Feel Better Now: The Very Practical TRIAP program

November 09, 2009
By Jacey Eckhart
 
I can’t go to the commissary without reading 39 signs urging me to GET HELP!!! No one is lining up to help me tug all these groceries into the house.  Everyone is busy being frantic that because I am a military spouse, I clearly need help of the behavioral health variety.

In my case, this is probably true.  Even though my husband isn’t deployed, I still have the same dealio as most military spouses.  I’m stressed out.  In my case, it’s stress from a job and returning to school and managing a 7-year old with special needs and scorching myself on the upholstery after my 16-year old and his girlfriend come up for air.  Oh, and the orders my husband brought home this week are going to require some very fancy financial finagling. 

I know my current method of handling stress—keeping a king-size Frito in my mouth at all times—is not really effective.  I tell myself should do something.  I should talk to someone. Yet these “problems” don’t seem like a terrifying crisis in action, do they?  They don’t seem exactly worthy of the drama of going to get a referral to see a therapist.  And besides, who has the time?

I do.  You do.  Because Tricare has put together a fantastic new web-based behavioral health program that requires no authorization and no referral and no driving around.  We now can talk at home to a licensed therapist about relationship problems and stress and deployment issues.  The best part about it is that you can do it at home on your computer by chat, phone or on webcam.

The program is called the Tricare Assisstance Program (TRIAP).  Granted, that is a dumb name.  It is one of those names that doesn’t seem to mean anything.  But the program itself will mean a lot to all spouses who are basically solid, but run into the glitches that are just part of military life.  TRIAP is the right level of help that so many of us could really use.

I’m thinking of TRIAP as the Tartar Control Method of behavioral health.  Military families all have problems with kids or relationships or work that crop up every day like plaque.  We use our personal support network of spouse and friends and Mom to brush those problems away.  So that’s one end of the scale.  At the other end of the scale are clinical problems like major depression and suicidal thoughts that require the level of behavioral health that’s like filling a cavity. TRICARE offers that, too.

But what about all those troublesome middling problems that aren’t quite clinical, but sure aren’t nothing?  They are the kinds of tartar-like problems that we spouses could use some help scraping away.  I’m thinking of questions I hear from military spouses all the time. 
Should I worry that someone told me my husband was flirting with a female when they were on TDY?
 
I know I should go back to school, but I just don’t know what I should do or what I should be.  Is that a waste of money?

How come my husband held my hand all the time when he first came back from deployment and now he doesn’t even like me?
 
These problems are sticky, bothersome, irritating.  We worry that maybe they will turn into a more serious problem if we don’t take care of them now.

I was interested in how military families were actually using this program, so I took part in a teleconference with a group from TriWest, the company that handles TRICARE’s western region. For them, TRIAP is another layer of care that they can make available to military families.
“Behavioral health encompasses a wide umbrella of thoughts and ideas,” said RDML Elizabeth Niemyer, Regional Director at TriWest, “Looking at stressful situations, it is important to try to deescalate problems before they occur.”

At Triwest, they found that active duty family members  are using TRIAP to talk about a variety of issues.  Niemyer said that about 45% of calls concern partner relationship questions, 20% of the questions involve relationships other than partner.

Most of the callers are women.  “That’s not surprising said Marge Crowl (LTC USA, Ret) TriWest’s Director of Integrated Behavioral Health.  “Very often when we look at who calls for appointments it is often the family member.  Often the wife is concerned about the active duty member.”

Crowl said that many of the TRIAP sessions involve deployment issues.   “The service member is about to return from deployment and there is concern that the relationship won’t be the same.  For families with young children, they call about children who aren’t sleeping well or temper tantrums.  In the older years, there are conduct issues for preteens and teens,” said Crowl.  Financial issues can also get in the way of the relationship during deployment.

TRIAP was created in a way to try to eliminate some of the barriers to getting help with non-clinical issues that often occur with military families.  In addition to requiring no referral and no authorization, TRIAP is available 24/7/365.  Any time of the day or night you can make this connection happen. In the TriWest region, participants have the option of speaking to the therapist on line by chat, phone or by webcam.

“We were a bit surprised at the number of people who wanted to chat,” said Niemyer. “I definitely think younger people have a different view of how we communicate. Patients are quite comfortable with chat.”

The chat option is also popular with deployed service members.  They can be surrounded by 15 other guys while they chat with a therapist at TRIAP and no one ever has to know or hear or see what they are doing. That kind of confidentiality has turned out to be quite important to getting over some of the barriers to getting care. 

“You can come in through the chatline very, very anonymously,” said Crowl.  There are some identifying questions, but you can chat without really identifying who or where you are.  By the time you get to webcam, they do know who you are, but the sessions are still confidential except for certain situations of abuse.  The operators make sure participants know about that before they even begin.

One of the other features of the program that I found reassuring was that if the problem turns out to be more serious, the program is set up to help you get the next level of care.  Shoot, they will walk you through the whole process so that you get exactly the kind of care you need at whichever level is appropriate.

That must be what all those signs urging us to GET HELP really mean.  Get some of the right kind of help. 

