General Orientation to the Warrior Transition Unit WTU

1

• General Orientation to the Warrior Transition
  Unit (WTU)

January 2008
UNCLASSIFIED
2
Lesson 1

• Overview of the Warrior Transition Unit (WTU)
• Terminal Learning Objective
• Given any situation involving Warriors in
  Transition, implement the principles of the Army
  Medical Action Plan in accordance with Department
  of the Army Warrior in Transition (WT)
  Consolidated Guidance

UNCLASSIFIED
3
WARRIOR TRANSITION PROGRAM
Unclassified
4
TOPICS
Warrior Transition Program Background Army
Medical Action Plan WT Assignment/Attachment
Criteria WTU Integrated Management Team (Triad)
5
Warrior Transition Background

• Road to War. The situation that created the
  current Wounded Warrior environment within the
  Army Medical Department was the result of three
  factors -
• The volume of Medical Evaluation Board (MEB)
  cases significantly increased from 6,560 cases in
  FY02 to approximately 10,000 cases in FY05 and
  06
• The number of Physical Evaluation Board (PEB)
  cases rose from just over 9,000 cases in CY01 to
  over 15,000 cases in CY05
• Policy variances between Department of Veterans
  Affairs, DoD, and Army regulatory guidance the
  need for additional training of personnel
  throughout the Army Physical Disability
  Evaluation System process and insufficient data
  management systems and information management.

6
Warrior Transition Background

• June 2003 - Mobilized Reserve Component Soldiers
• Medical Holdover operations began in 2003 as
  large numbers of Reserve Component Soldiers were
  mobilized in support of Operation Enduring
  Freedom (OEF) and Operation Iraqi Freedom (OIF).
• Soldiers who were not medically deployable were
  kept at MOB stations to fix and deploy or be
  referred to Physical Disability Evaluation System
  (PDES).
• Soldiers demobing were able to stay on active
  duty for treatment of "in line of duty"
  conditions.
• First Nurse Case Managers were mobilized to
  manage Reserve population.

7
Warrior Transition Background

• June 2003 - March 2004 - Formal Medical Hold-Over
  (MHO) structure and dedicated command and control
  established on installations.
• Dedicated providers and case managers
• New Command and Control (C2) and installation
  support structure
• Accelerated access standards

8
Warrior Transition Background

• March - April 2007
• Congress asks Army to evaluate structure, care,
  systems, and process for all Warriors in
  Transition regardless of Compo or GWOT
  affiliation
• Establishment of the Army Medical Action Plan
  (AMAP)
• Medical Holdover now termed Warrior in Transition
  (WT)
• Development of Warrior Transition Unit
• Staffing Ratios set for PCM, NCM, PLT SGT, PEBLO,
  BH, etc.
• Same standard set for all Soldiers
• Ombudsman Program established at MTFs
• Significant changes made in the Army Physical
  Disability Evaluation System (PDES)
• Greater emphasis placed on training of the Cadre

9
Mission Essential Task List

• WT Program Standards are based on the four
  Mission Essential Tasks for Warrior Transition
  Units
• Provide Command and Control
• Provide Provision of Clinical Care
• Provide Administrative Support
• Assist with Reintegration into the Force and/or
  Transition to Civilian Life

10
I am a Warrior in Transition. My job is to heal
as I transition back to duty or become a
productive, responsible citizen in society. This
is not a status but a mission. I will succeed in
this mission because I am Warrior.
11
Warrior Transition Unit (WTU)

• GOAL of the WTU Expeditiously and effectively,
  evaluate, treat, return to duty, and/or
  administratively process out of the Army, and
  refer to the appropriate follow-on health care
  system, Soldiers with medical conditions
• MISSION STATEMENT Provide command and control,
  primary care and case management for Warriors in
  Transition to establish conditions for healing
  and promote the timely return to the force or
  transition to civilian life.

12
Questions ?
13
Army Medical Action Plan (AMAP)

• The Office of the Surgeon General (OTSG)
  established the AMAP to develop an action plan to
  establish an integrated and comprehensive
  continuum of care and services for Warriors and
  their Families
• Warriors and Families are treated at MTFs in
  conjunction with DoD, VA, and civilian medical
  facilities
• Provide world-class care and services to match
  quality of service given to our Nation
• Five-phase plan starting April 2007 and ending
  January 2008

14
Army Medical Action Plan (AMAP)

• Actions to be implemented include -
• Establishing and institutionalizing a C2
  structure for Warriors undergoing long-term
  definitive, rehabilitative, and convalescent care
• Prioritizing mission support and creating
  ownership of actions and processes
• Flexing housing policies and focusing on Family
  support issues
• Developing training and doctrine to facilitate
  and ensure a system with provides timely and
  effective support
• Creating full patient visibility throughout the
  process and facilitating the continuum of care
• Improving the MEB process and eliminating delays
  in the PEB process

