoid incentivizing suicide. Evaluate current Army policies regarding LOD and suicide (e.g., AR 600-8-4 (Line of Duty Policy, Procedures, and Investigations)) to determine if policy should be amended to ensure consistent treatment award of DIC benefits; issue report to VCSA with policy recommendation. (O) Soldiers and their families receive accurate, consistent information regarding DIC payments, and DIC payment policy gap resolves.

Po 1.9.1 (T) Develop requirement at unit level to track and manage mandatory suicide prevention training of individual Soldiers IAW AR 350-1. (O) Improved ability to ensure all Soldiers receive required training.

Po 1.20.1 (T) Remove "moral turpitude" from AR 601-270 (MEPS) because it is a legal term being interpreted by unqualified personnel. (O) Clear regulatory waiver guidance.

Po 1.20.2 (T) Remove the word "generally" from AR 601-270 (MEPS) paragraph 6-4 to read " … medical examinations at the MEPS will consist of a medical history and clinical evaluations laboratory findings and other measurements as prescribed in AR 40-1." (O) Clear regulatory waiver guidance.

Po 1.20.3 (T) Revise AR 601-270 (MEPS) paragraph 9-15a to further restrict the conditions by which recruiting / accession waivers may be granted. Current policy is vague. (O) Reduce the number of high risk Soldiers recruited and accessed into the Army.

Po 1.20.4 (T) Mandate recruits furnish a waiver releasing all medical psychiatric and pharmaceutical records during the accession process directly to MEPS to identify individuals with pre-existing psychological conditions or treatment history and preclude enlistment / appointment of Soldiers determined to be high-risk for suicide. (O) Reduced number of high-risk individuals entering the Army.

Po 1.20.5 (T) Revise AR 601-270 (MEPS) to establish the use of a psychological screening tool at MEPS to evaluate emotional behavioral and social suitability for military service. (O) Reduced number of high-risk individuals entering the Army.

Po 1.20.6 (T) Review and recommend revision, as needed, of DoDI 6130.4 of the waiverable conditions / diagnoses / criteria required for entrance into military service. (O) Reduce the number of high risk Soldiers recruited and accessed into the Army

Po 1.20.7 T) Review and recommend revision, as needed, of DoDI 6130.4 to define the threshold of severity for which medical accession waivers will not be granted. Severity is a vague term left to be defined by non-medically trained personnel (O) Reduced number of high-risk individuals entering the Army

Po 1.21.1 (T) Require commanders to out brief the families of all Soldiers who die while in a duty status and whose deaths are determined to be suicide. (O) Enhanced communication between families and command.



Policy (Programs) Bin / # Task Po 1.21.2 (T) Develop standard Army policy for conducting memorial and ramp ceremonies for suicides. (O) Consistent policy

across the force for recognition of suicide victims while de-glamorizing suicidal behavior. Po 1.22.1 (T) Assess entry level officers against first term suicides; if necessary, revise policy to require separation for non-

disclosure of behavioral health history at appointment (pre-commission / commission / warrant). (O) Improved management of at-risk Officers and Warrant Officers.

Po 1.22.2 (T) Revise separation policy for officers and warrant officers who have been characterized / identified as "failing to perform" / "insufficient" if there is a history of a traumatic event (e.g. mTBI / PTSD) to receive a behavioral health evaluation.(O) Consistent application of Army policy / intent across all grades.

Po 1.23.1 (T) Rapidly revise policy to permit psychologists to serve on MEB / PEB and write the MEB report for behavioral health issues. (O) Expedite the board process by aligning assessments with the appropriate medical discipline specialty.

Po 1.24.1 (T) Expand the role of the public health nurse (PHN) as stated in DA PAM 40-11 (Preventive Medicine) to include behavioral health as part of conducting home visits for health and safety assessments. (O) Improved care to Soldiers and their Families.

Po 1.24.2 (T) Revise DA PAM 40-11 (Preventive Medicine) section 7-23 to ensure common terminology which has definitional consistency for "suicide gestures" and "suicide attempts". The definitions in the pamphlet are not consistent with other publications. (O) Consistent use of terms in all Army documents related to suicide prevention.

Po 1.24.3 (T) Revise DA PAM 40-11 (Preventive Medicine) section 11-3 to designate SPTF (currently Preventive Medicine) as lead coordinating agency for suicide prevention training. (O) Standardized and coordinated suicide prevention training.

Po 1.25.1 (T) Revise or rescind DA PAM 600-70 Guide to the Prevention of Suicide and Self-Destructive Behavior 1 NOV 85. (O) Removal of outdated policy.

Po 1.26.1 (T) Establish policy for quarterly reporting from MEDCOM and IMCOM to G1 for authorization / on-hand by location for Behavioral Health Officers and Civilians (Psychiatrists, Psychologists, Social Workers, Psychiatric Nurse Practitioners, Clinical ASAP providers) and Enlisted (68X MOS). (O) Provides quarterly evidence whether the Army is effective in recruiting hiring and retaining Behavioral Health professionals.

Po 1.26.2 (T) Evaluate the Soldier Wellness Assessment Program (SWAP) for expansion to all installations. (O) Best practice implemented to address Soldiers’ well-being on a continuous basis.

Po 1.26.3 (T) Ensure the Army Suicide Prevention Program nests with the draft DODI on suicide prevention currently being developed by the Suicide Prevention and Risk Reduction Council (SPARRC) for compliance with DOD. (O) Synchronized suicide prevention efforts.

Po 1.26.4 (T) Revise AR 600-63 to require commanders of active army units to share information on Title-10 reserve component Soldier suicides with parent reserve component unit. (O) Bi-directional communication.



Policy (Programs) Bin / # Task Po 1.26.5 (T) Assess and revise if necessary the Deployment Cycle Support (DCS) checklist tasks adequately identify high-risk

Soldiers prior to and following deployment. (O) Validate DCS tasks that support identification of high-risk Soldiers. Po 1.26.6 (T) Direct SPTFs from any command having geographically-dispersed Soldiers to develop resource listings and MOAs

with local prevention / intervention / treatment services. Develop STRATCOMs to educate Soldiers and Families of available local resources. (O) Geographically-dispersed Soldiers and Families are aware of and have access to available local services.

Po 1.26.7 (T) Develop relationships between Army (all levels) and civilian professional organizations (AAS, APA, etc.) to foster mutual participation in conferences seminars and professional exchanges in order to share best practices and ongoing research for suicide prevention. (O) Army suicide prevention efforts are informed by civilian best practices.

Po 1.26.13 (T) Codify and implement the battle buddy system throughout the deployment cycle across all grades, MOSs and components as a best practice. Ensure inclusion of IRR, Professional Filler System (PROFIS) providers, recalls, IMAs, etc. (O) Battle Buddy System inculcates network / Soldier Support for increased identification of high-risk behavior; subsequent intervention reduces suicide related events.

