Adolescent support and counseling services: A military health program

Keeping IT Brief introduction (0:00): From technology and acquisition to citizen services and mission execution, a culture shift is underway with federal government leaders increasingly seeking out solutions that disrupt the way business has traditionally been done. Here we connect with government and industry leaders driving this change and delivering the real results in support of their agency mission. This is Keeping IT Brief. Today Susan is speaking with Von Borg, the Program Manager and Clinical Supervisor at Leidos.

Susan Sharer (0:41): Von, can you tell us about the Adolescent Support and Counseling Services and why this program is so important?

Von Borg (0:50): Thank you, Susan. The ASACS Program started 34 years ago when the Army asked if there was anything we could do to support military families who were stationed overseas, particularly to support the adolescents who were there. It started as a pilot program to 11 countries, plus Hawaii and Alaska, and up to 65 counselors worldwide. We've focused on prevention, on early intervention counseling, and on identification referral. It's really networking with other providers to make sure that none of the adolescents were falling through the cracks. We've been in almost every middle and high school for American Service members outside the United States and have been doing so for the last 32 years.

Susan Sharer (1:38): Wow. So, Von, tell us about the needs that you're faced with and the support that's provided.

Von Borg (1:45): You know, when Service members are deployed, it's not just a military member, but it's their entire families who are deployed. We see particularly amongst the children that they're experiencing loss from being away from extended family and friends and all that's familiar to them. We've been tracking kids for all of these years to see what kinds of concerns they come to us with. The top of this list are areas such as stress, nervousness, lack of concentration, and because we're embedded in the schools, we also deal with problems having to do with peers, grades, low self-esteem, loneliness, and conflicts with parents. We partner with teachers and administration and this allows us to intervene early before the problems get too out of control.

Susan Sharer (2:40): Well, Von, can you tell us a little bit more about how you're addressing the needs of the adolescents?

Von Borg (2:46): Well, particularly this last year we had kids dealing with social isolation. Social isolation is an outcome of their social distancing, but it's missing out on drama and clubs and sports and music, all the organizations and activities besides the classroom education that support the well-rounded health and safety of kids. With us being able to be embedded in the school, we are there from the time kids get off the bus, throughout the school day, until they go home. We're available to the teachers so we can intervene on the spot and work alongside local mental health providers and frontline care workers to create this network of care. We have early intervention programs and we work with other support mechanisms. There is no single way to get to us. Being embedded, we're there when and where the needs present themselves.

Susan Sharer (3:50): Excellent. I know you're immersed in the community across the world globally. So how do people find out about your program and access to these services?

Von Borg (4:01): Interestingly, we've been fairly consistent that about one-third of our referrals come from schools, from the administrators and the teachers who notice a change or disruption in the student's life. About a third of our referrals come directly from the students themselves. Either somebody saw us doing a presentation and came up to talk afterwards, or a student who's had a successful interaction with us refers a friend. And finally about a third of our resources come from the community. It could be other mental health providers or a primary care physician or the local command who catches a young person shoplifting, or even a chaplain who thinks that having somebody in their life, where they spend most of their time in the school, could be helpful.

Susan Sharer (4:55): Excellent, Von. That's very interesting in terms of the resources that are referring to your program. So, share what you and your teammates have learned over the years of doing this work and share with us what's important to know about the incredible programs that you all are leading.

Von Borg (5:15): Conclusive research has shown, and our experience reflects, that the most powerful ingredient in change is the counseling relationship or, what we call, the alliance. Beyond theoretical model, therapeutic technique, or modality of service provided, it's having the participant know that someone else cares about and believes in them and the possibility for positive change for them. It's asking and genuinely listening about not only their wellbeing, but also about their perception of our work together. Counselors deliberately seek feedback each counseling session towards whether our work together is increasing or decreasing their distress. And additionally, asking if adjusting the way we work together could in any way improve upon the alliance. You know, the very act of asking for their feedback and acting upon their suggestions has shown to improve the relationship and increase their opportunity for change.

Susan Sharer (6:14):  Awesome. So, Von, cover or share with us what you recommend that the MHS psychological health community should be thinking about to curb increases in suicide and substance abuse.

Von Borg (6:30): Two things come to mind. The first, again, is the relationship. After parents, the most influential agent of support and change for an adolescence is a caring, compassionate, non-parental adult. This could be extended family members, but it's also teachers, coaches, instructors, administrators, club leaders, janitors, even lunchroom attendants. It doesn't only have to be, and can't only be, the behavioral health professionals. I had a high school senior share with me the reason they survived middle school. In fact, the reason they were still alive was because the school's crossing guard knew their name and greeted them daily. And I guess second, it's about being present in their lives. Just like the crossing guard was present two times daily in the lives of countless kids. We, as a profession, need to find ways to be present and available when we're needed.

A significant and necessary part of counselors' work with adolescents is building the alliance. When we meet kids daily, when they're getting off the school bus, we can notice when there's a change. When we hang out on the playground, the lunch room, or at their games or performances, we earn the privilege to both listen to them and be heard by them.

Suicide and substance abuse are often responses to overwhelming needs for wanting to change how they're thinking and feeling. As counselors, we believe and try to teach that the best way to change is through supportive, caring relationships that can make a positive change seem possible and desirable.

Susan Sharer (8:10): That's great information, Von. Thank you so much for sharing. So what does the future hold? Are there innovations that you see coming?

Von Borg (8:17):  You know, one thing that the COVID virus has taught us is the benefit of having multiple ways we can reach out to people and increase the ways we can offer help and support. Even when it's safe, again, to meet in person, we should no longer rely on just face-to-face contact with our participants. Telehealth or virtual counseling has opened up many new opportunities across time and space to be present. To build counseling relationships and office support, the window of opportunity is often small when someone in distress is open to and seeking support. One new and exciting area in our field is the use of artificial intelligence and chat bots that can detect risk based on key word usage or changes in how an individual interacts with the application. These types of interventions will help us to better identify those in need and target outreach when and where individuals need it the most.

Susan Sharer (9:17):  Von, thank you so much for sharing all the information today about the Adolescent Support and Counseling Services program that you all are leading. It is phenomenal for the nation to understand the importance of this program and the incredible work you're doing to fulfill that mission, and your teams are doing to fulfill that mission. Thank you so much for all that you do.

Von Borg (9:40): Thank you very much. It's been my pleasure.