Army CIO/G-6 Support to Army Campaign Plan for Health Promotion, Risk Reduction and Suicide Prevention (ACPHP) 12 Jan

1. Army CIO/G-6 Support to Army Campaign Plan for Health Promotion, Risk Reduction and Suicide Prevention (ACPHP) 12 Jan 10 Mr. Steve Ridings Army CIO/G-6 Army Net-Centric Data Strategy Center of Excellence https://www.intelink.gov/wiki/Suicide_Mitigation_COI

2. Suicide Mitigation Overview • Suicide rates among Army personnel have risen substantially since the beginning of the current conflicts in Iraq and Afghanistan, despite major surveillance and intervention efforts introduced by the Army to prevent suicides over this period. • In October 2008, a memorandum of agreement between the National Institute of Mental Health (NIMH) and the Army was signed, which authorized NIMH to lead an interdisciplinary team of four research institutions to carry out the largest study of suicide and mental health among military personnel ever undertaken. Called the Study to Assess Risk and Resilience in Service Members (STARRS) , it is being supported with $50 million in funding from the U.S. Army. • In December 2008, the Army Science Board presented the findings of its preliminary study on suicides in the Army. One of the findings of the report was that the data sources required to analyze the problem are disparate and not integrated. The current information environment does not support the identification and analysis of factors that impact Army suicide rates. • In Spring 2009, General Peter W. Chiarelli, the Vice Chief of Staff of the Army (VCSA), established a Council of Colonels designated as the Army Suicide Prevention Task Force (ASPTF) to manage a wide range of tasks intended to reduce the rate of suicide in the Army. • The Suicide Mitigation Data Management Working Group (SMDMWG) was then formed with the Functional Data Managers of ten data sources selected from the thirty-five data sources initially identified by the Army Science Board as potential data sources of interest.

3. Background: Army Campaign Plan for Health Promotion, Risk Reduction and Suicide Prevention (ACPHP) SOURCE: BG McGuire Presentation to 2009 Senior Leader’s Conference, 5 May 09

4. Hierarchy of the Suicide Mitigation Community

5. Suicide Mitigation Data Management Working Group Vision To enable the analysis of high quality data pertaining to U.S. Army suicides from many disparate sources; improving prevention and mitigation efforts by exposing, correlating, and integrating these data to provide a composite picture, enabling surveillance and decision-making that will positively impact social behaviors across the Army. Approach • The SMDMWG consists of representatives from the Office of the Vice Chief of Staff, the CIO/G-6, US Army Public Health Command (Provisional), NIMH, and the Functional Data Managers of each of the data sources identified as desired/required by USAPHC (Prov) and NIMH STARRS. • The SMDMWG meets every other week to address the project tasks as assigned by the ASPTF through a Task Action Plan (TAP). This TAP is managed using a detailed Synchronization Matrix, exploiting the spiral model development process to combine elements of design and prototyping-in-stages to produce results. • The initial SMDMWG addressed requirements for TAP 9.1.0 by establishing the USAPHC (Prov) ABHIDE system with data from ten data sources. This was Spiral 1 of the effort. • The current plan addresses requirements for TAP 9.1.5, and is organized into Spiral 1.5 and Spiral 2. To support these spirals, the data sources are vetted and sorted into three Priority Sets. • USAPHC (Prov) and the NIMH STARRS team have agreed to work together to evaluate potential data sources and to process data from the sources according to the same Priority Sets.