Po 1.26.17 (T) Produce a Strategic Communication Plan that provides for standardized multimedia, multimodal marketing program to create awareness of the existence, nature and availability all Army health promotion and risk reduction products and services. Standardize delivery of resultant communications. Standardize metrics to measure awareness of products and services by Soldiers and their Families. (O) Increased awareness which leads to the use of Army health and risk reduction products and services by Soldiers and their Families.

Po 1.26.18 (T) Clarify the Army G1 as the single proponent of the Army Suicide Prevention Program responsible for integrating all DA policy and memoranda to eliminate staff / agency duplication of effort. (O) The G1 is the single integrator for Army-wide suicide prevention efforts.

Po 1.27.1 (T) Evaluate the Automated Behavioral Health Clinic (ABHC) for implementation across the Army. (O) Improved identification and subsequent management of risks.

Po 1.27.2 (T) Review the policy and effectiveness of in-theater psychological debriefings (Critical Incident Stress Debriefings) after deaths, serious injuries and other critical events. Identify effective postvention protocols. (O) Identify effective techniques to demonstrate improved coping skills.

Po 1.27.3 (T) Revise policy and procedures to ensure a positive hand-off for Soldiers and Families of all Components transitioning from military to civilian providers. Implement case management programs for use by all Compos. This includes retirements ETS demobilization of RC Soldiers etc. (O) Continuity of behavioral health care.

Po 1.27.4 (T) Evaluate Nov 06 guidance from OASD (HA). Establish and publish objective behavioral health criteria to determine deployment fitness / eligibility. (O) Objective criteria ensuring resilient Soldiers on deployment.



Policy (Programs) Bin / # Task Po 1.27.5 (T) Develop MEDCOM policies to encourage best practices (e.g. psychotherapy, behavioral therapy, group therapy,

etc.) for Soldiers being prescribed multiple psychotropic medications based on provider recommendations. (O) Soldiers receive optimal behavioral health care that addresses the problems underlying stress, anxiety and depression and minimizes risk of unintended drug interaction

Po 1.27.6 (T) Establish / reinforce objective criteria for medical stabilization prior to PCS (e.g. ASAP enrollment, behavioral health treatment, etc.). (O) Clear criteria are established to ensure completion / continuity of care for PCS'ing Soldiers.

Po 1.27.7 (T) Revise policy and procedures to ensure a positive hand-off for Soldiers and their Families transitioning from military providers to civilian in-patient programs and back to military providers. This includes substance abuse, psychiatric and other medical specialties. (O) Continuity of health care.

Po 1.27.8 (T) Establish a quality assurance and peer review policy by which "at risk medication" prescriptions are tracked when more than two psychiatric / psychotropic medications are prescribed. (O) Increased oversight of psychiatric / psychotropic medications and a reduction in poly-pharmacy.

Po 1.27.9 (T) Establish a procedure for health care providers / pharmacy that cross-references active medications in AHLTA VISTA and TRICARE. (O) Improved quality of care and reduced risk of drug interactions.

Po 1.27.11 (T) Evaluate the need to conduct root cause analysis (Quality Assurance / Performance Improvement) for overdose, suicides and equivocal deaths occurring within 31 days of last scheduled medical appointment. (O) Results in improved situational awareness and lessons learned to enhance subsequent quality of care.

Po 1.27.12 (T) Evaluate the need to establish policy requiring the provider to initiate medical follow-up within 24 hours for any Soldier who misses a scheduled appointment where psychiatric medications are to be re-evaluated or re-filled. (O) Enhanced quality of care and reduction in suicide related events or accidental death.

Po 1.27.13 (T) Establish a policy requiring Soldiers to sign a statement acknowledging understanding / awareness of the dangers of mixing alcohol with prescribed medications upon receipt of prescriptions at pharmacies. The statement should also delineate responsibilities to notify the command if medications will impact the ability to perform duties (e.g. operating vehicles / heavy equipment). (O) Reduced suicide related events or accidental death.

Po 1.27.14 (T) Establish a policy mandating Combat Stress Control Teams enter appropriate clinical notes into AHLTA (or field medical record) specifically when medications are prescribed. (O) Improved communication and quality of care across the health care continuum.

Po 1.27.15 (T) Establish processes to ensure that behavioral health information of at-risk Soldiers is included in their deployment health records and transferred to servicing MTFs in theater, and theater treatment records are transferred out of theater with Soldiers. (O) Improved continuity of care.



Policy (Programs) Bin / # Task Po 1.27.17 (T) Establish a policy requiring a comprehensive alternative pain management approach for Soldiers coping with

chronic pain to reduce the dependency on Opioid narcotics (e.g alternative treatment modalities for pain such a spinal cord stimulation; acupuncture; massage therapy; cognitive behavior therapy). (O) Improve overall outcomes and individual management of pain; decreased incidence of pain medications contributing to accidental deaths.

Po 1.28.1 (T) Create policy to authorize MTF commanders to have direct hire authority for the full spectrum of personnel needed to support patient care. (O) Expedited hiring practices for access to care.

Po 1.28.2 (T) Recommend an amendment to TRICARE benefits to cover "V" codes (which are foci of treatment but not diagnoses e.g. relationship problems) as a "covered service" for Soldiers and Family members. (O) Early and affordable access to behavioral health care with reduced stigma and improved outcomes.

Po 1.29.1 (T) Establish policy to mandate Commanders (at all unit levels) publish a suicide prevention policy (e.g. full participation in behavioral health screenings, importance of reducing stigma, and unit program elements). Implement programs as identified in health promotion, risk reduction, and suicide prevention-related programs. (O) Organizations (company and above) have an established policy to promote health reduce risk and prevent suicide-related events.

Po 1.29.2 (T) Commanders will establish a policy to ensure Soldiers seeking help/identifying behavioral health problems are not belittled or ostracized. (O) Army culture is changed to one of support and tolerance of Soldier's behavioral health issues.

Po 1.29.3 (T) Identify modifiable risk and protective factors associated with suicide, mental disorders, and psychological resilience, by evaluating AD and RC Soldiers across all phases of Army service. Identify intervention options based on empirically-identified risk factors. Rapidly implement, as feasible, targeted interventions (medical and organizational) to reduce the incidence of suicides. Collaborate with MRMC and CHPPM to design and evaluate interventions for reducing risks and enhancing resilience. (O) Data-driven methods for mitigating or preventing suicide behaviors and improving the overall mental health and behavioral functioning of Army personnel during and after their Army service.



Doctrine Bin / # Task

D 2.1.1 (T) Write the Army Campaign Plan for Health Promotion, Risk Reduction, and Suicide Prevention (ACPHP) to synchronize actions across the Army through immediate and enduring Policy-DOTMLPF-Resource solutions. (O) A campaign plan that integrates, synchronizes, and implements a multi-disciplinary approach to health promotion across all Army disciplines.

