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CHIPS Articles: Recognizing Risk Sooner: The Integrated Clinical Management and Risk Mitigation System (ICM-RMS)

Recognizing Risk Sooner: The Integrated Clinical Management and Risk Mitigation System (ICM-RMS)
By DON Innovation - July 25, 2017
The Integrated Clinical Management and Risk Mitigation System (ICM-RMS) is a novel force preservation solution designed to provide commanders with real time force preservation data from multiple sources, enabling them to make holistic assessments of at-risk service members, preemptively identify those in need of intervention, and receive risk alerts and notifications when new data is entered by other key force preservation personnel.

The absence of effective risk surveillance techniques and limited communication between commanders, medical personnel, and mental health professionals are two primary obstacles to force preservation. To maximize force preservation efforts, tools must be developed that facilitate communication between key stakeholders, promote early identification of at-risk service members, and help commanders develop appropriate leader management plans and interventions. LCDR Yaron G. Rabinowitz, an Operational Stress Control and Readiness (OSCAR) Psychologist at 2d Marines, developed the ICM-RMS to address these specific vulnerabilities. This project has fundamentally transformed the Marine Corps Force Preservation process.

ICM-RMS is a force preservation database that captures risk factors for individuals assigned to a unit’s force preservation program, produces an empirical risk score from an algorithm developed and validated by LCDR Rabinowitz, and allows sustained coordination and communication between need to know entities (medical, command, and mental health). ICM-RMS was borne out of an effort to mitigate vulnerabilities which resulted in at-risk service members falling through the cracks. It enables key players to independently input risk factors into a single repository which is updated in real-time. When risk thresholds are met, alerts are disseminated to the appropriate parties. ICM-RMS also transmits data across units, mitigating a major risk vulnerability associated with the Permanent Change of Station (PCS) process. Moreover, commanders can track force preservation interventions to establish continuity and monitor progress over time.

The data burden associated with risk surveillance and case management often undermines Force Preservation Council (FPC) effectiveness. Because FPC members must navigate vast amounts of time-sensitive information, developing effective data management resources is imperative. LCDR Rabinowitz intuitively recognized that effective risk surveillance and identification necessitated a fundamental reconceptualization of how force preservation data was gathered, disseminated, and utilized. ICM-RMS represented a transformative approach to force preservation in that it dismantled traditional communication barriers, standardized how information was presented, and established formal mechanisms to ensure a multidirectional flow of information between need to know entities.

Among the many challenges confronting Marine Force Preservation Councils is the requirement to review vast amounts of data and identify salient points in a manner that facilitates efficient and effective decision making. To help Force Preservation Councils stratify risk, LCDR Rabinowitz developed a risk algorithm that approximates vulnerability to adverse outcomes. The algorithm produces a risk score that helps commanders ascertain the presence of risk factors that increase vulnerability. It has garnered significant attention from high levels in the medical and operational communities, and the use of the risk score has helped to transform force preservation into a more objective, empirical process. ICM-RMS has proven itself to be a vital tool for Force Preservation Councils to consolidate data, review cases, add command concerns, and build full resource action plans.

The 2d Marine Infantry Regiment adopted ICM-RMS in 2012. In 2013, the Commanding General, 2d Marine Division, requested the expansion of ICM-RMS across the Division. LCDR Rabinowitz subsequently worked with the II MEF Information Management Office to transition ICM-RMS into a web-based, enterprise solution. In April 2014, LCDR Rabinowitz briefed ICM-RMS to the Behavioral Health and Brain Injury Advisory Committee (BHBIAC) who recommended that ICM-RMS be developed as a program of record. In April 2016, LCDR Rabinowitz briefed the Marine Corps 3 and 4 star General Officers at the Commandant’s Executive Off-Site. Shortly thereafter, in May 2016, the Assistant Commandant of the Marine Corps signed a Marine Corps Requirements Oversight Council (MROC) Decision Memorandum (08-2016) confirming the requirement for sustained and formalized development of ICM-RMS. ICM-RMS is currently being managed by Marine Corps Systems Command, is fully funded, and will be deployed across the Marine Corps over the next two years.

Although it is difficult to demonstrate effectiveness for a program that is designed to prevent rather than bring about certain outcomes, ICM-RMS has been validated in a number of different studies. In October 2013, the Massachusetts Institute of Technology’s (MIT) Psychological Health System Operational Planning Team (OPT) conducted a review of ICM-RMS as part of a broader effort to examine the military psychological health system (Psychological Health System Study). After a series of interviews with 2d Marines users of ICM-RMS, the MIT researchers identified ICM-RMS as the most innovative program of its kind across the DoD and recommended to the Assistant Commandant of the Marine Corps that ICM-RMS be developed further.

Perhaps most importantly, when two years’ worth of eight-day briefs of completed suicides at II MEF were retrospectively entered into the system (with data that would have been known prior to suicide), all service members would have been identified as having some risk factors, and 76% would have been identified as “high risk” almost a year prior to the suicide. While one cannot definitively conclude from this data that suicides would have been prevented with ICM-RMS, it does suggest that these high risk service members would have been brought to the attention of their command FPC and in most cases, the FPC would have been afforded almost a year to cultivate risk mitigation strategies. If even one life is saved by ICM-RMS, it most certainly will be considered a success.

LCDR Yaron G. Rabinowitz was recognized with honorable mention for the 2016 Secretary of the Navy (SECNAV) Innovation Award in the Automated Process Development category.

The SECNAV Innovation Awards recognize the top innovators within the Department of the Navy (DON). Their accomplishments are remarkable and serve as inspiration for the Navy and Marine Corps to think boldly and solve the fleet and force’s most challenging problems.

Marine Corps Base Quantico, Va. (Sep 19, 2013) The Marine Corps is investing in a new fleet application designed to assist command leadership to proactively combat suicide and identify at-risk service members. The Integrated Clinical Management and Risk Mitigation System is automated electronic risk assessment tool that tracks factors like deployment history and military discipline, and then calculates individual risk scores for identified Marines improving overall unit health and readiness. (U.S. Marine Corps photo by Cpl. Daniel Wetzel)
Marine Corps Base Quantico, Va. (Sep 19, 2013) The Marine Corps is investing in a new fleet application designed to assist command leadership to proactively combat suicide and identify at-risk service members. The Integrated Clinical Management and Risk Mitigation System is automated electronic risk assessment tool that tracks factors like deployment history and military discipline, and then calculates individual risk scores for identified Marines improving overall unit health and readiness. (U.S. Marine Corps photo by Cpl. Daniel Wetzel)
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