Returning Home from Iraq and Afghanistan Preliminary Assessment of Readjustment Needs of Veterans, Service Members, and Their Families (2010) / Chapter Skim
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5 THE CURRENT RESPONSE
5 THE CURRENT RESPONSE
Pages 117-154
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The Department of Defense Most DOD programs designed to meet the needs of returning OEF and OIF military personnel are overseen by the Office of the Under Secretary of Defense for Personnel and Readiness (USD(P&R)
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Eligible service members may also enroll their dependent family members in TRICARE Prime, but dependents may choose to pay extra to enroll in TRICARE Extra, a preferred provider option–like benefit, or seek coverage through a 1 TRICARE Prime is a point-of-service health-maintenance organization that covers 100% of care at MTFs or any civilian provider that is a member of the TRICARE network. 2 The medical department of the Navy oversees health-care delivery for the Marine Corps.
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Other military programs have adopted more inclusive definitions of family. For example, the Yellow Ribbon Reintegration program permits participation by service members' spouses, children, parents, grandparents, siblings, and significant others (USD(P&R)
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If it can be reasonably determined that a service member is not fit to resume normal duty, the service member is referred to the Medical Evaluation Board (MEB) (Task Force on Returning Global War on Terror Heroes, 2007)
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counsel, witnesses FIGURE 5.1 Physical Evaluation Board process. SOURCE: Reproduced from VA Task Force on Returning Global War on Terror Heroes (2007)
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Because of incompatibility between the DOD and VA systems, when service members separate from the military and enter VA, their DOD health records do not transfer to VA providers. Several groups have recommended that DOD and VA develop a system that allows for medical record-sharing (GAO, 2008a; Office of the Surgeon Multinational Force–Iraq and Office of the Surgeon General United States Army Medical Command, 2008; Task Force on Returning Global War on Terror Heroes, 2007)
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OEF and OIF veterans enrolled in the VA system (63% from the Army, 13% Marine Corps, 12% Air Force, and 12% Navy)
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SOURCE: VA Task Force on Returning Global War on Terror Heroes (2007)
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can get care on a fee-for-service basis. TABLE 5.1 Veterans Integrated Service Networks and Numbers of Facilitiesa Community Hospitals and Based Other Medical Outpatient Other Outpatient Facilitiesb Vet Centers VISN Centers Clinics Clinics VISN 1: New England 11 18 0 21 0 VISN 2: Upstate New York 6 29 0 6 0 VISN 3: New Jersey, New 8 28 0 12 1 York VISN 4: Stars and Stripes 12 47 0 13 0 5c VISN 5: VA Capitol 15 0 9 0 VISN 6: Mid-Atlantic 8 13 5 10 -- VISN 7: Southeast 9 31 3 9 0 c VISN 8: Sunshine 8 39 8 19 2 VISN 9: Mid-South 9 30 6 11 0 VISN 10: Ohio 5 29 3 6 0 VISN 11: Partnership 8 23 22 9 0 VISN 12: Great Lakes 7 0 33 9 0 VISN 13 and 14: now 23 -- -- -- -- -- VISN 15: Heartland 9 42 1 7 0 VISN 16: South Central 11 32 14 13 0 c VISN 17: Heart of Texas 7 18 11 9 0 VISN 18: Southwest 7 41 1 14 0 c VISN 19: Rocky Mountain 6 37 2 14 0 c VISN 20: Northwest 9 26 1 15 2
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From page 126... ...
Since then, vet-center eligibility has been extended to combat veterans of other conflicts, including most recently in 2003 to all OEF and OIF veterans and their family members and federally activated National Guard and reserve personnel. Vet centers are community-based nonmedical VA facilities that offer access to a broad array of social services for veterans and their families.
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To connect with returning troops better, starting in 2004 the vet centers hired 100 OEF and OIF veterans as outreach workers and have focused efforts on or near active military out-processing stations and at National Guard and reserve sites. Beginning in October 2008, VA also introduced a fleet of 50 mobile vet centers -- 38-foot motor coaches that have spaces for confidential counseling -- to supplement the existing vet centers and to expand service to veterans in geographically dispersed rural areas (VA, 2008b, 2009c)
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In combat zones, medically trained military personnel administer immediate life-saving care to severely wounded service members until they can be evacuated to a forward surgical team, each comprising four surgeons. In Iraq and Afghanistan, the forward surgical teams have been deployed closer to the front lines than in past conflicts, and they provide emergency surgical intervention until casualties can be evacuated to a combat support hospital.
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. Navy and Marine Corps Wounded Warrior Programs The Navy Safe Harbor program was created in 2005 to provide assistance and support to severely injured sailors and their families, particularly those wounded in OEF and OIF.
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The Air Force Wounded Warrior program also provides professional services -- such as transition assistance, employment assistance, moving and financial counseling, and emergency financial assistance -- and further coordinates benefit counseling and services provided by DOD and other agencies, such as VA, DOL, the Social Security Administration, and TRICARE. Polytrauma System of Care In addition to the medical centers and wounded-warrior programs provided by DOD, VA provides care to severely wounded service members and veterans through the Polytrauma System of Care (Table 5.2)
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The final level is the polytrauma point of contact, which provides continuing support to those who have stable treatment plans (Rehabilitation Outcomes Research Center, 2007)
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The result is a system in which military personnel can access help through multiple channels that are different but that often overlap. As the DOD Task Force on Mental Health (2007)
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About 14% of patients screened positive, and 60% of the positively screened received a diagnosis of depression or possible PTSD. In total, the Army Medical Command estimates that nearly 3% of all visits resulted in recognition of and assistance for previously unrecognized behavioral health needs (Department of the Army, 2007)
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Through BHOP, behavioral health consultation services are provided to active-duty and retired military personnel and their family members in primary-care clinics, where mental health providers deliver both curbside consultation and direct patient care when indicated. This care typically entails brief, empirically supported interventions, primarily targeting self-management and behavioral prescriptions.