D 2.1.1.1 The ARNG and USAR will augment the ACPHP by providing informing documents for their respective components. (O) The ARNG and USAR have relevant guidance for integration and implementation of the ACPHP.

D 2.1.2 (T) Develop procedures and products in Phases I and II of the Army Campaign Plan for Health Promotion, Risk Reduction, and Suicide Prevention (ACPHP) to synchronize all suicide prevention efforts for HQDA / ARNG / USAR. (O) Situational awareness for senior leadership to make informed decisions.

D 2.1.3 (T) Develop procedures and products in Phase III to continuously update senior leaders on suicide related events. (O) Situational awareness for senior leadership to make informed decisions.

D 2.1.4 (T) Develop synchronization matrix as an annex to the ACPHP (O) A synchronized and integrated campaign plan.

D 2.2.1 (T) Establish partnership with Centers for Disease Control (National Violent Death Reporting System) to share in public health collaboration on suicides in the United States. Bring national research findings into the Army as applicable. (O) Correlate the Army's suicide statistics and findings with the statistics gathered on the general population.

D 2.2.2 (T) Integrate Army programs by defining roles and responsibilities of the Army Suicide Prevention Program, Well-Being, and the Army Comprehensive Soldier Fitness Program to eliminate redundancy, create efficiencies, leverage resources and effort, identify and close gaps to improve Soldier health. (O) Integrated and efficient Army programs.

D 2.2.4 (T) Examine coalition partners' suicide prevention and incorporate best practices to improve the effectiveness of the ASPP. (O) Best practices are adopted for health promotion, risk reduction, and suicide prevention.

D 2.2.5 (T) Define the lines of operations between the ASPP and DCoE to eliminate redundancy, create efficiencies, and leverage resources and effort. (O) A coordinated effort between DoD and the Army.

D 2.2.6 (T) Ascertain the factors leading to successful interventions and decisions by Soldiers to not follow-through on thoughts of harming themselves. (O) Reinforce successful programs to increase protective / coping factors.




D 2.2.7 (T) Determine if there is a correlation between the ARFORGEN cycle and suicide related events. If there is a correlation, ensure that proper resources are available during identified high-stress periods within the cycle. (O) Appropriate resource allocation.

D 2.2.8 (T) Ensure Army research programs are visible by DCoE, and Army equalities are represented within DCoE. (O) A coordinated and synchronized effort in improving the health of Soldiers.

D 2.3.2 (T) Assess and adopt, if appropriate, the Combat and Operations Stress Control Workload and Activity Reporting System (COSC-WARS), used by MNC-I, as an Army-wide system to uniformly collect and record behavioral health information. (O) A single system to collect behavioral health information and improved continuity of care.

D 2.3.3 (T) Establish in-processing and out-processing procedures for all Soldiers to include behavioral health, ASAP and/or FAP (Social Work Services) to effectively facilitate a positive hand-off to gaining installations. (O) Add behavioral health, ASAP and Social Work Services to Garrison in/out-processing checklists to improve continuity of care.

D 2.3.4 (T) Modify AHLTA to permit only current / relevant problems to be listed on the Active problem list. Currently all problems, including those that are resolved, are listed making it difficult to determine areas requiring assessment. (O) Treatment providers focus on current problem areas therefore improving quality of care.

D 2.3.5 (T) Enforce doctrine requiring documentation of medical treatment at point of injury. Review and consider adopting the Ranger Pre-Hospitalization Trauma Registry (PHTR) across the Army to assist in the tracking of all aspects of far-forward medical care. This will facilitate compliance with established doctrine for documenting medical treatment at point-of-injury. (O) Documented point-of- injury medical treatment to improve Tactical Combat Casualty Care, trauma outcomes, medical training, medical equipping and informed force protection research.

D 2.3.6 (T) Review and consider adopting tele-behavioral technology and concept of operations developed by OTSG for incorporation in ASAP prevention, assessment and intervention / treatment activities. (O) Increased number of services available, increased timeliness of service delivery, optimization of current resources and overall improved access to care.

D 2.3.8 (T) Develop a plan to support the roll-out of a comprehensive Tele-Behavioral health system across the Army, identifying unmet needs, and utilize technology and professional staff as a behavioral health force multiplier where appropriate. (O) Increased access to and availability of Behavioral Health clinical services for Soldiers & Families, increased timeliness of BH clinical service delivery, optimized resources, increased collaboration with other DoD Services’ Tele-Health efforts utilizing the established forums, shared best practices, improved identification of ‘at risk’ Soldiers (and Families).




D 2.4.1 (T) Use social networking technologies (ex. Twitter, Facebook, MySpace) to pass crisis (e.g., suicide / homicide) ideation information from concerned Family members and friends to co-workers, friends, and associates. (O) Leverage generation appropriate communication capabilities to accelerate response time and mitigate suicide.

D 2.4.3 (T) Establish a digital library of lessons learned on suicide related events to provide all leaders tools to enhance unit level suicide prevention efforts. (O) Collaborative distributed Suicide Prevention forum for use by Army leaders.

D 2.4.4 (T) Establish and disseminate "red-phone" voice and e-mail procedures / capability, to pass "priority traffic" on suicide ideation information within the Army and from concerned Family members. (O) The "helpers" will have a resource to provide immediate intervention to crisis situations.

D 2.4.5 (T) Establish procedures and protocols for Military OneSource to be promoted as a crisis intervention hot line allowing trained professionals to assist with crisis intervention and immediate referral as well as location-specific emergency points of contacts at installations. (O) Military OneSource personnel will have protocols and resources to provide immediate intervention to crisis situations for Soldiers, Family members, and DA Civilians.

D 2.5.1 (T) Develop metrics to measure the utilization and effectiveness of the Risk Reduction Program to decrease high risk behavior(s). (O) Optimized Risk Reduction Program that identifies high risk behaviors, thus allowing commanders to initiate interventions which lower the frequency of high risk behavior(s).

D 2.5.5 (T) Evaluate the effectiveness of HQDA Risk Reduction Program to include Risk Reduction measures of effectiveness and the Risk Reduction Working Group to properly compile, analyze and assess the measures being used at installations / State JFHQ / RSC to reduce suicide. (O) Confirmation or deletion of the HQDA RRPWG.

D 2.5.6 (T) Examine all on-going and proposed Army-sponsored studies related to suicide and identify redundancies. (O) Redundancies are eliminated and resources are better utilized.

D 2.5.7 (T) Develop measures of effectiveness for marketing, promotion activities and strategic communications associated with Army Health Promotion, Risk Reduction and Suicide Prevention programs. (O) Target audiences are identified and the strategic messages are effective.

D 2.5.9 (T) Examine all on-going and proposed State / USAR initiatives related to health promotion, risk reduction and suicide prevention. Establish a plan which identifies programs and disseminates requirements to ensure appropriate level of care for USAR and ARNG Soldiers. (O) Best practices are available across the ARNG and USAR.



