Post on 14-Jan-2016
description
Working with Military Families in
the community Harold Kudler, M. D.
(Harold.Kudler@va.gov)Mid-Atlantic Mental Illness Research,
Education and Clinical Center (MIRECC)Department of Veterans Affairs
Department of Psychiatry and Behavioral Sciences, Duke University
Where Do the Veterans of Iraq (OIF/OND) and Afghanistan (OEF) and
their families Live?•Citizen Soldier Support Program - UNC Chapel Hill
-- Provides mapping of OIF/OEF Veterans and their dependents:
http://www.unc.edu/cssp/datacenter/
106,264 AD Service Members
The Rural Dimension
• Rural Veterans–41% of all VA enrollees–39% of enrolled
OEF/OIF/OND Veterans–53% of Veterans in VISN 6
• Rural Service Members (including Guard and Reserve) and their families are less likely to have access to a local mental health professional
OEF/OIF/OND Veterans In VA• As of September 30, 2012:
– 1.56 million of 2.5 million total OEF/OIF/OND Veterans eligible for VA services
– 56% (866,182) have already sought VA care
• Three most common health issues:• Musculoskeletal• Mental Health• Symptoms, Signs and Ill-Defined
Conditions
Mental Health among OEF/OIF/OND Veterans
• Possible mental health problems reported among 53.6% (464,685
) of the 866,182 eligible OEF/OIF/OND Veterans who have presented to VA
• Provisional MH diagnoses include:PTSD 250,242 (29% of all who presented to VA)
Depressive Disorder 194,503Affective Psychoses 117,530Neurotic Disorders: 171,260Alcohol Dependence: 55,897Nondependent Abuse of Drugs:
40,147Tobacco Use Disorder 123,742
Our Focus: Deployment MH
PTSD
TBIDepressio
n
GriefFamily
SUD
MST
Homeless
Job
Chronic Pain
VA Has Programs addressing each and all
these issues but…• If only 56% of OIF/OEF/OND
Veterans and 27% of ALL Veterans use VA health services, what about the rest - and what about their family members?
• Are community providers and programs prepared to help?
Key Findings of Serving Those Who Have Served
• 56% of community providers don’t routinely ask patients about being a current or former member of the Armed Forces or a family member
• Only 29% of providers agreed with the statement: “I am knowledgeable about how to refer a Veteran for medical or mental health care services at the VA”
Needed:On behalf of service
members, veterans and their families
Military and Veteran friendly principles and practices as part of a
public health intervention
Ongoing NC Initiatives• The Governor’s Focus on Service
Members, Veterans and their Families– http://www.veteransfocus.org/
• NC as a mentor state in U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) national Paving the Road Home Program
• NC Institute of Medicine Report identifying gaps in services and policy– http://www.nciom.org/publications/?honoring-
their-service-a-report-of-the-north-carolina-institute-of-medicine-task-force-on-behavioral-health-services-for-the-military-and-their-families
• Recommendations now NC law!– http://www.ncga.state.nc.us/
EnactedLegislation/SessionLaws/PDF/2011-2012/SL2011-185.pdf
Treating the Invisible Wounds of War
www.aheconnect.com/citizensoldier• Free, accredited on-line trainings:
– Military Families– Deployment Mental Health– Deployment Primary Care– Women Veterans– Employment Assistance Programs
• 14,000+ community providers and stakeholders have completed at least one training
• New National AHEC Grant to train 70,000 more community providers
•Searchable Provider Database at www.WarWithin.org•1,500+ providers nationally• 1,200+ providers in NC
-- 96 of 100 NC counties• Developed by the Citizen
Soldier Support Program in partnership with the VISN 6 MIRECC
Keys to Building Military-Friendly Practices & Health
Systems
1. Ask each patient “Have you or someone close to you served in the military?”
– Train providers/students to ask
2. Flag military experience (including military family status) in medical records in a way that it is noted at each clinical encounter
– Champion in VISN 6/Reward in BC/BS
3. Train all staff on military cultural competence and basic deployment mental health
Keys to Building Military-Friendly Practices and Health Systems
4. Connect providers with support on military medical issues including– National Military/Veteran Health
Programs– VA’s National Center for PTSD
5. List trained providers/programs in a national referral database accessible to:4.Warfighters and family members in
need of referral5.Providers, employers, college
officials, congregational leaders and other stakeholders seeking consultation or to make a referral
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1.Have you or someone close to you served in the military? 2. When and where did you/he/she serve? 3. What do/did you/he/she do in the military? 4. Has your/his/her military experience affected your: a. Health? b. Family? c. Work? d. Other aspects of your life?
d. Other aspects of your life?
Draft Version of the First 4 Questions from the VA Office of Academic Affiliations Military Health
History Pocket Cards(http://www.va.gov/oaa/pocketcard/)
As They Might be Adapted for Use in an Electronic Health Record
If your patient answers “Yes” to any of these questions, ask:
“Can you tell me more about that?”
If your patient answers “Yes” to any of these questions, ask:
“Can you tell me more about that?”
Key VA Websites for Community Providers
• http://www.mentalhealth.va.gov/communityproviders– New from VA Office of Mental Health
• http://maketheconnection.net – For Veterans, families and providers
• http://www.ptsd.va.gov/– VA’s National Center for PTSD
Painting a Moving Train 20
The big blue button
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The VisionThere will be
No Wrong Doorto which ANY Service
Member, Veteran or family member can come for the
right help
With your help, this is an achievable goal!