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Even with such programs as RESPECT-Mil and OSCAR and campaigns promoting the benefits of mental health care in place to provide some safeguards to service members seeking it, stigma among military personnel remains. The Navy and Marine Corps state that "stigma over seeking help for stress problems is also a significant issue" (provided by the Department of the Navy in response to committee request, September 10, 2009)
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. Suicide Prevention Each military service manages its own suicide-awareness and suicide-prevention program.
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In November 2004, the Mental Health Strategic Plan called for numerous initiatives to prevent suicide in veterans. As a consequence, VA implemented such prevention programs as the National Suicide Prevention Center of Excellence, appointed a national suicide prevention coordinator, and began flagging patient medical records and establishing suicide-prevention programs in each facility and large community-based outpatient clinics, which have appointed full-time suicide-prevention coordinators.
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educates veterans and their family members on PTSD-related issues and offers guidance on how to find local therapists and support groups. Although not particular to OEF and OIF veterans, this additional source provides information on the illness and access points for treatment.
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; it should be noted that these programs are comparable with those offered by the Navy, Marine Corps, and Army. The Air Force program, called the Airman and Family Readiness Flight, is available at each Air Force installation and manages airman and family readiness centers, youth programs, child development centers, and family child-care programs on bases.
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• The Air Force Aid Society Partnership -- assists airmen and families as financial emergencies occur; in addition, community-enhancement programs supplement child care, educational needs, and deployment support of family members. • Relocation-assistance program -- includes relocation information and education, including predeparture and postarrival services.
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For example, the Air Force Home Community Care program provides over 57,000 hours of free care to Air National Guard and Air Force reserve families at locations near their duty sites and provides free, in-home child care during drill weekends. Other programs, such as Military Child Care in Your Neighborhood, meets child-care needs for remote active-duty military families by providing a direct subsidy (provided to the committee by the Department of the Air Force, June 10, 2009)
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. Similarly, the Survivors' and Dependents' Educational Assistance Program offers a maximum of 45 months of education benefits to eligible dependents and spouses of veterans who died while on active duty or who have permanent and total disability (http://www.gibill.va.gov/pamphlets/ch35/ch35_pamphlet_general.htm, accessed on September 30, 2009)
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Representatives of the VECS attend military career fairs and outreach events, maintain a presence at transition-assistance centers, and collaborate with DOD's Transition Assistance Program to inform separating and retiring veterans about VA employment options. By summer 2009, the program had contacted over 2,300 severely injured OEF and OIF veterans (VA, 2009u)
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Military OneSource, an official DOD program that began with the Marine Corps in 2002 and was expanded to serve the entire US military in 2004, provides free 24-hour information and referrals to more than 5 million active-duty military personnel, National Guard and reserve members (regardless of activation status) , and their immediate families (provided to the committee by the Department of the Army, August 31, 2009)
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It is a source of deployment-related health information for healthcare providers, service members, veterans, and family members. It is also the primary source of communication and support for the implementation of the DOD–VA Post-Deployment Health Clinical Practice Guideline.
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The TAP is a cooperative effort of DOD, DOL, and VA designed to assist military personnel and their family members as they transition out of active-duty service. Transition assistance offices administer TAP services and are on major military installations, generally at the family support service center for Air Force, Navy, and Marine Corps installations and at career and alumni program centers for Army installations.
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The program helps reservists to understand their benefits and entitlements as they transition in and out of active-duty status, and it links them to services provided through other sources, including Military OneSource, vet centers, and TRICARE. The Yellow Ribbon Reintegration Program is run through the Office of the Assistant Secretary of Defense for Reserve Affairs.
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. Some specific programs that are available to homeless veterans are VA's Homeless Providers Grant and Per Diem Program, the Compensated Work Therapy Transitional Residence program, and the Domiciliary Care for Homeless Veterans Program.
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While the number of programs is impressive, there does not appear to be any evaluation of the effectiveness of communication about the availability of programs, nor any information about whether the redundancy of programs is beneficial in meeting the needs of those individuals and groups they are meant to serve; finally it is unclear whether the programs are evaluated, in general, for their effectiveness in meeting the needs of service members, veterans, or family members. The committee recommends that the Department of Defense and the Department of Veterans Affairs oversee coordination and communication of the multitude of programs that have been created in response to the needs of Operation Enduring Freedom and Operation Iraqi Freedom service members, veterans, and their family members in an effort to maximize their reach and effectiveness.
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2009. DoD Yellow Ribbon Reintegration Program.
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. Marine Corps Wounded Warrior Regiment.
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08-029: Implementation of the Yellow Ribbon Reintegration Program within Family Readiness Programs. http://www.dtic.mil/whs/directives/corres/pdf/DTM-08 029.pdf (accessed September 27, 2009)
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http://www.vba.va.gov/bln/21/compensation (accessed January 15, 2010)
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2009. Evaluation of Suicide Prevention Program Implementation in Veterans Health Administration Facilities, January–June, 2009.
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