Photo by Sharon Taylor Conway From left, Capt. Ingrid Pacowski, primary care manager, Staff Sgt. William Brooks, Able Troop squad leader, and Capt. Valerie Liuskila, nurse case manager, serve as a ‘‘triad of care” for Able Troop Soldiers in WRAMC’s Warrior Transition Brigade.

This trinity acts as one unified team to lead you and guide you, build you up and encourage you, to counsel you and energize you; to make every step you take an effective one. At a moments notice, this team is ready to step in on your behalf.

This is the Armyís ìTriad of Careî.

Established by the Army Medical Action Plan last year to synchronize the efforts of leadership and clinical support, every outpatient Warrior in Transition receives his own triad: a team comprised of a squad leader, a nurse case manager and a company physician that serves as primary care manager. The triadís sole purpose is to help each Soldier navigate the bureaucratic health and rehabilitation system so he can focus on recovery and transition back to military duty or civilian life.

A well-oiled machine

Squad leader Staff Sgt. William Brooks, nurse case manager Capt. Valerie Liuksila, and primary care manager Capt. Ingrid Pacowski form a triad of care serving Able Troop Soldiers in Walter Reedís Warrior Transition Brigade (WTB).

Liuksila explained how the triad works. ìWe pull together in terms of what the Soldier needs. Dr. Pacowski will help and form the care plan, the medical aspect of it, and I will help and make sure that what she puts out as the plan gets carried out with the assistance of Sgt. Brooks. So if a patient needs to see physical therapy and neurology, I make sure that those appointments are booked and then let Sgt. Brooks know to make sure that the Soldier makes it to the appointments.î

ìSgt. Brooks sees [the] patients more often than I see them,î Pacowski said. ìHe sees them every single day. And he sees their family members more often than I do, so if there are any issues that may arise that he feels that I need to know about as their primary care physician, he lets me know about those or he lets Capt. Liuksila knowÖ she lets me know if there is some increased depression, some social issues or a family issue that may influence his overall health.î

Brooks, Liuksila and Pacowski all agree the three act as a well-oiled machine to provide care for their patients. They meet once a week on Tuesdays but that doesnít stop any one of them from picking up the phone to call one another at anytime.

Brooks said he believes the triad of care is successful. He said consistent, continual communication between himself, the case manager and physician is a key element. ìItís like Wal-Mart; we have it all in one area. Everything you need, itís in one place, one stop.î

The squad leader

ìIím the first one [the Soldier] sees in the morning and the last one he speaks to at night,î Brooks said. ìAny kind of issues that come up, Iím his first line supervisor. If I canít solve the problem I find someone that can solve it, and thatís usually his case manager or his primary care physician. If he misses an appointment, I find out why.î

The triadís squad leader is the first of the three-person team the Soldier meets when they are assigned to the Warrior Transition Brigade. The noncommissioned officer handles all non-medical things. He takes care of everything that doesnít involve medical care like picking up Soldiers from the airport or helping with paperwork.

A combat arms Soldier, Brooks has plenty in common with the Soldiers in his company. Brooks spent two tours in Iraq and one in Cuba. Although he was not injured while serving in Operation Iraqi Freedom, Brooks said itís helpful that heís seen a lot of the same things the Soldiers in his charge have and help him to relate. He shares a special bond with each Soldier in a different way.

ìI care about the Soldiers. They have any problems, they come to me and I listen. Weekends, we work weekends if we have to. We come in anytime they need usÖany day, anytime,î he said.

Brooks said heís traveled as far as Wilmington, N.C., to pick up a patient and bring them back to Walter Reed for treatment.

The staff sergeant has been a part of the triad for the last seven months. He currently leads nine Warriors in Transition but generally manages up to 12.

ìItís a great experience here, helping a SoldierÖanything I can do for them, theyíve got my phone number,î Brooks added.

The nurse case manager

Luiksila shares the care for nine Soldiers with Brooks. She is one of 12 Able Troop nurse case managers and sees on average about 24 patients per week.

As the nurse case manager, Liuksila sees the organization of patient care as one of the positive aspects of the triad. ìI organize their schedule so they know who it is who needs to see them. I meet with them on a weekly basis, which is a little more often than some of them meet with Dr. Pacowski,î Liuksila said. If a patient has problems with a medicine, needs a re-fill or has a question after they leave the doctors office, the nurse case manager can help or re-direct the question to the physician.

Within 24 hours of a Soldierís arrival in the unit, during their initial meeting, the nurse case manager works with each Soldier to develop a comprehensive transition plan, which encourages them to progress not only physically but educationally and socially, too. Liuksila said they develop a separate goal for the Soldierís mind, body, spirit and heart, taking a holistic approach. During their weekly meetings, she checks to see how she can help them and calls on their squad leader if they need additional support.

Liuksila was a nurse on WRAMCís Ward 68 before deploying with the 28th Combat Support Hospital in Iraq for 15 months and returning to Walter Reed. She said her time downrange has helped her serve in her current position as a nurse case manager for the WTB.

ìI feel like I can relate to them a lot more and give them a heads up to what they might expect,î Liuksila said.

The primary care manager

Pacowski shares the care of 30 Soldiers with Liuksila and oversees the medical care for approximately 208 Warriors in Transition as the company physician and primary care manager for Able Troop.

She had just completed her residency in Internal Medicine at Walter Reed before she assumed her role in the triad of care, working in Walter Reedís Warrior Clinic. Pacowski said she sees between 10 to 12 patients, per day and explained that her experience would be quite different if she were a physician working in a civilian clinic.

The Able Troop primary care manager estimates she would see 30 patients a day and provide care for a panel of 500 patients or more if she worked as physician in an outpatient clinic in the civilian world. That doesnít leave a lot of time patients. Pacowski said she usually spends 30 minutes with her patients, sometimes an hour.

ì[In a civilian clinic,] Youíre seeing the patient, youíre dealing with one problem. You take care of that problem and they go on their way and come back. We take a whole approach to the patientÖwe come up with a care plan for the rest of the time theyíre here so it involves a multitude of things.î

Within 24 hours of their arrival, the primary care manager meets with each Warrior in Transition and conducts a complete evaluation.

Pacowski said she believes the triad of care is effective for her patients. ìItís also effective for me for me as their physician.î She said itís helpful to have a team that can help coordinate command directives, along with administrative and medical information.

ìFrom a medical point of view this [arrangement] is very unique. You donít have this kind of continuity or overall oversight. I know a lot more about my patients and their families than I would in any other medical facility just because they live here, theyíre seen everyday here and Iíve got multiple people interacting with them and telling me whatís going on,î Pacowski said.