Organization

Bin / # Task

Org 3.1.1

(T) Assess current status and evaluate the need for a HQDA Army Suicide Prevention Council (ASPC) to initiate, implement, and approve multi-disciplinary suicide prevention solutions as specified in the Army Campaign Plan for Health Promotion, Risk Reduction and Suicide Prevention (ACPHP). (O) VCSA Chartered Army Suicide Prevention Council executing the ACPHP.

Org 3.1.2 (T) Draft and maintain a wire diagram outlining the relationship of the various entities involved with the Army Suicide Prevention Program. (O) Single-source depiction of all suicide prevention activities within the Army and their inter-relationships.

Org 3.1.3 (T) Assess the current status and re-establish a HQDA General Officer Steering Committee (GOSC) in ACPHP Phase III, per VCSA guidance. (O) Chartered, enduring GOSC that provides strategic oversight of the ASPP.

Org 3.1.4 (T) Assess the requirement to create a multidisiplinary (e.g. G1, G3, and OTSG) HQDA Suicide Specialized Augmentation Response Team (SSART). (O) A trained and ready quick response force ready to respond to pockets of increased suicide related events.

Org 3.1.5 (T) Establish a plan for a multi-staff / agency compliance arm (G1, MEDCOM, IMCOM, ARNG, USAR, etc) to measure and assess the effects of the ACPHP. (O) The Army is actively assessing, training and gathering feedback to adjust health promotion programs and initiatives.

Org 3.2.1 (T) Develop an Army Suicide Prevention Task Force Charter designed to integrate, synchronize, and implement a multi-disciplinary approach to suicide prevention across all facets of the Army to provide commanders with the programs, services, and resources to reduce Army suicides. (O) Charter signed by VCSA.

Org 3.3.2 (T) Establish in regulation stand-alone Suicide Prevention Task Forces (SPTF) at each installation / HQ USARC / DRUs / MSCs / State JFHQ. Incorporate Charter templates into policy. (O) SPTF becomes the single integrator for local suicide prevention efforts.

Org 3.3.3 (T) Establish at installation / HQ USARC / DRUs / MSCs / State JFHQ level a Risk Management Team (RMT) subordinate to the Community Health Promotion Council (CHPC). The RMT provides the commander information to synchronize medical and legal actions for Soldiers. Focus is on Soldiers who commit multiple criminal / substance abuse and other high risk events. (O) A single body that addresses the medical and administrative needs presented by high-risk cases.

Org 3.3.4 (T) Establish a Suicide Prevention Program Manager (SPPM) at the installation / O&F Command or MSC / RSC / State JFHQ (O) Single individual at the installation / O&F Command or MSC / RSC / State JFHQ responsible for



Organization

Bin / # Task integration and implementation at all levels of the ASPP.

Org 3.3.5 (T) Consolidate / co-locate clinical and non-clinical ASAP / FAP at Fort Campbell as a pilot to assess providing seamless services from education / prevention to counseling / treatment for implementation Army-wide. (O) Integration and synchronized command and control within the ASAP and the FAP, facilitating continuity and coordination of care reflecting best practices.

Org 3.3.6 Re-integrate and organize the non-clinical and clinical sides of the Army Substance Abuse Program (ASAP) under one organization. Define areas of policy, execution of services and realignment of funding and resources to support the initiative. (O) A seamless and comprehensive process for Soldiers, Family members and DA Civilians who are seeking / requiring ASAP services,

Org 3.4.1 (T) Establish enduring Army structure to project Epidemiological Consults (EPICON) field investigations Army-wide to evaluate and characterize outcomes from population-based studies. (O) Dedicated capability to conduct EPICON.

Org 3.4.2 (T) Establish Initial Operational Capability for the CHPPM Suicide Analysis Cell. (O) Data analysis conducted in near real time for early identification of trends.

Org 3.4.3 (T) Immediately assess and adjust the medical templates in the Automated Staffing Assessment Model (ASAM) to grow primary / behavioral health care provider populations to increase medical capabilities / capacity at all levels of the Installation; review TO&E design to increase behavioral health providers in tactical formations (DIV to BN level). Expand the Army medical community to compensate for both appropriate rules of allocation under a protracted conflict and to compensate for the “Grow the Army Initiative” from ~482K to ~548K to increase capabilities / capacity and to reduce “compassion fatigue” as outlined above. (O) Medical templates provide appropriate medical capabilities and capacity to service an Army at war.

Org 3.5.1 (T) Expand Reserve Component Risk Reduction Program assessment capabilities and resourcing. (O) Risk Reduction Program expanded to include reporting and tracking of applicable risk factors impacting overall unit health.

Org 3.6.1 (T) Fill Chaplaincy to appropriate levels using existing templates / rules of allocation, and then assess current rules of allocation (templates) to account for OCCH requirements and change in Chaplain mission / workload. (O) Units are appropriately staffed with Chaplain support to enable Soldiers and Families receive optimal counseling, spiritual guidance, and suicide prevention training.



Training

Bin / # Task T 4.1.1 (T) Determine training, certifications, and qualifications of all suicide prevention trainers, facilitators, and service

providers to ensure standardization. (O) Consistent implementation of training programs. T 4.1.2 (T) Evaluate results of the ongoing ASIST pilot test to determine target population, and to change training to an annual

requirement. (O) ASIST is validated by the ASPTF for appropriate audience and training frequency.

T 4.1.3 (T) Create interactive video to enhance intervention skills for Soldiers, Families, DA Civilians, RC and small unit leaders, and distribute it to all battalions across the Army. (O) Intervention skills training extended across the Army components and personnel.

T 4.1.3.1 (T) Create a RC specific interactive video to enhance intervention skills for Soldiers, Families, and small unit leaders, and distribute it to all battalions across the Army. (O) Intervention skills training extended across the Army components and personnel.

T 4.1.4 (T) Create an awareness video with senior leader messages and small unit leaders / Soldiers / DA Civilians / RC stories on suicide prevention to increase awareness and market the Army message "Shoulder to Shoulder: No Soldier Stands Alone" (O) Suicide prevention skills training extended across the Army components and personnel.

T 4.1.4.1 (T) Create a RC specific awareness video with senior leader messages and small unit leaders / Soldiers / stories on suicide prevention to increase awareness and market the Army message "Shoulder to Shoulder: No Soldier Stands Alone" (O) Suicide prevention skills training extended across the Army components and personnel.

T 4.1.5 (T) Create and disseminate quick reference pamphlets for small unit leaders. (O) Increased suicide prevention program awareness.

T 4.1.6 (T) Integrate resiliency training into the Deployment Cycle Support task list from the ARNG for broader application as best practices within the Army. (O) Improved Active Component resiliency programs.

T 4.2.1 (T) Establish methods to inform Soldiers and Family members about behavioral health treatment options when moving from MTF care to civilian providers (ex. geographically dispersed or Reserve Component) to ensure continuity. (O) Improved continuity and access to care.



