The BHO is hands down the most important training rotation you will complete during your internship, as you’ll learn that ins and outs of your job as a behavioral health officer. I elected to engage in this rotation for a full 12 months, so that I could squeeze out as much training as possible. This experience proved to be incredibly valuable as I thrown into the fire when I did secure my first BHO gig (more on that later).
As a BHO, you running multiple missions in the realm of behavioral health. You’re expected to split half of your time providing clinical care to Soldiers and perform staff officer responsibilities on behalf of your BDE.
When I arrived to my rotation, there was no BHO at the BDE I was supporting. As such, the responsibility fell on me to support the BDE. I realized quickly how this job is operationalized in a combat function. I was consulted with on multiple occasions about the state of individual Soldier dispositions, functionality of macro systems, and responding to crisis.
It was challenging to get my feet underneath me as I was learning to practice within a new climate as well as understand the unique role of military readiness. We don’t only provide clinical care to Soldiers, we also collaborate with other medical professionals as well as consult with other stakeholders to discuss Soldier readiness. The Army exists to fight wars, and the BHO plays an important function in identifying who is deployable and who ultimately can’t perform war-fighting functions. It’s here where I realized the perpetual ethical dilemmas we fall into as providers. Ethically, we swear to do no harm to patients, meet them where they’re at, empower them, and advocate for them. However, we operate under DoD guidelines that can violate the aforementioned values. I couldn’t recommended ethical and clinical supervision as you navigate this unique dilemma.
One unique aspect of being a BHO, is the likelihood you’ll come across nearly every DSM condition. The bulk of this clinical issues that would present to the clinic would hover around adjustment disorder, Depression, Anxiety disorders, or PTSD. These issues are influenced further by each of these Soldiers unique (and often) traumatic upbringing paired with the inherent stressors that accompany serving in the military.
Clinically, I was challenged to adapt to the diverse issues that would present to the clinic. I found myself reverting more and more back to the basics of practice to build rapport and avoid the assessment / EBP trap of providing an intervention without a detailed biopsychosocial. I found that practicing reflexive practice allowed me to support those from differing cultures, backgrounds, and genders. Soldiers often feel disempowered, as such finding way to empower them not only as individuals, but as experts in their story immediately benefitted practice. As I empowered those to inform me of their culture, religion, sexuality, etc., and allowed it to flow freely in and out of practice I was finally able to create momentum to make meaningful change.
The aforementioned focus in addition to utilization of Motivational Interviewing is the baseline of all my clinical practice and makes up close to 75% of the work we do. This other 25% is utilizing of EBPs I have found success with, given their diagnoses, their intellectual / emotional functionality, and their goals.
I utilize the philosophies that align with ACT in almost every encounter, but will leverage EMDR for strict trauma processing. I’ll flex and practice others depending on the patient.
Whether you’re practicing as a social worker in or outside of the military, I couldn’t recommend enough the importance of finding an evidence based practice that inspires you and mastering it for at a minimum of three years. I continue to refine my craft in ACT, MI, and EMDR.
Throughout the BHO rotation, I found myself attending various BDE functions. I would reserve my afternoons to go to differing BDE locations to see Soldiers in their environments to talk to them, learn their story, and get a pulse as to the experiences of the unit. This was valuable in providing resources and providing much needed preventative care. In doing so, we could identify issues that we could inform leaders on and educate them on in order to improve overall morale within the unit.
One important aspect to being a helpful BHO is to be the subject matter expert of all things, behavioral health. It’s paramount to spend this time to understand the policies around medical readiness, administrative actions, and the disability evaluation system, as you’ll have a key function in educating your leaders on these policies.
On the tale end of my rotation, I focused solely on clinical interviews needed for administrative actions, including administrative separation for misconduct. In hindsight, I wish I would’ve focused more on these as they are paramount in your role as a BHO.
Before I knew it, February 2020 rolled around I was given my order to my first duty station. At this point, I had completed licensure requirements for my state (Utah), and was a fully licensed independent provider and could finally sign my own notes (how exciting). I terminated patient care and shifted gears towards graduation, PCSing, and tying up other loose ends.
See that last few weeks of my SWIP experience, here: