Wednesday, November 26, 2008

A Good Idea, Pending Implementation

Image credit: Ann Erickson for the U.S. Army. The caption for this photo reads:

Purple Heart recipients Staff Sgt. Cypress Phipps, Staff Sgt. Michael Henning and Spc. David Talbot sing the 'Dog Face Soldier Song' during their Purple Heart ceremony, Nov. 20 at Winn Army Community Hospital. Phipps, Henning and Talbot were assigned to a 3rd ID unit at the time of their injuries and are now assigned to the Warrior Transition Battalion.

One of my local newspapers, the Tacoma News Tribune, featured an article today on a visit by the Secretary of the Army to Ft. Lewis:

Secretary of the Army Pete Geren reached into the inside pocket of his sport coat and pulled out four blue notecards.

The palm-sized cards were filled with comments soldiers had made to him: praise of resources for injured and wounded soldiers, complaints about the slow-moving bureaucracy that determines if a soldier is medically fit for duty.

Such feedback doesn’t always make it back to the Pentagon, Geren admits. Listening to real-world concerns of soldiers is one reason he tours Army installations around the world, including a stop Tuesday at Fort Lewis.

“There are a lot of filters between individual soldiers and the office of the Secretary of the Army – or anybody at the Pentagon,” he said. “Every trip is a chance to hear first-hand from soldiers: How are we supporting them? Are they getting what they need?”

Army Boss Fears From Fort Lewis' Hurt Warriors

Geren was visiting the Warrior Transition Battalion there, which is a unit made up of soldiers who are recovering from wounds or post-traumatic stress disorders (PTSD). Warrior Transition Units were set up by the Army this year to help soldiers recover and return either to their regular duties or to civilian life:

The Army is ready to launch a new phase in caring for wounded warriors, the assistant surgeon general for warrior care and transition told Soldiers and Army Civilians during an Army Leader Forum at the Pentagon Tuesday.

Brig. Gen. Mike Tucker announced that the Comprehensive Care Plan is scheduled to begin March 1, and will focus on healing the whole person - body, mind, heart and spirit - and not just physical well-being.

The program will include educational, vocational and life-skills development, leadership and mentoring, relationship coaching and behavior-health treatment in addition to medical treatment and physical and occupational therapy.


"We want them to return to duty or return to be a citizen in society and be successful and be proud of their service," he said. "If we're not careful, we'll raise a generation, 10-15 years from now, that will be panhandling because they don't have any life skills.

"It's important that we give these kids life skills. They all want to be something in life, other than what they are right now. They have to aspire. We have to allow them to achieve all they can be and provide them the structure at a time in their lives when they need it the most."

Army to Launch New Program for Wounded Warriors

As I've noted before, treatment ideas, particularly for PTSD, have changed quite a bit since the Second World War. This program makes it the soldiers' duty to recover, and assigns specific tasks for them to do that are designed to accomplish that goal. Occupational therapy, I suppose you could call it, combined with other forms. Soldiers, at least in my experience, are people who want to feel like they're making a contribution to their group. In such units they will be around other people who are in similar circumstances, which can make it easier to empathize with and support each other. So this sort of unit seems to me like a good idea.

Unfortunately, good ideas encounter plenty of hurdles in the Defense Department. The TNT article continues:

Geren talked to five soldiers participating in a weekly woodworking course, which helps relieve stress brought on by post-traumatic stress disorder. Staff Sgt. Irma Proffitt, who’s been in a medical holding unit since 2006, showed off her wood carvings of bears.

She used her time with Geren to voice concern about the staffing levels of clinical providers – a doctor, a nurse practitioner or a physician’s assistant – assigned to the battalion.

“We need more for the WTB,” said Proffitt, who’s been in the Army for 23 years. “We’re a big battalion and we’re going to grow. We need more” primary care managers.

Geren listened and asked a few more questions. Once he moved into another room, he asked Maj. Gen. Patricia Horoho, the commanding general of Madigan Army Medical Center, about Proffitt’s complaints.

Horoho said four clinical providers were assigned to the 512 soldiers of the Warrior Transition Battalion, which is better than the 1-to-200 ratio goal.

“I think it’s just a misperception on her part,” Horoho said.

Army Boss Fears From Fort Lewis' Hurt Warriors

This is a disheartening exchange for several reasons. First, there's the rather obvious issue of getting a bureaucratic response to a statement of a problem - the unit needs to grow, but there isn't enough care being provided. The response, that they already have more than their allocation, ought to be enough to give a thoughtful person pause: Are there really enough resources being allocated? A ratio of 200 (potential) patients to 1 caregiver sounds like an awfully large one to me. Let's face it, anyone who is wounded or injured is a potential PTSD sufferer. Even if only the physical injuries are of concern, that's a lot of people to keep track of. Many of these soldiers are young men in their late teens or early twenties - not the most self-aware population when it comes to taking care of themselves.

This is how good ideas can be lost in a bureaucracy. The resources are allocated per our direction, bureaucrats will say, what's the problem? Any process, whether it's intelligence, science, engineering, or caregiving, requires constant review to see if it's being done as well as it can. Directives aren't commandments from some deity, they are created based on a perception of need and the resources available. Such perceptions can be, and often are, wrong.

I give the Army and Secretary Geren major props for implementing this idea. I just hope it's not lost in a fog of bureaucratic rationalization.

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