Training

Bin / # Task T 4.2.2 (T) Develop suicide prevention training products for conditions-based, high-stress periods / activities; distribute via a

single integrated online catalog to supplement organizational programs. (High-stress periods/activities include but are not limited to deployment, re-deployment, post-suicide events, rear-detachment activation, holiday exodus.) (O) Comprehensive and standardized resources for the field.

T 4.2.3 (T) Develop measures of effectiveness for suicide prevention training to assess attainment of training objectives. (O) Viable and relevant training that contributes to the reduction of suicides and suicide-related events.

T 4.2.4 (T) Modify the POI to include behavioral health / risk reduction topics (e.g., high-risk behavior identification and suicide prevention) in all 56M (chaplain assistant) and 68W (medic) MOS training to sharpen suicide prevention skills. (O) Typical first responders better prepared for assessment and intervention.

T 4.2.5 (T) Evaluate results of the ongoing ACE pilot test to determine target population, and to change training to an annual requirement. (O) ACE is validated by the ASPTF for appropriate audience and training frequency.

T 4.2.6 (T) Award Continuing Education Units / Continuing Medical Units for standardized suicide prevention training to encourage participation. (O) Increased participation in suicide prevention training by medical and other helping professionals.

T 4.3.1 (T) Develop and implement specific suicide prevention tactics, techniques, and procedures (TTP) for commanders, military law enforcement, and Judge Advocate General (Trial Defense Services and Legal Assistance) personnel to mitigate potential suicide related events during investigations, adjudications, or other adverse actions. (O) Improved identification and intervention skills.

T 4.3.2 (T) Mandate annual suicide prevention training (awareness \ intervention) for Soldiers and offer similar training to Department of the Army Civilians to increase awareness of risk factors and to enhance early intervention. (O) Better informed Soldiers and DA Civilians.

T 4.3.3 (T) Develop a document for integration of ASPP into all officer accession programs (USMA, ROTC, OCS, State OCS, WOCs, etc.) training programs (cadre and cadets) to maximize compliance with the ASPP. (O) A standardized ASPP block of instruction is taught across the Army.



Training

Bin / # Task T 4.3.4 (T) Integrate an ASPP POI into preparatory/orientation courses for Soldiers/DAC preparing for joint assignments and

geographically-dispersed training/education programs to maximize compliance with the ASPP. Training and education programs include: fellowships, training with industry, degree completion, Health Professional Scholarship Programs, graduate programs, and other Transient Trainee Holding Student (TTHS) accounts. (O) A standardized ASPP block of instruction is taught to Soldiers/DAC who will be serving in external assignments.

T 4.3.5 (T) Provide formal training for counseling at the Chaplain Basic and Advanced Courses. Develop and field in-service training for one-on-one and group counseling skills; seek external training / certification opportunities (e.g., professional courses, fellowships, internships, exchanges, etc.). Focus counseling on comprehensive wellness, behavioral health referral consultations, and integration within the behavioral health community including behavioral health providers, CSCTs, ASAP / FAP, MFLCs, etc. Define clear boundaries between counseling and referral requirements; develop standards of conduct and behavioral integration points at BN and CO levels. (O) Chaplains are fully trained to provide front-line counseling, and aware of the integrated community and referral requirements.

T 4.4.1 (T) Develop a training program for Casualty Assistance Officers (CAO) to address the unique characteristics of suicide cases. (O) Cooperative relationship with the Army which allows gathering complete and accurate information from the family.

T 4.4.2 (T) Evaluate the feasibility of expanding the Risk Reduction Program, or portions thereof, to provide services to Commanders / Soldiers while deployed. Implement as appropriate. (O) Seamless Risk Reduction Program services available across all phases of the ARFORGEN cycle.

T 4.5.1 (T) Augment the in-processing orientation for Soldiers and their Family members to include information on medical and behavioral health services and access to care. (O) Increased awareness of resources to mitigate the risk associated with suicide-related events.

T 4.5.2 (T) Develop and/or augment standardized installation-level training program for incoming, redeploying Brigade, Battalion, Company and rear-DET Commanders and their Non-commissioned Officers that addresses policy, processes and institutional requirements regarding Health Promotion, Risk Reduction and Suicide Prevention. Special attention will be directed towards: (a) disciplinary actions, separation process regarding a positive urinalysis and referral to treatment and (b) positive outcomes when associated with risk avoidance, suicide prevention and stigma reduction. (O) Informed Commanders and NCO's with increased awareness about Health Promotion, Risk



Training

Bin / # Task Reduction and Suicide Prevention that can significantly influence a reduction in Soldier high-risk behaviors, increase Soldier/Unit readiness and decreased stigma through positive reinforcement.

T 4.6.1 (T) Develop a Reserve Component awareness program to train employers of Reserve Component Soldiers to identify and intervene with Soldiers who exhibit high-risk behaviors. (O) An increased awareness among employers in identifying and referring high-risk Soldiers; awareness of Army programs and services (health promotion, risk reduction, and suicide-related programs).

T 4.7 (T) Evaluate the programs offered by the Neuroscience Education Institute, and other similar CME efforts, to determine their effectiveness and application in the military health system. Coordinate with the DCoE to reduce duplication of effort among the Services. (O) If appropriate, implement Institute training program Army wide to improve healthcare outcomes.

T 4.8 (T) Amend Suicide Prevention Training to include instruction that dependents of active duty Soldiers may not receive DIC benefits, in order to avoid incentivizing suicide. (O) Soldiers and their families are aware of DIC payment limitations related to suicide.

T 4.1 (T) Develop a targeted training program and educational tool to correct misperceptions that seeking behavioral health care negatively impacts the adjudication of a Soldier's security clearance. The training program will clearly demonstrate that the adjudicative process works, it is fair and equitable, and that seeking behavioral/mental health counseling may not negatively impact the security clearance and associated career opportunities. (O) Soldiers, Civilians, and Family members will understand the clearance approval process and are confident in seeking behavioral and/or mental health services.

T 4.10 Task / Outcome:(T) Develop, market, and distribute suicide awareness briefing for Family members and DA Civilians. (O) Increase awareness of risk factors, warning signs, and suicide behaviors to help minimize suicidal behavior on Soldiers, Family members and DA Civilians



Materiel

Bin / # Task M 9.1.0 (T) Integrate / consolidate all data points that capture suicide-related and high risk event data into a comprehensive

suicide prevention database. G6 is tasked as the integrator of the databases and G1 is the overall lead (e.g. eMILPO, DAMIS, DODSER, AHLTA, VISTA, COPS, ACI2, SIR, LOD, DCIPS, 15-6, VCSA Template, Psych Autopsy). (O) A single source point for analyses, research, and dissemination of lessons learned to the field and HQDA.