6. Suicide Mitigation Spirals Spiral 1 – USAPHC (Prov) (completed July 09) Initial Suicide Mitigation effort to collect data from ten data sources for the Army Behavioral Health Integrated Data Environment (ABHIDE), to support USAPHC (Prov) epidemiologist studies. This data was gathered for deceased soldiers only. Spiral 1.5 – NIMH STARRS (started July 09) All efforts required to provide National Institutes of Mental Health (NIMH) STARRS team with data to support their Historical (Component 1) Study, includes living and deceased soldiers. Spiral 2 – USAPHC (Prov) (started July 09) Creation of net centric data services to automate exchange of data with ABHIDE. Additions to ABHIDE New data sources New data elements for existing sources from Spiral 1 Data for living soldiers with suicide ideations and attempts Future Spirals NIMH STARRS 5 year Prospective (Component 2) Study, includes living and deceased soldiers

7. Suicide Mitigation Data Extracts

8. Spiral 1 – Army Behavioral Health Integrated Data Environment • An initial pilot database was designed by CIO/G-6 & USAPHC (Prov) as a prototype suicide registry to support USAPHC (Prov) behavioral analysis and to potentially support the VCSA Suicide Report. The prototype was completed in March 2009. • The pilot database was populated by the Armed Forces Health Surveillance Center (AFHSC) with data collected from various sources. The database, and the extract, transform, and load environment to populate the database, was later named the Army Behavioral Health Integrated Data Environment (ABHIDE). • The ASPTF developed a Task Action Plan (9.1.0) that required an integrated database to expand upon the prototype suicide registry. The ABHIDE met the initial requirements, and was adopted as Spiral 1 (ABHIDE) for this mitigation effort. ABHIDE entered production in July 2009. • ABHIDE provides the USAPHC (Prov) with the information management capabilities needed to integrate non-related/dispersed data into a single comprehensive suicide tracking and mitigation database. This database and its capabilities support enterprise-wide population-based surveillance reporting of Army suicide (deceased Soldiers only). The database will also support the mitigation efforts for future suicide events across all phases of Army service (living and deceased soldiers).

9. Spiral 1 – ABHIDE Data Sources Army Suicide Event Report (ASER) Standardized risk and protective factor information collected on suicide events Integrated Total Army Personnel Database (ITAPDB) Consolidated human resource database providing the Army and DOD with a single repository for personnel info for all components of the Army Defense Casualty Information Processing System (DCIPS) Tracks causality data pertaining to service members and their families, manages mortuary information, repatriation data, and survivor case management Drug & Alcohol Management Information System (DAMIS) The Army’s official repository for all current and historical Army Substance Abuse Program (ASAP)-related information Military Health SystemData Repository (MDR) Centralized data repository for MHS that captures, validates, and distributes defense health data to users worldwide Clinical Data Mart (CDM) Tool to measure , analyze, and mange performance of direct patient care, wellness, prevention, and disease management to improve care delivery Medical ProtectionSystem (MEDPROS) Medical readiness database that includes all medical and dental readiness requirements in accordance with Army regulations Centralized OperationsPolice Suite (COPS) A database driven, Web-enabled, secure intranet application to support processing the Army Military Police reports CID InformationManagement System (CIMS) A consolidated data system for criminal investigation reports, criminal intelligence applications, and record storage. Army Central Registry (ACR) A victim-based registry documenting substantiated spouse and child abuse events involving Army service members

10. Details of Spirals 1.5 and 2

11. Spiral 1.5 – NIMH/STARRS • Data Providers support the Army Suicide Mitigation Project and NIMH STARRS team by: • Providing Data Dictionaries, related supporting information, and sample data extracts to NIMH for investigation • Providing extract data for historic study and prospective study for NIMH via USAPHC (Prov) • Providing the extracts to USAPHC (Prov) for verification of extracts and for de-identification of Personal Identifiable Information (PII) • Developing Data Thread illustrations to depict decision points for data input, time periods necessary to obtain data, and other data sources that feed into the primary data source • Assisting CIO/G-6 with formulation and approval of Data Use Agreements

12. Spiral 1.5 – NIMH STARRS Data Requirements 2 We recognize that not all data elements will be available for all years for all Soldiers. In particular, some Army data systems may only have come online in recent years, and/or may only capture partial data for some Soldiers (e.g., for Guard and Reserve component Soldiers only when they are activated).

