unclassified taking care of our wounded, ill, and injured sailors and their families navy...
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UnclassifiedTaking Care of Our Wounded, Ill, and Injured Sailors
and Their Families
Navy Comprehensive Casualty Care ProgramSAFE HARBOR COMMAND BRIEF
CAPT Key WatkinsCommanding Officer
2Unclassified 03/10/2008
Comprehensive Care Mission Statement Wounded, Ill, and Injured (WII)
The Navy’s comprehensive casualty care program will provide support and assistance to all wounded, ill, and injured Sailors and their family members throughout their recovery and beyond.
Shipmates for LifeShipmates for Life
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Concept for Comprehensive Care Wounded, Ill, and Injured (WII)
The Navy has a continuum of capabilities that provide support for all wounded, ill, and injured Sailors and their families – SAFE HARBOR is the Navy’s focal point– Successful, long-established programs: Limited Duty, Light Duty, Medical
Hold, and Line of Duty enhanced with SAFE HARBOR case tracking, policy oversight, and individualized case management on an as needed basis
– Comprehensive, non-clinical case management system tailored to support each Sailor’s unique challenges and circumstances
– Programs assist Sailor reintegration with their family, community, and Command
– Ongoing program refinement based on best practices and lessons learned
Navy will continue to enhance non-clinical support for those Sailors most in need (severely wounded, ill, and injured) while also continuing to look after the needs of all wounded, ill, or injured Sailors
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Covenant Leadership Wounded, Ill, and Injured (WII)
There’s Nothing More Important All Levels of Leadership Need to be Engaged Wounded, Ill, and Injured – Still Linked to their Shipmates Personal Relationships
– Sailors Talking to and Taking Care of Sailors– Unit Affiliation– Command Involvement– Families, Peers and Community
Culture – “Shipmate for Life”– Reaching Out to Those In Need– Taking Care of Those Who Care for Our Wounded, Ill, and Injured– A Continuum of Support– Trust and Recognition
They’ve Delivered on their Obligation...We Will do the Same They’ve Delivered on their Obligation...We Will do the Same
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Mission Statement:SAFE HARBOR Command is the Navy’s focal point for the non-medical care of all wounded, ill and injured Sailors and their family members. We provide support and assistance throughout a Sailor’s recovery and beyond.
SAFE HARBOR COMMAND Guiding Principle: Numquam Navigare Solus – Never to Sail Alone
We are the Navy...taking care of our Sailors!We are the Navy...taking care of our Sailors!
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Vision:Our vision is for SAFE HARBOR Command to be recognized as the gold
standard of care throughout the Wounded, Ill, and Injured community because of the world class support that we provide to each and every one of our SAFE HARBOR Sailors and their families.
Goals:1. Take care of the Sailors and Families who need care.2. Craft an enduring organization that is responsive to the changing needs
of our customer.3. Build quality into everything we do – improve the process at every
opportunity.4. Share our successes with our Wounded Warrior community partners -
learn from theirs.5. Create a climate where the core values of honor, courage & commitment
are paramount.6. Support the professional and personal development of our SAFE
HARBOR Staff.7. Recognize sustained superior performance.