M 9.1.1 (T) Conduct a comprehensive review to revise policy and procedures to integrate reporting and database sharing among “need-to-know” commanders and help providers (e.g., law enforcement, medical, clinical, and preventive services) to integrate Soldier medico-legal processes. Integrate, reconcile, and report comprehensive, composite Soldier data (ACI2, COPS, DAMIS, ACR, etc.) to inform appropriate Soldier medico-legal actions and reduce risks associated with fractured Soldier profiles. (O) CDRs, medical health providers, ASAP / FAP clinicians and non-clinician personnel have a composite picture of high-risk Soldiers to sync medico-legal actions for Soldiers who commit multiple criminal / substance abuse events, prevent recidivism, and reduce high-risk Soldier populations.

M 9.1.2 (T) Revise CID investigative protocols for suicide and equivocal deaths to incorporate recommended checklist for collection reporting and data-basing of suicide information into the ABHIDE. (O) CID in coordination with MEDCOM and IMCOM provide a composite data-base of suicide data-points for subsequent trend analyses.

M 9.1.3 (T) Develop IMCOM protocols for collection, reporting and data-basing of suicide information (fatality review board) into the ABHIDE. (O) IMCOM in coordination with CID and MEDCOM provide a composite data-base of suicide data-points for subsequent analyses.

M 9.1.4 (T) Develop MEDCOM protocols for collection, reporting and data-basing of suicide information into the ABHIDE. (O) MEDCOM in coordination with CID and IMCOM provide a composite data-base of suicide data-points for subsequent analyses.

M 9.1.5 (T) Establish a Net Centric Data Environment that will make data elements / sources discoverable, available, and accessible within the suicide prevention community to support both retrospective and predictive analysis. (O) Environment that will enable and support current and future data exchange requirements.



Materiel

Bin / # Task M 9.1.6 (T) Develop the Army Behavioral Health Integrated Data Environment (ABHIDE), a CHPPM Suicide Registry, that will

obtain data on suicide/serious events for the purpose of categorizing and analyzing data. ABHIDE will require a periodic feed of new suicide incidences to manage information and to conduct population health-based surveillance of Army suicide incidences from ACR, DCIPS, CIMS, COPS, MDR, CDM, DAMIS, ITAPDB, MEDPROS. (O) Registry that allows for analysis.

M 9.1.8 Task / Outcome: (T) Modify the Medical Operational Data System (MODS) to develop an active “push” interoperability workflow between the demobilization health assessment (DHA) and the Medical Non-Deployable module (MND) for all components. (O) A modified MODS which allows visibility of all PDHA/PDHRA referrals for better case management.



Leadership Bin / # Task

L 5.1.4 (T) Incorporate into Strategic Communication Plan the use of public service-type announcements / commercials using leaders and/or celebrities with a message encouraging help seeking behaviors and suicide intervention practices. (O) Increased willingness of Soldiers to seek help and awareness by Soldiers, Civilians, and Family members of how to help.

L 5.2.1 (T) Leverage the new electronic profile and the "Medical Nondeployable" data field in MEDPROS to communicate to Commanders significant psychological health issues. Develop mechanism to push profile information electronically to Commanders to inform decisions regarding administrative, operational and disciplinary actions. (O) Commanders are fully informed on all behavioral health issues when taking administrative, operational and disciplinary actions.

L 5.2.2 (T) Educate WTU / CBWTU Cadre on the roles, responsibilities, programs and services provided by the Soldier and Family Assistance Center (SFAC). Local education will supplement institutional education provided at the AMEDD WTU Cadre Training Course. (O) WTU / CBWTU Cadre are well versed in the capabilities of the SFAC and are able to properly advise Soldiers and Family Members.

L 5.4.2 (T) Establish a web-based survey for key leaders and Soldiers to annually assess attitudes toward Soldiers who exhibit behavioral health related performance issues. (O) To measure progress in de-stigmatizing help seeking behavior.

L 5.4.5 (T) Encourage CDRs at all levels to comply with regulatory guidance to Administratively Separate Soldiers for misconduct to include serious drug / alcohol or multiple drug / alcohol incidents. Clarify policy to provide clear guidance and reduce additional administrative requirements to simplify and expedite CDR actions. (O) An Army-wide reduction in high-risk Soldiers and influencers to a growing high-risk Soldier population, and an increase in Soldier / unit readiness. NOTE: This policy change will not impact or otherwise influence CDR’s discretion in dealing with the criminal aspects of illicit drug use.

L 5.4.8 (T) Require officers/NCOs during their initial and performance counseling sessions to discuss the rater officer/NCO responsibilities in support of behavioral health goals and their influence on command climate and overall unit performance as a special interest item during the counseling session. (O) Decreased stigma and socialize positive attitudes toward behavioral health issues.

L 5.4.9 (T) Require a AR 15-6 investigation for suicides or equivocal deaths; coordinate AR 15-6 investigation with CID and LOD investigations to provide a comprehensive review of all possible causes; and when available, coordinate psychological autopsy findings. (O) Investigations informing Commanders and medico-legal actions are synchronized to protect the integrity of investigative/judicial processes.



Leadership Bin / # Task

L 5.5.1 (T) Implement standardized command team training on health promotion, risk reduction, substance abuse and suicide-related programs at Pre-Command Courses, Captains' Career Courses, Sergeants Major Academy. (O) Immediate command emphasis from all incoming commanders, CSMs and 1SGs.

L 5.6.1 (T) Issue "VCSA Sends" or ALARACT emphasizing the requirement for Commanders to refer Soldiers to ASAP whenever a Commander learns that a Soldier has tested positive for illicit drugs or engaged in alcohol-related misconduct. (O) Commanders refer at-risk Soldiers to ASAP IAW AR 600-85.

L 5.7.1 (T) Provide guidance / directives to installation ADCOs to manage the ASAP and deliver services related to prevention / education for Soldiers, DA Civilians, and Families as a critical requirement. This will require the ADCO to submit additional funding requirements based on changing conditions. (O) ADCOs are resourced to provide conditions-based prevention activities for Soldiers, DA Civilians and Families.



Personnel Bin / # Task Pe 6.1.3 (T) Review the MEDCOM Memorandum, SUBJECT: [ASAP] Counselor Hiring Policy Change in Response to Mission

Requirements, dated, 30 March 2009, that changes licensing and certification standards to “widen the pool of otherwise qualified candidates, to include those who meet professional educational and licensing requirements and lack only the Army required ASAP certification…” Assess the memorandum against findings to ensure it encapsulates all hiring / retention issues; revise the memo if necessary (e.g., consider revising Memo to lengthen certification period / Army pays with contract term proviso). (O) The memorandum addresses / resolves ASAP Counselor hiring / retention issues identified during the VCSA HP Trip and identified in the ASPCP Sync Matrix.

Pe 6.1.4 (T) Develop and establish a directive mandating a minimum percentage of patient care contacts per privileged provider to reduce the amount of time providers spend in administrative roles. (O) Fully leverage existing resources to increase provider availability in patient care and therefore increase capacity and access to care.