“People who are often in high stress don’t focus on how to solve anything,” said Crowl.  “I’d like see them take charge of their lives so that they are not in a stressful state.”  Me too.  Less stress, fewer Fritos, more happiness.
 
Which is a nice idea.  A very nice idea.  Yet talking about this kind of program is one thing.  Actually using it is another.  I mean, really, what if secretly TRIAP is hard to use? What if I sent you to use it and it totally sucked?

I decided to try it out myself.  The folks at TriWest offered to set me up with a trial in their region which sounded like a good idea.  However, I’m an Internet wastrel.  I was worried that if they set me up with a trial they would walk me through it and everything would all be picture perfect with the bestest people on their bestest behavior.  Then when you tried to use it, it would suck.

That didn’t sound right.So I started from scratch.

The first thing that happened was that I could not remember the name of the program to save my life.  I’ve got a lot of things in my brain.  The name of the program was not one of them.  So I did it the easy way.  I Googled. 

The term TRICARE popped up with  www.tricare.mil.  I didn’t see anything on the home page about behavioral health.  So I clicked on Tricare Beneficiaries.  I was just guessing.  But guessing often works, doesn’t it?

On the next screen I clicked the tab that said “Mental Health and Behavior.”  Then I clicked” Mental Health and Behavior Resources”.  Actually, that’s not true.  First I clicked on everything else on the page and it all sounded so much more serious than the kind of help I was looking for that I almost gave up.  But then I clicked on Mental Health and Behavior Resources.  And I found a bewildering array of choices.  Ack.  Then I scrolled down to the very, very, very last thing on the page: TRICARE assistance Program Demonstration.  

So my first bit of advice is:  don’t forget the name of the program.  Repeat the name after me three times:  TRIAP, TRIAP,…….

OK.  Google TRIAP and your region to begin with and you’ll save yourself a lot of trouble.  Still, if you can’t remember the name when you need it someday, you can still find it if you stick with it long enough.  Or click here:
http://www.tricare.mil/mybenefit/home/overview/SpecialPrograms/TRICAREAssistanceProgram
 
 The first thing I did was to find out if I was qualified to use the program.  As an active duty family member, I was eligible.  The program is also available to active duty service members, Selected Reserve members and their family members who are enrolled in TRICARE Reserve Select, and Those covered under the Transition Assistance Management Program (TAMP).  Military kids  can’t use the program unless they are over 18.

I skipped the demo.  I’m a demo skipper from way back.  I’m the kind that would rather plunge right in.  But the professional demo is there if you want to look at it virtually before you try it out yourself.

The next thing I needed to know was to which region of TRICARE I belonged.  If you don’t know your region, just Google TRICARE and the name of your state.  It pops right up.  Then click the name of your region at the bottom of the TRICARE Assistance Program page and it will take you to your particular program.  This is important because TRIAP is shaped a smidge differently depending on your region.  For example, the region I’m in doesn’t offer the online counseling by chat.  But they did offer it by webcam if you have your own webcam.  Which I do.  It’s that little eye at the top of my laptop.  Here are the specifications for computer stuff:

Windows PC

A Web cam
Windows 2000, XP or Vista
Internet connection (preferably broadband)
Microphone and speakers
Minimum of 1 GHz processor and 256 MB RAM
50 MB free space on hard drive

Mac

A Web cam
Download drivers (link to http://webcam-osx.sourceforge.net/) for Web cam
G4 800 MHz processor or faster
Mac OS X v10.3.9 Panther (or later version)
Broadband Internet connection with at least 384kbps upload speed 512 MB RAM
40 MB free space on hard drive
Microphone and speakers (or a headset)
 
I had no clue if I had any of that.  I just bet that I probably did.  The thing I worried about was that I also had to have a Skype  account before I called TRIAP.    The last time I tried to use Skype, it didn’t work well with my Mac.  But Skype now has a program for mac that I downloaded at http://www.skype.com. Setting up the entire Skype account including the download and getting up to get some more Fritos took maybe ten minutes.

For my region, I was ask told that to  initiate participation in Web-based video counseling, call 1-800-404-5085.

The assistance operator asked me some questions including the social security number of my sponsor to determine that I was eligible.  She also needed to know my user name on Skype.  She read me a message about how the program was confidential and private and nonreportable.  Then she offered me a same day appointment.  She told me Natalie, a licensed clinical social worker who has been in practice 10 years would call me.

It felt a little funny.  A little surreal.  A little Star Trekkish.  A therapist through the computer?  And yet, when Natalie called it was really…. nice.  I could see her office in the background.  She could see my office in her background.  We talked about the things that were stressing me out.   She offered some really solid suggestions.  In the middle of our discussion, my 16 year old son came home from school. 

“Hey,” he said.

“Come meet my therapist,” I said.

Sam edged into the room expecting to see someone.  I pointed at my screen.  “Natalie, this is my son Sam,”

“Hey,” Sam said to Natalie.  “That’so cool.”

“Why?  You think I need therapy?”

“People are just more comfortable in their own environment.  It makes sense.”  He left to make nachos. 

I finished talking with Natalie.  I made a follow up appointment to talk to her online the next week.  Because my boy was right.  TRIAP really is a program that makes sense.