SAFE HARBOR COMMAND Guiding Principle: Numquam Navigare Solus – Never to Sail Alone
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SAFE HARBOR Evolution...Built on Basic Guiding Principles in Navy Medicine
20 OEF/OIF Wounded
Sailors
Military Severely Injured Center (MSIC) requests Navy liaison
SAFE HARBOR (SH) Director appointed from N135
Out Reach Case Manager assigned to SAFE HARBOR
Military Severely Injured Center (MSIC) requests Navy liaison
SAFE HARBOR (SH) Director appointed from N135
Out Reach Case Manager assigned to SAFE HARBOR
2005 Staff of 3
40 OEF/OIF Wounded
Sailors
Additional Navy Liaison assigned to MSIC
SAFE HARBOR Representative assigned to NNMC Bethesda supporting Basic Advocacy
Additional Navy Liaison assigned to MSIC
SAFE HARBOR Representative assigned to NNMC Bethesda supporting Basic Advocacy2006 Staff of 4
145 Severely Wounded, Ill, or Injured (SWII)
Sailors
2007 Staff of 13
C3WG renamed Comprehensive Casualty Care Working Group to reflect expanded mission
CAPT Watkins assigned as CO of SH & CAPT Wright as director of C3WG (5 members)
3 additional staff members on board & SAFE HARBOR Mission expanded to provide tracking and oversight for all wounded, ill, and injured
C3WG renamed Comprehensive Casualty Care Working Group to reflect expanded mission
CAPT Watkins assigned as CO of SH & CAPT Wright as director of C3WG (5 members)
3 additional staff members on board & SAFE HARBOR Mission expanded to provide tracking and oversight for all wounded, ill, and injured
2008 Staff of 16
174 SWII Sailors
Over 5,000 Wounded, Ill or Injured Sailors
Planned growth to 14 Case Managers at 9 sites and 14 HQ Staff in DC & Millington, TNPlanned growth to 14 Case Managers at 9 sites and 14 HQ Staff in DC & Millington, TN
Combat Casualty Care Working Group (C3WG) established by RDML White – 4 members
8 Case Managers hired for MTFs and VA Polytrauma Centers
SAFE HARBOR Program moved from N13 to N12
SAFE HARBOR Mission expanded to all severely wounded, ill, or Injured (not just OEF/OIF)
CNO appointed RDML White as Special Assistant for Comprehensive Casualty Care
Combat Casualty Care Working Group (C3WG) established by RDML White – 4 members
8 Case Managers hired for MTFs and VA Polytrauma Centers
SAFE HARBOR Program moved from N13 to N12
SAFE HARBOR Mission expanded to all severely wounded, ill, or Injured (not just OEF/OIF)
CNO appointed RDML White as Special Assistant for Comprehensive Casualty Care
8Unclassified 03/10/2008
Program BreakdownContinuum of Wounded, Ill, and Injured (WII)
The Navy’s continuum of care covers the full spectrum of Navy Wounded, Ill, and Injured
The Navy’s continuum of care covers the full spectrum of Navy Wounded, Ill, and Injured
Severely WII Enrollees (174) Entry –N1 (SAFE HARBOR CO)/ Exit - “SAFE HARBOR for Life”
Medical Hold Status (220) DCNO (MPTE) /SAFE HARBOR Tracking &
Oversight- Entry/Exit - N1
Line of Duty Status (780) DCNO (MPTE) /SAFE HARBOR
Tracking & Oversight- Entry/Exit - N1
Wounded Warrior
Regiment
Approximately 9,000 Wounded, Ill, and Injured
Light Duty (Tracked by Parent Command)
Entry and Exit – Medical Provider in Collaboration with
Chain of Command
Limited Duty Status (4,642) /SAFE HARBOR Tracking & Oversight- Entry/Exit-Convening Authority at MTF and PERS 8 (if >12 Months)
Navy Marine Corps
Parent Command
(May go to WWR)
Population Served
Severely Wounded, Ill, and Injured
Reserve personnel on orders greater than 30 days, requiring medical
evaluation/treatment to resolve condition incurred while on active duty
Reserve personnel on orders less than 30 days, requiring medical
evaluation/treatment to resolve condition incurred while on inactive duty
Active personnel wounded/ill/injured expected to remain on a restricted status
for more than 90 days
Active Duty personnel ill/injured on restricted duty in 30 day increments for
up to 90 days
Program (# of participants) Final Entry/Exit Authority
SAFE HARBOR
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Limited Duty StatusLimited Duty Status4,6424,642
Line of Duty StatusLine of Duty Status780780
Medical Hold Medical Hold StatusStatus
220220
Daily Snapshot
Daily Snapshot
~ 58005800
(Data Update 06 Mar 2008)
(Data Update 06 Mar 2008)
Minor Orthopedic Conditions