13. Spiral 2 – ABHIDE New Data Sources and Data Services • Data Providers support the Army Suicide Mitigation Project by assisting the CIO/G-6 task force and USAPHC (Prov) with: • the identification and extraction of additional data elements for the ABHIDE population to foster USAPHC (Prov) epidemiological study • the identification and extraction of data elements for ABHIDE from new data sources identified by NIMH STARRS to foster USAPHC (Prov) epidemiological study • the identification and extraction of living soldiers' attempts/ ideations for ABHIDE population • the establishment of standardized and periodic feeds of data for the data sources • the creation of web/data services to automate information flow to ABHIDE

14. Data Source Automated Integration with ABHIDE Implements ADSL Data Services Implements Manual Data Extracts NIPR APC SOA STACK USAPHC (Prov) Data Store ADS 1 WS Web Service Client ADS 1 Infrastructure Security Data Store ADS 2 WS ESB: Messaging ADS 2 Infrastructure Data Abstraction Data Store ADS 3 WS ADS 3 Infrastructure ESM Data Store ADS 4 WS PROXY ADS 4 Infrastructure Data Store ADS 5 WS ADS 5 Infrastructure Data Store ADS 6 WS ADS 6 Infrastructure ABHIDE Data Store ADS 7 Infrastructure Secure EMail Data Store ADS 8 Infrastructure Preliminary Architecture

15. Backup

16. Suicide Mitigation: Overview Data Process Flow – Slide 1 of 2 Determine Funding Impacts Data Source Create & Deploy Data Service Get Stakeholder Buy-In * Create Manual Extracts Identify Business Needs * Define Data Element Requirements Project Team Scope Problem / ID Strategy Create & Deploy Data Service Pilot And Feedback * Develop Data Models ** Identify Data Providers Get Stakeholder Buy-In Identify Business Needs * Load Manual Extracts Target System Create & Deploy Data Service Obtain IRB and IA Certification Determine Funding Impacts Identify Legal, PII, PHI Constraints Support Entities (Legal, IA, Privacy, etc.) Establish Legal Working Group Identify IA / DIACAP and IRB Requirements Create SORN - Draft, Publish, & Satisfy Comments Notes: * See next slide for detailed process ** See ADS process for details

17. Suicide Mitigation: Detailed Process Flow - Data Elements, Requirements, Models, Extracts Slide 2 of 2 Data Source Develop / Test Extract Script; Verify Output Provide Data Dictionary Agree to Provide Data Map Data Provider to Business Needs Send Full Data Extract Clarify Data Elements Create/Send Sample Data Project Team Create LDMs Create Uniform Data Elements List Finalize Data Elements List; Obtain sign-off Update Data Dictionary for Consumer Create PDMs Target System Test Load Process with Sample Data; Confirm sample to Data Elements List Receive Updated Data Dictionary De-Identify Data (if required) Identify Requested Data Elements Define Medium For Data Exchange Extend Existing Database as Needed Load Full Extract Key: Define Data Element Requirements Process Develop Data Models Process Create/Load Manual Data Extracts Process

18. Suicide Mitigation: Supplemental Process Flow – Define Data Elements to be included in Data Extracts, Develop Data Dictionaries Receive & Review Data Dictionary Add Basic PII/HIPAA Indicators Update Official Selection Spreadsheet Create/Send Sample Extract* Specify Data Elements in Data Use Agreement Create/Send Full Extract Create Standardized Data Dictionary in a Project Database Verify All “De-Identified” Data Elements & Indicate Those That Cannot Be Sent Load Sample Extract Coordinate Meetings to Clarify Data Elements Map Data Provider to Business Needs Confirm via signoff Identify & Resolve Discrepancies Review Data Dictionary Select Required Data Elements Generate Official Selection Spreadsheet Confirm via signoff Resolve Discrepancies Generate Uniform Data Elements Spreadsheet per Data Provider ITERATE Key * Updated sample extracts as required. Consumer Data Provider Coordinator Modeler