By Lt. Yaron G. Rabinowitz, Lt. Russell P. Balmer, Lt. Darren Norris, Hospital Corpsman 3rd Class Justin Seabrook, Hospital Corpsman 2nd Class Stephen Windle, and Hospitalman Samuel Malone, 2D Marine Regiment, 2D Marine Division OSCAR TEAM
Of the numerous challenges facing embedded mental health providers, mitigating suicide risk is one of the most important.
Recent experience has demonstrated that traditional paradigms of mental health treatment are not sufficient to attenuate the escalating numbers of suicides and adverse outcomes in operational commands. Rather, effective risk surveillance practices must be adopted to enhance communication, coordination, and detection of at risk service members. Second Marines, OSCAR Team (Operational Stress Control and Readiness) developed and implemented a novel force preservation tool designed to proactively identify risk and support the unit’s Force Preservation program.
The Integrated Clinical Management and Risk Mitigation System (ICM-RMS, pronounced: “I.C.M. – Rams”) is a networked and interactive data management system with dedicated portals for key force preservation players. Each portal has capabilities and access to information specific to that individual’s position and unit (e.g., differing levels of accessibility to protect HIPPA, PHI, and patient data).
From a Force Preservation perspective, ICM-RMS was designed to capture risk factors for individuals assigned to a unit’s Force Preservation program, produce an empirical risk score, and allow sustained coordination and communication between “need to know” entities (Medical, Command, and Mental Health). It enables key players to independently input risk factors into a single repository, and provides medical and mental health capabilities such as automated alerts and controlled medication tracking.
Risk scores are generated using an original algorithm of known risk factors, and automated alerts make specific recommendations to commanders based on the risk score. If a risk score supersedes a predetermined threshold, an alert is sent to all individuals involved in force preservation for that service member. This alert is generated irrespective of whether that individual is a current mental health patient, which permits mental health providers to identify those in need prior to referral to mental health. Lastly, users can easily generate reports for a selected unit delineating risk scores and contributing factors.
ICM-RMS allows for more informed command decisions and risk management plans, and helps facilitate the transition from reactive to proactive mental health treatment. By leveraging objective data, ICM-RMS focuses attention on key variables, helps quantify and elucidate force preservation information, and minimizes the degree to which decisions are made on emotion or “gut instinct”. Moreover, it lessens the impact of human error by automating alerts and generating modifiable cross sectional reports.
ICM-RMS was initially developed by 2d Marines OSCAR mental health professionals to help manage front desk and administrative responsibilities when the OSCAR team was without psych tech support during their first year. Thus, in addition to its force preservation capabilities, ICM-RMS includes a full suite of clinical management tools to include the ability to track appointments, schedules, biographical data, intake data, vitals, medication, and psychological testing. It also includes auto note generation and remote data entry via laptop for all appointments.
ICM-RMS has been embraced by both the 2d Marine Division and 2d Marine Expeditionary Force Commanding Generals, and Headquarters Marine Corps has begun development of an enterprise, web-based, CAC enabled version. The initial release is anticipated to be late fall and will include broader connectivity to key entities such as the unit Substance Abuse Control Officers, Substance Abuse Rehabilitation Program, and Marine Corps Community Services providers. The overarching intent of development is to provide local commanders with a viable Force Preservation solution that bridges the gap between command and medical.
To read the OSCAR MARADMIN (MARADMIN 597/11) go to: http://www.marines.mil/News/Messages/MessagesDisplay/tabid/13286/Article/110997/operational-stress-control-and-readiness-training-guidance.aspx