Pe 6.1.5 (T) Consider and implement mechanisms to expand the pool of available behavioral health professionals. This could include the creation of a Warrant Officer occupational specialty which would draw upon a pool of individuals presently licensed at the state level for whom MTF privileges are not currently available. This could also improve retention and promotion opportunities for enlisted MOS (e.g., 68X). (O) Behavioral health para-professional counselors provide care for Soldiers and support to commanders.

Pe 6.1.7 (T) Review and revise Army and MEDCOM policies (including AR 601-142) policies to retain medical personnel in redeploying units for 90-120 days during the reset phase to ensure continuity of care, cognizant-mitigation of unit and Soldiers stressors, and sufficient treatment “handoff” to incoming medical personnel. (O) Continuity of medical and behavioral health care in units is maintained for 90-120 days post-deployment, mitigating development of high-risk factors through medical reset plans / processes.

Pe 6.1.8 (T) Manage Combat Stress Team (CST) providers under a central authority (Senior MTF CDR / Director) at installations to optimize patient care; provider to patient workload; and provider professional development. (O) All health care providers at installations are centrally managed.

Pe 6.2.1 (T) Fill FAP (treatment side) to appropriate levels using existing templates / rules of allocation, and then assess current rules of allocation (templates) to account for requirements and change in FAP mission / workload. (O) Organizations are appropriately staffed with FAP clinical and non-clinical personnel to enable Soldiers and Families to receive optimal services.



Personnel Bin / # Task Pe 6.2.3 (T) Establish a Suicide Response Team (SRT) at each installation / State JFHQ / USAR DRUs. The SRT, as a group,

will approach unit CDRs within 48 hours of the Command’s notification of a Soldier’s suicide, to assist the CDR with postvention efforts alleviate the CDR’s need to contact them, and ensure that all concerned entities respond swiftly to the suicide. The SRT members would include, e.g., the Suicide Prevention Task Force Coordinator and representatives from the Chaplaincy, Behavioral Health, OSJA, CID, Office of Public Affairs, and the Military Family Life Consultant and Army Family Assistance programs. (O) Key individuals and organizations required to respond to a suicide will approach and assist the CDR, thus enabling a swift, integrated, and comprehensive effort.

Pe 6.4.1 (T) Revise policies and procedures to improve the Civilian Human Resources Agency (CHRA) ability to effectively support the hiring of medical professionals and support staff in a timely manner. (O) Optimized hiring processes resulting in staff being hired more expeditiously.

Pe 6.4.2 (T) Maintain the staffing levels required for the minimum of two Applied Suicide Intervention Skills Training (ASIST, T4T) certified trainers at each installation / HQ USARC / DRUs / MSCs / State JFHQ to conduct ASIST training for subordinate units. (O) Installations / commands have the requisite capability / capacity of ASIST facilitators.

Pe 6.4.3 (T) Evaluate the lengthy delay in operationally deploying DA Civilians or contracted Behavioral Health specialists / practitioners. Develop practices and procedures to expedite deployment. (O) Increased access to care while deployed.

Pe 6.4.4 (T) Centralize management of primary care and behavioral health care providers under a central authority (Senior MTF CDR / Senior Medical Officer) at installations to optimize patient care, provider to patient workload, and provider professional development. (O) All health care providers at installations are integrally managed in providing patient care to Soldiers.

Pe 6.4.5 (T) Restructure and increase medical bonuses for primary and behavioral health care providers from a 2 / 3 / 4 year bonus structure to a single year increased bonus to promote hiring and retention and compensate / compete with civilian pay and benefits for additional surge requirements and case volume / complexity leading to “compassion fatigue”. Bonuses are aligned to retention trends for medical care providers at their ~12 year mark in service. (O) Medical care providers are making annual commitments (year-over-year) rather than hesitating to commit to longer service obligations, with a step-down decrease for 2 and 3 year obligations.



Personnel Bin / # Task Pe 6.4.6 (T) Review classification, grade, and compensation for Behavioral Health and ASAP personnel to better attract and

retain them. (O) Increased recruitment and retention.

Pe 6.4.7 (T) (1) Clarify and align policy permitting CDRs to refer a Soldier to the MMRB after a PEB determination to retain an MOS-limited Soldier and educate / train CDRs on board options. (O) distribute ALARACT reinforcing current policy (AR 40-400) for MMRB, MEB, PEB actions; (2) Modify MEB/PEB policies and procedures to extend the deadlines for MEB processing to complete the board with a single series of medical consults; for expired cases, authorize resumption of MEB processing with a file review as an option to expedite the case. (O) Revision of time standard for medical documents that are sent from MEB to PEB for adjudication on Soldier fitness (3) Allocate additional medical / legal personnel for MEB/PEB service to expedite backlogs / surges (e.g., pre- and post-deployment, WTU support, etc), (O) Support personnel are on hand to ensure timely adjudication of all MEB/PEB cases.

Pe 6.4.8 (T) Develop policy to effectively recruit, hire, fund, retain and reorganize HQDA staff to support the ACPHP. (O) A robust staff to implement the ACPHP.

Pe 6.4.9 (T) Staff the development of an ASI / SQI / PSI to track certified suicide prevention trainers for utilization by the SPTF and a means to track certification status. (O) Appropriate use of certified trainers across the Army.

Pe 6.4.10 (T) Revise assignment policies and criteria for nominating and vetting WTU cadre to ensure that only officers and NCOs who have demonstrated success in prior equivalent-level leadership roles are assigned to WTU leadership positions. Develop a training program for WTU cadre to address common medical, substance abuse, and behavioral health issues; MEB / PEB / MMRB processes; and other recurring medico-legal issues faced by WTU Soldiers and leadership. Assess efficacy of CBWTUs as compared to WTUs and revise policy to facilitate command and control. (O) WTU leadership positions are staffed with officers and NCOs who have demonstrated success as leaders, with requisite training specifically designed to meet the challenges of leading in a WTU environment.



Personnel Bin / # Task Pe 6.4.11 (T) Revise policies to retain Command Teams [all levels] of redeploying units for 90-120 days during the reset phase

to ensure leadership continuity and cognizant-mitigation of unit and Soldiers stressors (e.g., complete PDHRA, insolate Soldier teams / networks, complete disciplinary / separation actions, integrate Soldiers and Families, naturalize health promotion, etc). Review CoC policies in theater to align command terms to encompass unit reset phases within the 24 month term. Additionally, review and revise policy to prescribe “successful command terms” as 20-24 months to provide flexibility in timing CoCs with deployment / redeployment cycles. (O) Continuity of leadership in units is maintained for 90-120 days post-deployment, while minimizing command terms beyond 24 months.

