Veronica R. Baechler, MDLTC, MC, USA

Developmental Pediatrician

OIF / OEF2003 Operation Iraqi Freedom

2001 Operation Enduring Freedom

History

• OEF: 2001• OIF: 2003• Ongoing Mission• WRAMC Wounded Warrior Program• Warrior In Transition• Influx of transient population of WW Children• Littlest Warrior Comprehensive Care Program• PEDIATRICS Medical Home

Walter Reed SFAC

• Soldier and Family Assistance Center• Mr. Stephen Maguire – Director of Services• Ms. Karen Keon – Child, Youth, and School

Services Liaison

Residential OriginAge Soldier Name Guardian Name Guardian Phone Residence Orders? Previous CYS Previous Location School

3 G G C G Marriot Yes Yes Yuma Proving Ground N/A

9 N C M C Marriot Yes Yes Ft. Drum, NY N

6 N C M C Marriot Yes Yes Ft. Drum, NY N

3 NC M C Marriot No Yes Ft. Drum, NY N

12 A M D M Fisher-FG No Yes Fort Bragg, NC

13 A M D M Fisher-FG No Yes Fort Bragg, NC

12 SP R P Mologne Yes No N/A Y

14 S P R P Mologne Yes No N/A Y

9 RS A S Ft Meade No No N/A Ft Meade

13 R S A S Ft Meade No No N/A Homeschool

15 R S A S Ft Meade No Yes Ft Wainwright Homeschool

8m R G R G Ft Meade No Yes Ft Meade N/A

6m E S Glen Haven N/A

8m P T RT Crowne Pl No No N/A N/A

2 PT R T Crowne Pl No No N/A N/A

2y S E S Glen Haven N/A7w 2.5 P M Mologne Yes No Ny

7 K W A W Fisher-WR No Yes

3 B B T B Mologne Yes No Fort Hood TX N/A

7m J H 10 J JB Fisher-WR

SFAC Intake Process

Family Centered Care

• Parents as Teachers• Additional Services

– Lodging– Logistics– Finance

• Child and Youth Services• Operation Brave Families

Developmental RangesAge Soldier Name Guardian Name Guardian Phone Residence Orders? Previous CYS Previous Location School

3 G G C G Marriot Yes Yes Yuma Proving Ground N/A

9 N C M C Marriot Yes Yes Ft. Drum, NY N

6 N C M C Marriot Yes Yes Ft. Drum, NY N

3 NC M C Marriot No Yes Ft. Drum, NY N

12 A M D M Fisher-FG No Yes Fort Bragg, NC

13 A M D M Fisher-FG No Yes Fort Bragg, NC

12 SP R P Mologne Yes No N/A Y

14 S P R P Mologne Yes No N/A Y

9 RS A S Ft Meade No No N/A Ft Meade

13 R S A S Ft Meade No No N/A Homeschool

15 R S A S Ft Meade No Yes Ft Wainwright Homeschool

8m R G R G Ft Meade No Yes Ft Meade N/A

6m E S Glen Haven N/A

8m P T RT Crowne Pl No No N/A N/A

2 PT R T Crowne Pl No No N/A N/A

2y S E S Glen Haven N/A7w 2.5 P M Mologne Yes No Ny

7 K W A W Fisher-WR No Yes

3 B B T B Mologne Yes No Fort Hood TX N/A

7m J H 10 J JB Fisher-WR

Impact on Children

• Stress in Children of Iraq War Soldiers• By Matthew Tull, PhD, About.com Guide• Updated: June 22, 2009• About.com Health's Disease and Condition

content is reviewed by the Medical Review Board • Many soldiers are returning from the Iraq War

are showing signs of PTSD and other difficulties, and the impact the war can also increase levels of stress in children of veterans.