15
Warrior Transition Office

• The WTO serves as OTSG/MEDCOMs focal point for
  the coordination of activities, programs and
  services that are provided in support of the
  Armys WT Programs.
• The Warrior Transition Office consists of the
  Office of the Director, the MEDCOM Medical
  Assistance Group, and the MTF Ombudsmen. The
  Director
• The Director has primary responsibility for
  creating an environment of collaboration and
  maintaining staff coordination relationships
  within OTSG/MEDCOM and with non-MEDCOM agencies,
  ensuring effective collaboration and integration
  of resources committed to WT Programs.

16
Warrior Transition OfficeMEDCOM Ombudsman Program

• Function as Soldier-Family Advocates for the U.S.
  Army Medical Command (MEDCOM) in support of the
  Armys Warrior in Transition (WT) Program.
• Located at the Army military treatment facilities
  (MTFs) and serve as a liaison between the MEDCOM,
  and the Soldier, his or her Family, and MTF
  Commander acting as a communicator, facilitator,
  and problem solver.
• Utilize administrative, organizational,
  listening, and educational skills to assist the
  Soldiers and their Families with their issues.
• Have a collaborative relationship with the MTF
  Patient Advocacy Office. The Ombudsmen work
  closely with the MEDCOM Medical Assistance Group
  (MAG) to assist with the resolution of issues
  that come through the Army Wounded Soldier and
  Family Hotline.

17
Warrior Transition OfficeMEDCOM Medical
Assistance Group

• Ensures that Warrior in Transition Soldiers and
  their Families are provided with responsive and
  thorough investigations of their concerns
• Provides functional knowledge of operations in
  MTFs the Veterans Administration compensation
  and disability rating systems the Army Physical
  Disability System
• Serves as subject matter expert for Patient
  Administration Division (PAD) operations in MTFs,
  the Warrior in Transition Programs and structure
• Provides functional knowledge of the
  Soldier-Family Advocates programs and services,
  and provides the skills needed to optimize the
  efficiency and effectiveness of the SFAs
• Prepares the MEDCOM response to all questions or
  issues regarding all aspects of the MEDCOM
  Soldier-Advocate Program

18
Soldier Family Assistance Center
(SFAC)orWarrior and Family Assistance Center
(WFAC)

• Provide full spectrum of personnel, finance, and
  administrative support and assistance to the
  Wounded Warriors and their Family members
  One-stop shop
• Coordinate with other government and private
  organizations from support services
• Receive and distribute donated items to deserving
  Soldiers and Family members
• Key Personnel
• Soldier Family Assistance Liaison
• Inventory Specialist
• Budget Analyst
• Military Coordinator
• Family Program Specialist

19
Questions ?
20
WTU Assignment/Attachment Criteria

• Each Army MTF will maintain a warrior transition
  unit (WTU). Units will vary in size from small
  detachments to brigades, depending on patient
  population.
• A Warrior in Transition is any Soldier who
  requires significant medical intervention in
  order to heal and return to duty or to make a
  successful transition to veteran status.
• Service members must meet the criteria of AR
  40-400.
• All Service members who present to the MTF for
  medical evaluation or treatment from
  off-installation locations and who will be
  present more than 24 hours will be required to
  report to the WTU for accountability and control
  purposes.
• For those Soldiers who are on medical TDY orders,
  the orders will specify that the Soldier is under
  the command and control of the WTU while at the
  MTF. All Service members in a TDRL status will
  report to the WTU upon arrival at the MTF.

21
WTU Assignment Criteria for Active Component

• Requires a temporary profile of more than 6
  months duration
• Treatment plan requires the Soldier to spend most
  of his/her time receiving and/or traveling to and
  from medical treatment
• Requires an MEB and therefore requires a
  permanent profile with duty limitations that
  preclude the Soldier from contributing to the
  parent units mission
• Profile limitations preclude deployment (AR
  40-501, chapter 5) within the next 60 days and
  the unit is scheduled to deploy within 60 days
• Unit has no rear detachment
• Rear detachment capabilities are insufficient to
  accommodate the Soldiers physical limitations
• Limitations prevent the Soldier from contributing
  to the rear detachments mission