Pe 6.4.11.1 T) Review ARNG Policies and if appropriate, revise to retain Command Teams [at all levels] of redeploying units for 90-120 days during the reset phase to ensure leadership continuity and cognizant-mitigation of unit and Soldiers stressors (e.g., complete PDHRA, insolate Soldier teams / networks, complete disciplinary / separation actions, integrate Soldiers and Families, naturalize health promotion, etc). (O) Continuity of leadership in units is maintained for 90-120 days post-deployment.

Pe 6.4.11.2 (T) Revise USAR policies to retain Command Teams [all levels] of redeploying units for 90-120 days during the reset phase to ensure leadership continuity and cognizant-mitigation of unit and Soldiers stressors (e.g., complete PDHRA, insolate Soldier teams / networks, complete disciplinary / separation actions, integrate Soldiers and Families, naturalize health promotion, etc). (O) Continuity of leadership in units is maintained for 90-120 days post-deployment.

Pe 6.4.11.3 (T) Revise policies to retain Chaplains [all levels] of redeploying units for 90-120 days during the reset phase to ensure continuity of pastoral care in units. (O) Continuity of care in units is maintained for 90-120 days post-deployment.

Pe 6.4.12 (T) Implement the assignment policy to encourage TDA assignment priority for multiple deployers within PCS cycle. This policy was recommended by the Mental Health Assessment Team (MHAT). (O) Reduced fatigue and stress on the Soldier and Family.



Facilities

Bin / # Task F 8.1.0 (T) Co-locate behavioral health and primary care providers within medical service facilities to combat stigma, physically

dovetailing the services, to allay Soldiers’ concerns that they will be seen by peers as they enter behavioral health, encourage informal communication between behavioral health and medical service providers, and improve Soldier access to behavioral health care. (O) Decreased differentiation between behavioral health and primary care services; increased access to care; and improved quality of care (through better communication between services) to reduce risk factors.



Resources

Bin / # Task

R 7.1.2 (T) Assess the IMCOM centralized contract placing 10 SPPMs at various high risk installations as identified by suicides over a 10 year period; following the assessment, resource as necessary installations / State JFHQ / HQ USARC / DRUs / MSCs with full-time Suicide Prevention Program managers. (O) Ensure long-term program viability by establishing a permanent position.

R 7.2.1 (T) Evaluate suicide prevention research and establish long-term budget requirements. (O) Adequate and appropriate resources are programmed.

R 7.2.3 (T) Conduct needs assessment of detoxification and inpatient substance abuse rehabilitation programs at installations (especially partial residential treatment) within the Army to rehabilitate Soldiers with acute substance abuse problems. Educate CDRs on options when Soldiers opt out of network inpatient treatment via an AMA release. (O) MEDCOM assesses the need, if any, for detoxification and inpatient treatment, and the scope of that need (e.g., number of inpatient programs, specific locations, etc.).

R 7.2.4 (T) Assess current and anticipated demand for expanded non-emergency behavioral health treatment hours, as well as feasibility of expanded hours given the already stressed behavioral health workforce; consider use of RC assets, especially IMAs. Assess availability of current and future funding for expanded hours, if indicated. If indicated and fundable, expand hours of services to nights, weekends, or both. (O) Improved access to non-emergency behavioral health services for Soldiers and their Families, optimizing efforts to mitigate behavioral health risk.

R 7.2.5 (T) Establish an interactive web-based suicide prevention best practices forum for medical and behavioral health care providers to virtualize communication, increase collaboration, share best practices, and improve identification of at-risk Soldiers (and Families), maximize care for those individuals, and enhance general suicide prevention measures within the Army community. (O) A web-based best practices forum.



Resources

Bin / # Task

R 7.2.6 (T) Review MEDCOM Memorandum, SUBJECT: [ASAP] Critical Staffing Shortages in the Army Substance Abuse Program, dated 02 April 2009. This memorandum (with enclosures) describes an ASAP staffing shortage ongoing since at least 2007 and a shortfall, using the staffing ratio of ASAP Counselor /population (1:2,000), of 106 ASAP Counselors. Assess requirements (106) and current modeling against current findings / conclusions to determine if the Memo captures current and projected ASAP staffing needs; revise the memo accordingly. (O) Policy accurately accounts for current and anticipated ASAP staffing needs, including those identified during the VCSA HP Trip and in the ASPCP Sync Matrix.

R 7.3.1 (T) Evaluate existing funding streams and proposed funding requirements to determine if the resources can be consolidated into a single / few Management Decision Package (MDEP) or Army Program Element (APE) for better visibility of suicide prevention requirements and funding. (O) ASPP requirements are funded.

R 7.3.2 (T) Develop FY09 and FY10 funding solutions to support the ACPHP. (O) ACPHP is sufficiently funded.

R 7.3.3 (T) Develop FY11 - 15 funding solutions in PBR FY11-15 to support the ACPHP. (O) ACPHP is sufficiently funded across the FYDP.

R 7.4.2 (T) Develop a Staffing Allocation Model for local suicide prevention related services for all Army Components. (O) A baseline that reflects the needs of the Army.

R 7.4.4 (T) Expand the Expeditionary Substance Abuse Program (ESAP) pilot to provide prevention services and treatment to deployed forces. (O) An enduring ESAP that provides prevention and treatment services for deployed Soldiers.

R 7.5.1 (T) Measure current and anticipated demand for the Strong Bonds program among Soldiers and their Families. Fund and expand program capacity to meet that demand. (O) Soldiers and their Families receive maximum access to the Strong Bonds program and reduce their risks accordingly.

R 7.6.1 (T) Proportionally increase the number of hours of free child-care at the Child Development Center (pre-deployment, during the deployment and post-deployment) based on the length of a Soldier's deployment. (O) Improved coping for Families.



Resources

Bin / # Task

R 7.6.2 (T) Assess the capacity of MFLCs Army-wide; if appropriate request DOD consider increasing MFLCs at a ratio of one per brigade to provide support and assistance to Soldiers, military Families, and civilian personnel. Synchronize assessment and expansion with strategic communications to increase Soldier/Family awareness of the benefits of MFLCs through standardized marketing and advertising program. (O) Optimized MFLC capacity, availability and utilization Army-wide.

R 7.7.1 (T) Review data and information from any existing Warrior Adventure Quest (WAQ) survey and assessment tools, and develop other metrics if indicated, to assess effectiveness of WAQ in reducing high-risk behaviors in Soldiers; if necessary expand the WAQ program within the Army to ensure Soldier access to the program. (O) Additional WAQ program sites.

R 7.7.2 (T) Provide a mechanism for the G1 and ACSIM to permit program services that are "in crisis" to be given exceptions to Common Levels of Support (CLS) standards and are not subject to OA22 and OA2 taxing. (O) Sufficient and protected funds to provide required services.

R 7.7.3 Task / Outcome: (T) Assess, implement, and fund the critical requirement for tuition assistance permitting chaplains to obtain a necessary post-graduate education. (O) Tuition assistance is available for Chaplains continuing education.

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