Child-Focused Care• Child and Youth

Services• Operation Brave

Families• ? School needs

September 2010

WR Department of Pediatrics PEDIATRICS Medical Home

CHILD & YOUTH NEEDS ASSESSMENT PLEASE IDENTIFY THE SERVICES OR TOPICS YOU ARE INTERESTED IN LEARNING ABOUT DURING YOUR VISIT:

CHILD, YOUTH & SCHOOL SERVICES (CYSS) Hourly Child Care (6 weeks – 12 years) Child Care Registration Services (6 wks – 17 yrs) Full Day Child Care (6wks – 4yrs) Tutoring Assistance Home Schooling Washington DC-Area School Placement Assistance Child Care Options for Family outside of Washington DC Middle School/ Teen Programs Summer Program Enrollment Grants and Scholarships for extra-curricular activities

PEDIATRIC & MEDICAL SERVICES Well Baby Check Ups Immunizations Sport or School Health Physical Developmental / Educational Needs Refills for Currently Prescribed Medications Diagnosed Special Needs Follow Up

(Explain: ) Vision Screenings Assigned Walter Reed PCM Pediatrician

PARENTS AS TEACHERS Health Screening Play Groups Library Storytime 1-1 Developmental and Age Appropriate Activities

Parent Group Meetings

OPERATION BRAVE FAMILIES PROGRAM (CHILD & ADOLESCENT PSYCHIATRY SERVICE) Discussing Wartime Injury with Children Behavioral Health Specialist Info (counselor, social worker, psychologist) Art / Play Groups How to Identify Adjustment Concerns/ Issues

ADDITIONAL SERVICES Transportation Around WRAMC and surrounding areas

(Shopping Mall, Target, Banks etc) Wounded Warrior Caregiver Events (Movies, Dinners, Massages etc) Wii Game Lounge – Post Library New Parent Support Group New WRAMC Family Dinners Arts and Crafts Dept – Forest Glen Annex

ESSENTIALS Diapers (Size: ) Puzzles

Markers/ Crayons

Coloring Books

Books Clothing

Toys (Age/ Gender: ) Stuffed Animals Movies/ Videos

OTHER:

Name: Service: Date:

Phone: Email: Child(ren) Ages: (We will contact you to ensure your Child-related needs at WRAMC are met and exceeding your expectations, including surveys and program reminders)

MEDICAL HOME

Definiton: Primary care that is

AccessibleContinuousComprehensiveFamily centeredCoordinatedCompassionateCulturally effective.

*American Academy of Pediatrics, 2010

PEDIATRICS Medical Home

• TIER 1: PRIMARY CARE Needs• Well Child Care • Acute Illness• Immunizations• School Physical Evaluations• Sports Physical Evaluations• Dental Referral

• Anticipatory Guidance– Home– Education– Social Life

Primary Care Providers

Kristen BickleLeah Enright Katie Charnock Heather DeLuca

Luis RohenaCarrie ParkerBen NelsonRyan MascioApril Hurlston

Ruth Gardner

Coping in Children• Troops' kids feel war toll Updated 6/25/2009

By Gregg Zoroya, USA TODAY

• WASHINGTON — After seven years of war, most children of combat troops are showing more fear, anxiety and behavioral problems, according to the Pentagon's most sweeping survey of the effects of war on military children.

• Six out of 10 U.S. military parents told researchers their children have increased levels of fear and anxiety when a parent is sent to war, according to a survey of more than 13,000 military spouses of active-duty servicemembers. The results, tabulated early this year, were released to USA TODAY.

Intake Tracking LogFiscal Year 2010 Littlest Warriors Pediatric Services Contacts

October

Soldier Name Intake Name Child Name Email Date PEDS Form? Referral Length of Stay PED

Beneficial? UPDATES

1 M.A. A.A. M. A. 10/27 Yes Yes Unknown n/a

2 L. R. III A. R. L. R. IV 10/27 Yes No Unknown n/a

November

Soldier Name Intake Name Child Name Email Date PEDS Form? Referral Length of Stay PED

Beneficial? UPDATES

1 K. D. K. D. T. D. 11/4 No No Unknown No 2 G. W. J. Wi. G. W. 11/24 Yes No 2 Months Yes

3 G. W.

4 W. C. S. C. A. C. 11/24 No No 4 days NoAustic and speech disability

5 H. C.

6 B. P. R. P. B. P. 11/25 No No 3 years Yes N/A

7 U. C. S. C. J. C. 11/5 Yes No Unknown YesSpeaks alternate languages

8 B. F. J. F. B. .F. 11/5 Yes No 6 months Yes

9

SFAC Tier 2 Screening

• Are you concerned about your child’s academic performance or learning?