22
WTU Assignment Criteria for Reserve Component

• Soldier was mobilized on 10 USC 12302 orders in
  support of named operations and diverted from
  his/her normal mobilization mission or
  demobilization processing in order to receive
  medical treatment
• Soldier is in need of medical evaluation,
  treatment, and disposition including definitive
  health care for an illness, injury, or disease
  incurred in the line of duty and/or for
  aggravation of a pre-existing medical condition
  incurred in the line of duty
• MTF Commander determines if soldier will or will
  not be able to RTD within 60 days, but will have
  fewer than 120 days remaining on USC 12302
  partial mobilization order. If so, the Soldier
  will be converted from partial mobilization
  orders to medical retention processing (MRP)
  12301(h) orders, subject to Soldier's consent in
  accordance with the current personnel policy
  guidance

23
Medical Retention Processing (MRP) Orders

• Medical Retention Processing (MRP) Orders extend
  RC soldiers for pay and benefits
• Medevaced soldiers who require more than 60 days
  for treatment are taken off MOB orders and placed
  on MRP
• Demobing soldiers extended on AD for care
• Soldiers must volunteer to remain on AD
• Medical Holdovers (MHO) on MRP are assigned to a
  Medical Retention Processing Unit (MRPU) on
  designated installations
• Qualified soldiers may be attached to a Community
  Based Health Care Organization (CBHCO)

24
Decision Matrix for Assigning or Attaching a
Soldier to the WTU

• Purpose of the Matrix
• Assist Unit Commanders in identifying those WT
  eligible Soldiers who may be at the most risk
  remaining in their units and who may benefit most
  from the assignment or attachment to a WTU
• Goals of assigning or attaching a Soldier to a
  WTU
• Optimize medical, surgical, and psychiatric
  outcomes
• Prepare a Soldier for transition
• Prevent delays in clinical and administrative
  evaluation
• Increase unit readiness

25
Decision Matrix for Assigning or Attaching a
Soldier to the WTU

• FRADO 2 to HQDA EXORD 118-07
• Requires Unit Commanders to nominate all WT
  eligible Soldiers for assignment or attachment to
  a WTU or to have approved this Decision Matrix
  for each WT eligible Soldier who has not been
  assigned or attached to a WTU
• Nomination or the Decision Matrix must be
  completed within 30 days of determining that a
  Soldier meets the eligibility criteria (contained
  in the Warriors in Transition Consolidated
  Guidance)
• See Decision Matrix handout to view matrix and
  additional instructions

26
Questions ?
27
WTU Integrated Management Team
28
The Triad

• The Warrior Care Triad consists of a joint and
  collaborative effort by the Primary Care Manager
  (PCM), Nurse Case Manager (NCM), and the Squad
  Leader to provide each WT with comprehensive,
  holistic care
• The team participates in all aspects of care
  while ensuring the needs of the Army, Soldier,
  and Family members are met

29
Primary Care Manager (PCM)The Physician

• 1 PCM 200 WTs
• Provides principal oversight and continuity of
  health care
• Facilitates movement of WTs through the medical
  process while ensuring the highest quality care
• Promotes the physical, spiritual, emotional and
  mental healing of the WTs and their families
• Assures timely disposition of back-to-duty or
  medical separation

30
Nurse Case Manager (NCM)

• 1 NCM 18 WTs (MEDCEN) or 36 WTs (MEDDAC)
• The vital link between WTs and every medical
  specialty clinic in the MTF
• Licensed health care professional (registered
  nurse)
• Assesses, plans, implements, coordinates,
  monitors, and evaluates options and services to
  meet the Soldiers health needs
• Ensures that the medical health care plan is
  followed and that there is steady progress

31
Squad Leader

• 1 Squad Leader 12 WTs
• The vital link for the WT to the chain of
  command, NCM, and PCM
• During in-processing
• First to welcome the WT and counsels, orients,
  mentors, and guides both the WT and Family
• Ensures living conditions are appropriate
• Submits requests for awards and decorations, and
  ensures that the Warriors records are
  transferred from losing to gaining units
• Keeps the platoon sergeant/leader informed on
  medical status and requirements of members of
  his/her squad

32
Squad Leader
Accountability

• During treatment phase
• Accounts for all Warriors on a daily basis
  through personal contact at formation, in rooms,
  phone calls, etc., depending upon the condition
  and location of each Warrior
• Coordinates with NCM and PCM to ensure WTs show
  up for appointments and activities
• Resolves personnel or financial issues
• Uses WT Program standards to help the WTs
  understand their medical condition, physical
  profile, and treatment programs

Accountability
Accountability
33
Squad Leader

• During medical disposition phase
• Ensures WTs are aware of all MEB-related
  appointments and the progress of their MEB
• Maintains contact with WTs during preparation of
  MEB packet in case of issues that need quick
  resolution

34
WTU Integrated Team Training

• Distributed Learning (DL) required within 30 days
  of assignment to WTU
• January to October 2008 additional training
  provided by mobile training teams and AMEDD
  training support package (delivered by local
  trainers)
• October 2008 resident training provided at
  AMEDDCS, Fort Sam Houston, TX
• Replaces training support package
• DL becomes phase 1 of required training and still
  must be completed within 30 days of assignment to
  WTU
• Resident Training must be completed within 6
  months of assignment to WTU