Traumatic Brain Injury, Amputees,
severe Burns, Debilitating Illness
Recovery time ranges from months to years - Case Management Support can range from hours to a lifetime
Recovery time ranges from months to years - Case Management Support can range from hours to a lifetime
Severely Wounded, Ill, and Injured
Program ~250 annually
SAFE HARBOR Reported Population Continuum of Wounded, Ill, and Injured (WII)
Condition Acuity ContinuumMinor Severe
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PROGRAM(Management)
POPULATION SERVED DECISION AUTHORITY AND CASE MANAGEMENT TRACKING
SAFE HARBORSeverely
Wounded, Ill, and Injured
Program (N12/SAFE HARBOR)
Severely Wounded, Ill, and Injured Final Entry Authority: N12 SAFE HARBOR COFinal Exit Authority: None - “SAFE HARBOR for Life”
Non-clinical Case Manager assigned to individual; clinical case manager assigned
Non-clinical case management tracked in Military Severely
Injured Tracking System (MSITS) Database; clinical case
management in DoD’s Armed Forces Health Longitudinal
Tracking Application (AHLTA)*
MEDHOLD(SAFE
HARBOR, PERS-95 &
NOSCs)
Reserve personnel on orders greater than 30 days, requiring medical evaluation/treatment to
resolve condition incurred while on active duty
Final Entry Authority: DCNO (MPTE) N1Final Exit Authority: DCNO (MPTE) N1
Non-clinical and clinical case manager with caseload at Navy Mobilization Processing Sites; case worker with caseload at
PERS-95; SAFE HARBOR tracking & oversight, Individual Case Management (as required basis)
Non-clinical case management tracked in Microsoft Access
Database; Clinical case management in DoD’s Armed Forces Health Longitudinal
Tracking Application (AHLTA)*
LINE OF DUTY(SAFE
HARBOR, PERS-95 &
NOSCs)
Reserve personnel on orders less than 30 days, requiring medical evaluation/treatment to resolve
condition incurred while on inactive duty
Final Entry Authority: DCNO (MPTE) N1Final Exit Authority: DCNO (MPTE) N1
Medical Department Representative at Navy Operational Support Center (NOSC) tracks case locally; case worker with caseload at PERS-95; SAFE HARBOR tracking & oversight,
Individual Case Management (as required basis)
Medical Readiness Reporting System (MRRS) Line of Duty (LOD) module supports non-clinical case-management;
clinical case management tracked in a separate LOD record (paper)
at NOSC
LIMITED DUTY(SAFE
HARBOR, PERS-82 &
Parent Commands)
Active personnel wounded/ill/injured expected to remain on a restricted status for
more than 90 days
Final Entry and Exit Authority: Convening Authority at MTF and BUPERS (PERS 8) if longer than 12 months
Command Limited Duty (LIMDU) Coordinator; staffed through MedBoard office at Military Treatment Facility; based on
clinical acuity, clinical case manager assigned; SAFE HARBOR tracking & oversight, Individual Case Management
(as required basis)
Medical Board Online TRICARE Tracking (MEDBOLTT) System; Weekly SECNAV report; Clinical
Case management in AHLTA
LIGHT DUTY(Parent
Commands)
Active Duty personnel ill/injured on restricted duty in 30 day
increments for up to 90 days (length of Light Duty based on
condition)
Final Entry and Exit Authority: Medical Provider in Collaboration with Chain of Command
Member provides light duty chit to Command; Binnacle list shipboard; Primary Care Manager provides medical oversight
No electronic tracking – operational assets tracked by
Operational Medical Department and Command
* Armed Force Health Longitudinal Tracking Application (AHLTA): DoD electronic medical record for clinical documentation* Medical Readiness Reporting System (MRRS): Navy and Marine Corps (AC and RC) electronic tracking system for IndividualMedical Readiness data
Navy Oversight and Tracking Continuum of Wounded, Ill, and Injured (WII)
11Unclassified 03/10/2008
Guiding Principle: Numquam Navigare Solus – Never to Sail Alone
The SAFE HARBOR Severely Wounded, Ill, and Injured Program will provide superior quality, life-long non-clinical case management to the Sailors and their family members that are most in need. The SAFE HARBOR team of caring professionals will develop and administer individually tailored support plans to ensure long-term, sustained engagement in providing for the health and welfare of our Sailors and their families.
Safe Harbor Severely Wounded, Ill, and Injured Program
12Unclassified 03/10/2008
Targeting a Key Navy PopulationSeverely Wounded, Ill, and Injured (SWII)
Severely Wounded, Ill, and Injured Program– In 2005, Navy established the SAFE HARBOR program to support severely injured Sailors
from OEF/OIF– In FY 2008,
Mission expanded to provide non-clinical case management to all “Severely Wounded, Ill, and Injured” Sailors and their families in addition to tracking & oversight of Navy’s non-severely WII programs
Program enhanced with Command and Control element Severely Wounded, Ill, and Injured population projected at 250 Sailors and their families annually
(increase from current 175 total SAFE HARBOR SWII Cases) Frequency of contacts based on needs but a minimum of once per month Sailors enrolled for “Life” Clearly identified interfaces with Federal Recovery Coordinators, USMC Wounded Warrior Regiment,
and Other Organizations Emphasis on FY10-15 funding Participant to Case Manager ratio: 24:1 (Current); 18:1 (Planned) Case Managers assigned to all Major Hospitals and Fleet Concentration Areas Participants have 24/7 access to Case Managers via Toll Free Number and Website
Navy responded by expanding its Program to include all Severely Wounded, Ill, and Injured Sailors
Navy responded by expanding its Program to include all Severely Wounded, Ill, and Injured Sailors
13Unclassified 03/10/2008
Strategic Reach Wounded, Ill, and Injured (WII)
BETHESDA / WRAMC (2)
BAMC (2)
SAN DIEGO (2)
AT-LARGE WEST (1)
TAMPA (1)
PALO ALTO (1)
JACKSONVILLE (1)
PORTSMOUTH/RICHMOND (1)
MILLINGTON TN (2)
WASHINGTON DC (12)
AT-LARGE EAST (1)
BREMERTON (1)
GREAT LAKES / MINNEAPOLIS (1)
SAFE HARBOR AND A NATIONAL NETWORK OF NAVY SAFE HARBOR AND A NATIONAL NETWORK OF NAVY OPERATIONAL SUPPORT CENTERSOPERATIONAL SUPPORT CENTERS
VA POLY TRAUMA CENTER
MILITARY TREATMENT FACILITY
SAFE HARBOR HEADQUARTERS STAFF
NAVY OPERATONAL SUPPORT CENTER
14Unclassified 03/10/2008
Oversight and CoordinationWounded, Ill, and Injured (WII)
Direct Lines of Action/Reporting with Senior Oversight facilitate Comprehensive Casualty Care
Direct Lines of Action/Reporting with Senior Oversight facilitate Comprehensive Casualty Care
VCNO
CNO
N12BUPERS
N1/CNP
Internal Coordination
Comprehensive Casualty Care
Working Group
NAVY SAFE HARBOR COMMAND
External Coordination
Wounded Warrior Regiment, BUMED, CNIC, SOCOM, Army/Air Force
Wounded Warrior Programs
MED HOLD, LIMITED DUTY, LINE OF DUTY PROGRAMS
Case Tracking, Program Policy Oversight, Individual Case Management (as required basis)
Program Sponsorship / Management & Execution
SEVERELY WOUNDED, ILL & INJURED
Full Tracking & Case Management
Special Assistant for Comprehensive Casualty CareDual Hat
15Unclassified 03/10/2008
TSGLI / MPT&E Support
YC-2/Millington
Admin OfficerYC-2/DC
Admin Support Military Personnel
E-6/DC
Family Support / NGO Coordinator
YA-2/DC
IT/Data Mgmt SupportE-6/DC
Public Affairs OfficerADDU N1 PAO/DC
VA LiaisonDetailee/DC
Commanding OfficerO-6/DC
Executive OfficerO-6/DC
Senior Enlisted AdvisorE-9/DC
Senior Medical OfficerO-6/DC
Ops OfficerO-5/DC
Pgm/Financial AnalystYA-2/DC
Strategic Support Officer
YC-3/DC
OIC Navy ReserveSurge Unit (10 Pers)
NNMC Case ManagerMilitary-Mob
NMCSDCase ManagerMilitary-Mob
NNMC Case Manager
YA-2
NMCSDCase Manager
YA-2
GLAKES/MLPS VACase ManagerMilitary-Mob
NH Jacksonville Case ManagerMilitary-Mob
NMPC/Richmond VA Case ManagerMilitary-Mob
BAMC Case ManagerMilitary-Mob
NH Bremerton Case ManagerMilitary-Mob
BAMC Case Manager
YA-2
At-Large (DC HQ) Case Manager East
YA-2
Palo Alto VA Case ManagerMilitary-Mob
At-Large (NMCSD) Case Manager West
YA-2
Tampa VA Case ManagerMilitary-Mob
Admin Support Correspondence
E-6/DC
Additional Duty as CO/XO Administrative Assistant
MPT&E OfficerYA-2/Millington
DOL LiaisonDetailee/DC
Additional Duty for Case Manager Training and Oversight
ChaplainO-4/ADDU DC
MED HOLD, LIMDU,
LOD Programs
DCNP/CNPC
SAFE HARBOR Staff Severely Wounded, Ill, and Injured (WII)
16Unclassified 03/10/2008
Snapshot of Typical CaseManagement Services Provided
Sample of Some of the Services Provided
Providers
Pay & Personnel
Navy Service Members are provided these services by many
existing programs depending on specific situations and needs.
In most cases, Service Members willnot require services beyond medicalcare coordination and pay/personnel
support. However, in the event ofcase complications or specific needs,
tailored non-medical casemanagement support will be made
available to the member and thefamily.
Invitational Travel Orders
Warrior Support
Housing & Lodging
Child & Youth Programs
Recreation & Leisure
Transportation Needs
Legal & Guardianship Issues
Education and Training Benefits
Commissary & Exchange Access
Respite Care
TBI/PTSD Services
17Unclassified 03/10/2008
Hearing the “Voice of the Customer”– Regular bedside and family visits– Assessment team visits to MTFs, VA Centers, and
Navy Mobilization Processing Sites– Severely/Non-Severely Wounded, Ill, and Injured
participant feedback– SAFE HARBOR Advocate Survey Report (Dec 07)
Semi-Annual survey of all actively managed cases (Planned/Will be coordinated across DoN)
– Formal DoN Quality of Life survey under development (late FY08 planned rollout)
Ensure long term, sustained engagement in providing for the health and welfare of our Sailors and their families
Ensure long term, sustained engagement in providing for the health and welfare of our Sailors and their families
Program AssessmentsWounded, Ill, and Injured (WII)
18Unclassified 03/10/2008
Improved Organizations– Line of Duty, Medical Hold, and Limited Duty functions and processes aligned
at NPC with SAFE HARBOR as the Navy’s focal point to improve effectiveness and program management including: Case Tracking, Program Policy Oversight, and Individual Case Management (on an as required basis)
– SAFE HARBOR aligned under VCNO & N12 (Special Assistant to CNO for Comprehensive Casualty Care) to enhance command and control
Enhanced Case Tracking– Appointed Senior Medical Officer in PERS to track and review cases for
disposition– Line of Duty Tracked in Medical Readiness Report System (MRRS) and
Limited Duty Tracked in Medical Board Liaison Tracking Tool (MEDBOLTT) to enhance visibility of status; SAFE HARBOR cases tracked in Military Severely Injured Tracking System (MSITS) Database
Refined Processes– Medical Hold and Line of Duty processes codified in SECNAVINST 1770.3D– Implemented new criteria and strict timelines for Light Duty and Limited Duty
periods
Initiatives Examples
19Unclassified 03/10/2008
Coordinate and assess multidisciplinary support for all Wounded, Ill, and Injured Sailors and their families …ensure long-term engagement– Partner with Reserve Component, Navy Operational Support
Centers to extend Strategic Reach and improve overall assistance to our Sailors and their family members
Craft an enduring organization that is responsive to the changing needs of our customer– Continue to improve understanding and address future requirements
Collect data and refine support processes as best practices and lessons learned are identified
Continue on-going coordination, integration, and collaboration efforts with USMC Wounded Warrior Regiment (e.g., Call Center) and other organizations
Ensure long term, sustained engagement in providing for the health and welfare of our Sailors and their families
Ensure long term, sustained engagement in providing for the health and welfare of our Sailors and their families
Navy Way Ahead Wounded, Ill, and Injured (WII)
20Unclassified 03/10/2008
QUESTIONS?
We are Sailors caring for SailorsContact us:
www.nmpc.navy.mil/ CommandSupport/SafeHarbor
CAPT Key Watkins, USNCommand Officer, Safe Harbor Command