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!