Health on the Homefront: Integration of Primary Care and Mental Health Services on Behalf of Service Members, Veterans and their Families: Building a Community of Care What the Data Tells Us About Our National Capacity to Manage Deployment Related Mental Health Issues Of 22 million living Veterans, 8.9 million (40%) are enrolled in VA Healthcare Nearly three quarters served during a war or an official period of conflict VA currently provides health care to 6.3 million veterans (29%) www.va.gov 1
OEF/OIF/OND Veterans In VA As of December 31, 2013: 1.8 million of 2.5 million total OEF/OIF/OND Veterans eligible for VA services 58% (1,027,801) have already sought VA care Three most common health issues: Musculoskeletal Mental Health Symptoms, Signs and Ill Defined Conditions http://www.publichealth.va.gov/epidemiology/reports/oefoifo nd/health care utilization/index.asp Mental Health among OEF/OIF/OND Veterans Possible mental health problems reported among 55.7% (572,569) of the 1,027,801 eligible OEF/OIF/OND Veterans who have presented to VA Provisional MH diagnoses include: PTSD (30% of all who presented to VA) 311,688 Depressive Disorder 248,891 Affective Psychoses 152,587 Neurotic Disorders: 229,361 Alcohol Dependence: 72,055 Nondependent Abuse of Drugs: 53,839 Tobacco Use Disorder `149,714 2
Our Focus: Deployment MH Chronic Pain TBI MST Depression Job PTSD Homeless Family SUD Grief 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 3
Beyond the DoD/VA Continuum Ideally all deployment related Mental Health problems would be picked up somewhere within the DoD/VA continuum of care but: Despite their historic level of engagement in VA, if 58% of OEF/OIF/OND Veterans eligible for VA care have come to VA where are the other 42%? Comparison to the National Vietnam Veterans Readjustment Study Perhaps we should only be concerned about those who choose to seek care but: Only 20% of the Vietnam Veterans with PTSD at the time of the study had EVER gone to VA for Mental Health Care yet: 62% of all Vietnam Veterans with PTSD had sought MH care at some point Kulka et al. 1990, Volume II, Table IX 2 4
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92535 AD Members 208,657 Dependents 6
24, 037 RC Members Service Members, Veterans and their Families are Distributed Across the Entire Nation and Many Seek Care Within Their Own Communities An estimated 40 75% of OEF/OIF/OND Veterans seen in DoD/VA also receive part of their care in the community Family members also deal with deploymentrelated stress and virtually all of them seek care in the community Are Community Providers and Programs prepared to identify, treat or triage deploymentrelated mental health problems? 7
Serving Those Who Have Served: Educational Needs of Health Care Providers Working with Military Members, Veterans, and their Families Web based survey of 319 rural and urban community mental health and primary care providers Available at VA Intranet Link: http://www.mirecc.va.gov/docs/visn6/serving_those_who_have_served.pdf Funded by VA s Office of Rural Health Kilpatrick, D.G., Best, C.L., Smith, D.W., Kudler, H., & Cornelison Grant, V. Charleston, SC: Medical University of South Carolina Department of Psychiatry, National Crime Victims Research & Treatment Center, 2011 Participants 97.6% participation rate among 327 providers who opened link Two thirds were mental health professionals Psychologists were most prevalent group followed by psychiatrists, social workers/ other mental health professionals Remainder self identified as primary care providers or other professionals Most prevalent were family medicine providers followed by pediatricians and internists One third (34%) self described as Rural 6% were not sure if Rural or Urban 8
Experience with Military/Veterans: Military Cultural Competence Only one out of six (16%) providers had ever served in the Armed Forces including the Reserves or National Guard Although VA is a national leader in provider training, only one third (31%) had any VA training Only one out of eight (12%) have ever been employed as a health professional in VA Key Findings of Serving Those Who Have Served 56% of community providers don t routinely ask their 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 9
NEEDED: On behalf of Service Members, Veterans and their families: Military and Veteran friendly principles and practices as part of a public health intervention 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 20,000+ community providers and stakeholders have completed at least one training New National AHEC Grant has trained >12,000 more community providers in past two years 10
Searchable Provider Database at www.warwithin.org 1,500+ providers nationally 1,200+ providers in NC In 96 of 100 NC counties Developed by the Citizen Soldier Support Program in partnership with the VISN 6 MIRECC 11
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 Association of American Medical Colleges (AAMC) American Academy of Nurses (AAN) Incentivize NC BC/BS as a model, replicable project 2. Flag military experience (including military family status) in medical record EHR Aspect of AAMC Project/Meaningful Use 3. Train all staff on military cultural competence and basic deployment mental health DoD/VA Free On Line Training Keys to Building Military Friendly Practices and Health Systems 4. Connect providers with support on military medical issues including www.aheconnect.com/citizensoldier Defense Centers of Excellence VA National Center for PTSD 5. List trained providers/programs in a national referral database accessible to: Warfighters and family members in need of referral Providers, employers, college officials, congregational leaders and other stakeholders seeking consultation or to make a referral 12
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 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. Physical Health? b. Mental Health? c. Family? d. Work? e. Other aspects of your life? (If your patient answers Yes to any of these questions, ask: Can you tell me more about that? ) 25 A Core Relationship Across the Commonwealth Partner with the Virginia Wounded Warrior Program and the Virginia Public Health Association 13
Key VA Websites for Community Providers http://www.mentalhealth.va.gov/commu nityproviders 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 28 14
The Big Blue Button 29 The Vision There will be No Wrong Door to which ANY Service Member, Veteran or family member can come for the right help With your help, this is an achievable goal! 15
QUESTIONS? Harold Kudler, M.D. Clinical Lead for Rural Health VA Mid Atlantic Health Care Network (VISN 6) Harold.Kudler@VA.GOV 16