• Does your child receive special educational services or is he/she on an Individual Education Plan?

• Are you concerned about your child’s attention or activity level?

• Are you concerned about your child’s mood or emotions i.e. depression, anxiety, withdrawn behavior, compulsions?

• Are you concerned about a change in your child’s eating or sleeping habits?

• Are you concerned about any aggressive behavior or anger management issues in your child?

• Are you concerned about your child’s peer relationships or socialization?

Parents’ Evaluation of Developmental Status Developmental Questionnaire 8-17 yo

TIER 2

CoordinatorsVeronica R. Baechler, MD Ruth Hoffman, Ph.D.LTC, MC, USA Clinical PsychologistDevelopmental Pediatrician

BB: 202-642-0009FAX: 301-295-50698901 Rockville Pike, Bldg 10, 7th FloorEast Bethesda, MD 20889-5600

PEDIATRICSMedical Home

• TIER 2: Consultative Needs

– Methods:• Screening• Assessment

– Dysfunction in: • Psychosocial adjustment • Behaviors of concern• Mental health needs

– EDUCATIONAL NEEDS

Quarterly Follow Up

CHILD & YOUTH NEEDS ASSESSMENT PLEASE IDENTIFY THE SERVICES OR TOPICS YOU ARE INTERESTED IN LEARNING ABOUT DURING YOUR VISIT:

CHILD, YOUTH & SCHOOL SERVICES (CYSS) Hourly Child Care (6 weeks – 12 years) Child Care Registration Services (6 wks – 17 yrs) Full Day Child Care (6wks – 4yrs) Tutoring Assistance Home Schooling Washington DC-Area School Placement Assistance Child Care Options for Family outside of Washington DC Middle School/ Teen Programs Summer Program Enrollment Grants and Scholarships for extra-curricular activities

PEDIATRIC & MEDICAL SERVICES Well Baby Check Ups Immunizations Sport or School Health Physical Developmental / Educational Needs Refills for Currently Prescribed Medications Diagnosed Special Needs Follow Up

(Explain: ) Vision Screenings Assigned Walter Reed PCM Pediatrician

PARENTS AS TEACHERS Health Screening Play Groups Library Storytime 1-1 Developmental and Age Appropriate Activities

Parent Group Meetings

OPERATION BRAVE FAMILIES PROGRAM (CHILD & ADOLESCENT PSYCHIATRY SERVICE) Discussing Wartime Injury with Children Behavioral Health Specialist Info (counselor, social worker, psychologist) Art / Play Groups How to Identify Adjustment Concerns/ Issues

ADDITIONAL SERVICES Transportation Around WRAMC and surrounding areas

(Shopping Mall, Target, Banks etc) Wounded Warrior Caregiver Events (Movies, Dinners, Massages etc) Wii Game Lounge – Post Library New Parent Support Group New WRAMC Family Dinners Arts and Crafts Dept – Forest Glen Annex

ESSENTIALS Diapers (Size: ) Puzzles

Markers/ Crayons

Coloring Books

Books Clothing

Toys (Age/ Gender: ) Stuffed Animals Movies/ Videos

OTHER:

Name: Service: Date:

Phone: Email: Child(ren) Ages: (We will contact you to ensure your Child-related needs at WRAMC are met and exceeding your expectations, including surveys and program reminders)

Transition Plan of Care

• Survey• Tracking• Informational Brochure• Mentoring Program • Links towards Homeward Bound Services• Reintegration to Home Schools• Continuation of Psychosocial Supports at Home

Review

• OIF and OEF Ongoing Missions• Littlest Warrior Comprehensive Care Program• Pediatrics Medical Home• Primary Care Clinic Psychosocial Adjustment

Screening• Transition to Homeward Bound Services• Referral: call or e-mail LTC V. Baechler and/or

Dr. Ruth Hoffman.

Questions ?