35
Distributed Learning Completed within 30
days (ongoing requirement)
2008 JAN FEB MAR APR MAY JUN JUL
AUG SEP OCT NOV
FY 08
FY 09
Designated Trainers Deliver TSPs Deliver by end
of FY08
Resident Course at Fort Sam Houston Begins Oct
2008 (FY09) Must attend within 6 mos
36
Military Leadership
37
Military Leadership

• Company 1 Company for approximately 200 WTs
• Company Commander - Provides compassionate
  leadership and maintains 100 accountability,
  conducts training programs, develops cadre,
  establishes Family Readiness Group, and conducts
  quarterly sensing sessions
• First Sergeant - Assists Company Cdr to plan,
  coordinate, and supervise activities coordinate
  unit administration and assists/conducts
  inspection of unit activities and facilities

38
Military Leadership

• Platoon Sergeant Maintains accountability of
  WTs serves as the first line of defense if
  Warriors develop behavioral, personal, or other
  health problems maintains communication logs
  and notifies NCM of potential recovery issues
• Squad Leader the critical link for the WT to
  the chain of command, NCM, and PCM first line
  supervisor for the WT responsible for
  maintaining the trust and confidence of the WT
  while assisting them in their daily activities.

39
Leaders Roles

• Recognize Combat Stress Reactions
• Encourage Soldiers to seek mental health care if
  they need it
• Encourage buddy-aid, utilizing the chain of
  command, Chaplain and mental health staff
  assistance
• Create a climate where there are no stigma or
  barriers to seeking mental health care

40
Leaders Should Know

• Know how their behaviors impact Soldiers
  well-being
• Know how their Soldiers well-being affects
  health, readiness and performance of their unit
• Know your own limitations
• Soldiers have experienced significant combat
  stressors
• Some Soldiers do not develop significant
  impairment
• Some will develop Post Traumatic Stress Disorder

41
Leaders Must

• Do the right thingalways
• Do what is right for the Soldier first
• Follow the example of leaders that do it right

42
10 Effective Leader Behaviors

• Be fair
• Admit mistakes
• Underwrite honest mistakes
• Protect subordinates
• Communicate
• Visit your troops
• Encourage involvement
• Team build
• Instill discipline
• Punish judiciously

Camera Operator STAFF SGT. JON SOUCY
43
Leadership Philosophy

• The challenge of leading and mentoring such a
  diverse group of Warriors takes time, patience,
  and strong leadership skills. Warriors assigned
  to the WTU have experienced life-challenging
  medical events and are in the process of
  receiving medical treatment for their injuries or
  illnesses on an outpatient basis. Leaders within
  the WTU must adhere to the Army values that
  firmly binds all Army members into a fellowship
  dedicated to serve the Nation and the Army.

44
Company Structure
45
WTU VISION

• An effective Company or Battalion that takes
  care of Warriors in Transition so they can focus
  on their mission to heal. High quality living
  conditions and no unnecessary procedural delays.
  A TRIAD of Squad Leaders, Case Managers, and
  Primary Care Managers (Physicians) who all work
  together to ensure advocacy for Warriors,
  continuity of care, and a seamless transition
  into the force or return to a productive civilian
  life.

46

• The needs of Warriors in Transition are unique
  to each individual (and) they should be
  provided a standard of care commensurate with
  their service and sacrifice to our Nation
• BG Michael S. Tucker

47
Questions ?
48
Summary

• A. Background
• 1. Large number of RC Soldiers mobilized in
  support of OEF and OIF
• 2. Army Medical Action Plan established
• 3. Medical Holdovers now Warriors in Transition
  (WTs)
• 4. Creation of Warrior Transition Units (WTU)
• B. Army Medical Action Plan (AMAP)
• 1. Established by OTSG
• 2. Four phase plan
• 3. Warrior Transition Office
• 4. Soldier Family Assistance Center (SFAC)
• C. Assignment and Attachment Criteria
• 1. Assignment/attachment to WTU
• 2. Criteria for active component
• 3. Criteria for reserve component
• 4. Medical retention processing orders
• D. Integrated Management Team - Triad

49
References

• For more information, refer to the Warrior in
  Transition Consolidated Guidance
• Warrior Transition Program website for numerous
  references and information - https//www.us.army.m
  il/suite/page/328110 via AKO portal
• AMAP home page via AKO portal -
  https//www.us.army.mil/suite/page/400750
• EXORD 118-07 (Healing Warriors) and associated
  FRAGOs
• Click here to print your Completion Certificate